Washington follows Oregon to legalise physician assisted suicide

The US state of Washington has become the second US state to legalise physician assisted suicide, 11 years after Oregon, its neighbour to the south.

Initiative 1000, modelled on Oregon’s Death with Dignity Act, was passed on 4 November by a majority of 59% to 41%. It will allow doctors to prescribe a lethal dose of drugs for mentally competent patients with less than six months to live.

Patients will have to be residents of the state and will have to go through a 15 day waiting period after asking for the lethal dose. They will then have to make the request again, orally and in writing. If the doctor thinks depression might be clouding the patient’s judgment, the patient must be referred to a mental health professional.

Two doctors must approve the request, and the drugs will have to be administered by the patient not the doctor.

Since Oregon’s law came into effect 11 years ago, 341 people have used it to end their lives. Many more have obtained prescriptions but never used them.

A study last month in the BMJ found that three of a sample of 18 patients who received a prescription for assisted suicide in Oregon were depressed at the time (2008; 337:a1682, doi: 10.1136/bmj.a1682). One of the three had her depression treated before she took the lethal dose.

The researchers accept that the requirements of the Death with Dignity Act would be satisfied if the depression was detected by the doctor but not considered to influence the patient’s ability to make an informed choice. But they say that this may not be easy to determine and call for better screening.

Physician assisted suicide is also legal in the Netherlands, Belgium, and Switzerland. About 100 Britons have travelled to Switzerland, which has no requirement of residency, to end their lives.

The matter is high on the agenda in the United Kingdom, where two high profile cases have highlighted the risk of prosecution in the UK for people who help relatives make the trip to Switzerland to commit suicide. No one has been prosecuted so far, but several people have been questioned by police.

Debbie Purdy, who has multiple sclerosis, recently failed in a High Court bid to try to get the director of public prosecutions to outline his policy for deciding whether or not to prosecute. She wants her husband to accompany her to Switzerland but does not want to expose him to the risk of prosecution and prison (BMJ 2008;337:a2368, doi: 10.1136/bmj.a2368).

The parents of Daniel James, a 23 year old tetraplegic man, accompanied him to Zurich in September, where he killed himself with the help of the non-profit making assisted suicide organisation Dignitas. They are waiting to find out whether they will be prosecuted (BMJ 2008;337:a2195, doi: 10.1136/bmj.a2195).