As of yesterday, Thursday 5th March, terminally ill patients in Washington State can invoke a new assisted suicide law called the Death with Dignity Act which allows them to ask for a lethal prescription from their doctor if they have less than six months to live.

Washington's new law is based on a similar one introduced in Oregon ten years ago, where last year 60 patients made use of it. That is the highest number in a year since the law came into force in 1997, reports the NWPR news service of Washington State University.

Since then around 400 Oregon residents have used it to end their lives reports the Seattle Times who also said that Washington's new law was approved in last November's election and carried a nearly 60 per cent "yes" vote.

Like the Oregon act, Washington's new law requires that any patient asking for a lethal prescription must be a resident of the state, be at least 18 years old, declared mentally competent to make the request, and two doctors have to certify that he or she has six months or less to live, reported the Seattle Times.

The patient's request must be put into writing and witnessed by two people, and they must also make two oral requests 15 days apart, the so-called "15 day waiting period".

A representative of Compassion & Choices, the largest aid-in-dying advocacy group in Washington State told NWPR that the names of patients asking for assistance with dying will not be made public, but there will be a need to report such requests. Terry Barnett said:

"The initiative strikes a balance between patient's rights to privacy and the public's interest in information about how the process works."

Groups who support the initiative say that the new law gives people another option and helps them to feel in control of the dying process and thereby preserves their dignity.

Groups who are against the initiative say that the reporting requirements aren't strong enough and there should be stricter safeguards to make sure patients are offered enough end of life options, including pain management, reported NWPR.

Eileen Geller, a spokesperson for True Compassion Advocates, a group that is against the new law, told the Seattle Times that it:

"Puts at risk far too many people for the far too few who would actually have choice."

"One person's autonomy is another person's coercion," said Geller, adding that the message the patient actually receives once the idea of assisted suicide is raised is that they should do it because they are a burden.

Geller, who is a hospice nurse, said that last year as her father in law was dying, a healthcare professional raised the idea of assisted suicide and this led him to feel like he should take up the option in order to stop being a burden to his family.

This was not the view of Barbara McKay of Kirkland, who said she will use the new law. McKay is terminally ill with advanced ovarian cancer and has already made a written request to her doctors declaring her wish to have lethal medication. She told a news conference on Thursday that she will be talking to her doctors about her other end of life options, reported the Seattle Times.

60-year old McKay said she watched both her parents suffer with few choices at the end of their lives. At the news conference sponsored by Compassion & Choices she told reporters that when her time comes she wants to be able to choose her own time and way to die:

"I don't want my family to have to watch me wither away as can happen with cancer."

Dozens of people stood outside University of Washington School of Medicine yesterday to protest against the new law. Some health systems have chosen not to take part while others have. Those against the new law are concerned that many terminally ill people who are depressed may not get the help they really need and the law will facilitate unnecessary deaths.

Not to be overlooked in all this is the need for health professionals to have fine tuned people skills to balance their medical expertise.

Helping patients to review options about how to spend their dying weeks and whether to terminate their lives deliberately or naturally places a considerable load on the health professional's emotional wellbeing and they may need as much psychological support in this process as their patients.

Sources: Seattle Times, NWPR at Washington State University.

Written by: Catharine Paddock, PhD