Wash. voters may find themselves in national debate

Wash. voters may find themselves in national debate
Former Washington Gov. Booth Gardner speaks to reporters Wednesday, Jan. 9, 2008, at the Capitol.
VANCOUVER, Wash. (AP) - Washington voters will find themselves at the center of a national right-to-die debate this year if Initiative 1000, modeled on Oregon's Death With Dignity law, makes it onto the November ballot.

The campaign turned in nearly 320,000 signatures July 2, far more than the 225,000 valid signatures it needs to qualify.

Already, out-of-state money is pouring into the campaign to pass the measure, including $315,000 so far from the Death With Dignity National Center, a Portland-based group that seeks to see the Oregon law replicated in other states. So far, the campaign has raised $1,124,000.

"Most of our donations come from Washington, Oregon, California, New York and Florida," said Peg Sandeen, the center's executive director." The average donor to our (nonprofit) would be a 55-year-old white woman from Portland."

Opponents have raised just $95,600, nearly all from Washington residents. But initiative backers expect the Roman Catholic Church to bankroll a multimillion-dollar TV advertising campaign opposing the measure this fall.

Initiative 1000, sponsored by former Washington Gov. Booth Gardner, would give terminally ill, competent adult residents of Washington who have less than six months to live the right to request and self-administer lethal medication prescribed by a physician.

Washington voters defeated a broader right-to-die measure in 1991 by 54 percent to 46 percent. That initiative would have allowed doctors to administer lethal drugs directly to dying patients if they were unable to take the drugs unassisted. Critics said it was tantamount to legalized euthanasia.

This year's initiative has split the state's Democratic Party. Prominent Democrats, including Gov. Chris Gregoire and Sen. Margarita Prentice, chairwoman of the Senate Ways and

Means Committee, are among those publicly opposing the measure, though the governor has said she won't actively campaign against it.

Two Spokane attorneys have formed "Democrats Against Assisted Suicide" to educate people that the issue crosses party lines, income levels and years of education. Planned

Parenthood's political action committee has voted to stay neutral on the initiative.

Even the question of what to call the measure has stirred debate. Sponsors prefer the "Death with Dignity Initiative." Opponents call it "assisted suicide." Thurston County Superior

Court, which approved the ballot measure title, chose the more neutral "aid in dying."

Whatever the label, the concept that the state should enable people with terminal illnesses to end their lives on their own terms remains a highly personal and emotional subject in

Washington, 14 years after its sister state passed a law allowing physician-assisted dying, 11 years after Oregon voters defeated a referendum to overturn the law, and two years after the U.S. Supreme Court upheld it on a split decision.

"This very dangerous initiative never would have passed the Legislature," says Prentice, a registered nurse. The risk, she says, is that under such a law, low-income and vulnerable people would be pressured into prematurely ending their lives.

Sandeen counters that there's no evidence that any such pressure has been brought to bear on any of the 341 Oregonians who used the law from 1998 to 2007. The measure, she said, is about autonomy.

"Medical technology can keep people alive and alive and alive, and you can't say stop. The right to die is about people saying, 'I will control my life.'??" Safeguards debated

Like Oregon's law, the Washington measure contains safeguards designed to prevent misuse. A patient requesting lethal medication would have to make two oral requests, 15 days apart, and submit a written request witnessed by two people. Relatives, heirs or the attending doctor of the requester could not serve as witnesses, nor could persons connected with a health facility where the requester is living or being treated.

Two doctors would have to concur on the diagnosis of a terminal disease - affirming that the patient has six months or less to live - and would have to agree that the patient "is competent, is acting voluntarily, and has made an informed decision." There would be a two-day waiting period following the final written request before the lethal prescription could be dispensed.

Critics, including doctors and disability-rights advocates, say assisted suicide laws create a slippery slope leading to legal euthanasia, or mercy killing.

"We understand the convenience of people wanting to have control at the end of their lives, but this also takes away control from people who are vulnerable," said Dan Duringer, a volunteer with the pro-life group LifePAC in Clark County. "Coercion can be a very subtle thing."

Duringer is not impressed with the Oregon law's safeguards.

"We don't think the safeguards are there or can be there," he said. "There's a real concern when Mr. Gardner says this is just the first shot. We know he wants to go further."

LifePAC plans to survey candidates for public office about their positions on I-1000 and publish the results on its Web site, Duringer said.

The Washington Medical Association has opposed assisted suicide since 1991, when the first Washington initiative went to voters.

"We believe physician-assisted suicide is fundamentally incompatible with the role of physicians as healers," said Dr. Brian Wicks, the association's president. "Patients put their trust in physicians, and that bond of trust would be irrevocably harmed by the provisions of this dangerous initiative."

The Coalition Against Assisted Suicide has accused initiative proponents of using paid signature-gatherers to "endanger" Washington's elderly, low-income and disabled. The campaign to get the initiative on the ballot enlisted 2,500 signature-gatherers.

"The initiative backers spent almost a million dollars and unleashed a small army of paid mercenaries to collect signatures," said Duane French, head of the disabilities rights group, Not Dead Yet - Washington. "It shows they have very little public support and a very small volunteer base."

At a press conference in the Secretary of State's office in Olympia, two physicians warned that the law would give HMOs and insurers the opportunity to exploit assisted suicide to cut costs while subtly encouraging depressed patients to end their lives.

"We're concerned that an option to die by assisted suicide will, for some folks, come to be perceived as a duty to die," said Dr. Patricia O'Halloran.

Defenders of the initiative say there's no evidence that the Oregon law has resulted in any such problems.

Of those who have used the law, most have had their lives shortened by about three weeks, said Dr. Tom Preston, founder of the group Compassion and Choices Washington. Any doctor who used the law to "kill the disabled" would quickly lose his or her license, Preston said.

In fact, proponents say the Oregon law helped prevent 11 violent suicides last year, helped more than two dozen clients receive better pain management, and referred 49 clients to hospice care.

Even the American Medical Association acknowledged in its magazine last year that the Oregon law has raised awareness of the need for comfort care of dying patients and has encouraged doctors to discuss end-of-life issues with their patients sooner rather than later.

Preston, a retired Seattle cardiologist, says the issue has evolved with medical technology and the aging of the baby-boom generation.

"They like to have control," he said. "Now they are watching their parents die, and they want another way."

With the exception of Oregon, where more people die at home or in hospice care, nationwide 80 percent of Americans die in medical facilities, and 89 percent to 90 percent die after a medical decision, Preston said. And most of us will die of a condition that wasn't known 60 years ago.

With the technological advances in medicine, "all of us, except those of us who die suddenly, do not die at the time of natural dying," Preston said.

Oregon's law is there for people facing terminal illnesses even if they never choose to use it, says Teresa Grove, a hospice nurse who works in Oregon and lives in the hills north of Camas.

When people contact the nonprofit group Compassion and Choices Oregon, volunteers "try to find out if they have adequate pain relief," Grove said. "Sometimes that is what they need and they are no longer interested in using the law. "

About one-third of patients who obtain lethal doses of barbiturates under the Oregon law don't end up using the drugs.

"Sometimes people will get the medication and let it sit in the medicine cabinet, and that's enough comfort for them," Grove said.