In 2017 only 2% of those given a lethal prescription were referred to a psychiatrist or psychological for evaluation. This low rate does not reflect the known prevalence of depression in people diagnosed with a terminal illness and indicates a cavalier attitude by prescribing doctors.
In some cases the prescribing doctor knew the patient for less than a week before writing the prescription, and in more than half the cases (51%) the doctor knew the patient for less than 25 weeks.
Washington State’s Death With Dignity Act, based on Oregon’s, came into operation on 9 March 2009.
Increase in numbers
In the first full calendar year of operation, 2010, some 87 prescriptions for lethal drugs were provided under the Act. By 2016 this had nearly tripled (286%) to 249 but dropped to 212 in 2017.
Deaths from lethal drugs prescribed under the Act nearly quadrupled (376%) from 51 for 2010 to 194 for 2016, increasing by 13.6% from 2015 to 2016 alone, but dropping to 164 for 2017.
Lethal drugs unaccounted for in the community
Not all of those who are prescribed lethal drugs end up taking them. Some die of natural causes. There is no tracking of lethal drugs that are not used by those for whom they are prescribed so these lethal drugs are available in the community and could be used accidentally or intentionally to cause death. Of the 1401 prescriptions for lethal drugs issued since 2009 only 1012 (72%) have been reported as used leaving some 489 doses of lethal drugs unaccounted for.
Pain control not the issue but being a burden is
Some 62% of those for whom a prescription for lethal drugs was provided in 2017 did not cite any concern about pain control as a reason for asking for the prescription.
However, 90% cited concerns about loss of autonomy and 56% cited concerns about being a burden on family, friends or caregivers.
Significantly, 10% cited concerns about the financial implications of treatment.
Poor screening for mental health and short term doctor patient relationships
Only 2% of those given a lethal prescription were referred to a psychiatrist or psychological for evaluation. In some cases the prescribing doctor knew the patient for less than a week before writing the prescription, and in more than half the cases (51%) the doctor knew the patient for less than 25 weeks.
Although the Act specifies that only persons who have a disease that will “produce death within six months” may request lethal doses of medication from a physician, the data shows that in each year between 5% and 17% of those who die after requesting a lethal dose do so more than 25 weeks later with one person in 2012 dying nearly 3 years (150 weeks) later, one person in 2015 dying nearly two years later (95 weeks) and one person in 2016 dying more than two years (112 weeks) later.
Not a peaceful death
In 2017 one person took 6 hours to lose consciousness after ingesting the lethal dose and one person took 35 hours to die after ingesting the lethal dose. In 2016 one person took 11 hours to lose consciousness after ingesting the lethal dose. In 2015 one person took 72 hours (3 days) to die after ingesting the dose. In 2013 one person took 3 hours to lose consciousness after ingesting the lethal dose and one person took 41 hours (1 day and 17 hours) to die after ingesting the dose. In 2009 two people awakened after initially losing consciousness. In 2014 one person suffered seizures after ingesting the lethal medication. At least 18 patients have regurgitated the lethal medication.
Seven of these cases occurred in 2016 alone.
This may be related to the use of new experimental cocktails of lethal drugs being used since the price of the previously used drugs, secobarbital and pentobarbital (Nembutal), escalated.
The first of the new cocktails is a mix of phenobarbital, chloral hydrate and morphine sulfate. It was prescribed in 88 cases in 2015 and 106 cases in 2016 but no longer prescribed in 2017 no doubt due to the fact that it was found to be very caustic and to cause a profound burning in the throat.
The second experimental cocktail includes morphine sulfate, propranolol, diazepam, digoxin and a buffer suspension. It was prescribed used in 4 cases in 2015, 53 cases in 2016 and 130 cases (66%) in 2017.
If they struggled who would know?
There is no requirement under the Act for a physician or any other person to be present when the lethal dose is ingested. Since 2009 there have been 224 cases where no health-care provider was present when the lethal dose was ingested and a further 147 cases where it is not known if a health-care provider was present.
In other words in some 371 cases people have died ingesting a dose of lethal medication, legally prescribed under Washington law, and nobody knows whether the person freely ingested the lethal dose or they were cajoled, coerced or forced to do so by another person.
Washington continues its experiment with prescribing various cocktails of lethal drugs to be taken, often with no witness present, leaving people at risk of distressing complications and at risk of being killed by a family member or someone else interested in their early death. It is not a safe model for any other jurisdiction to follow.