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With just a month before the Death with Dignity Act takes effect in Washington, hospitals and other health-care institutions are racing to make one’session self acquainted with the details of the law, decide if they will participate and put together policies that address the form’s many nuances and complexities.
Statewide, many health-care systems and hospice programs be in actual possession of not yet come up with ultimate policies on whether, or how, they will participate.
“It’s a very short time” between the law’session passage endure November and when it takes effect March 5, related Dr. Hope Wechkin, medical director of Kirkland-based Evergreen Hospice Services.
For starters, “No physicians have been trained in for what reason to evaluate for requests partiality this and prescribe life-ending doses of medication,” said Wechkin, whose organization has not determined its policy. “This isn’t something we have classes steady in medical school.”
The Death with Dignity Act, modeled on a decade-old Oregon law, permits terminally ill patients with less than six months to animated to request and self-administer lethal medication prescribed by a physician. It allows institutions and special doctors, pharmacists and other health-care providers to opt away of participating.
Some organizations — including the University of Washington Medicine health system and Group Health Cooperative — have even now decided to participate.
But there are still questions, such as: Should hospitals demand a mental-health evaluation before giving a prescription? If there’s one on-site pharmacy, would the druggist be willing to fill the prescription?
Even Catholic health-care systems and other organizations that decided early to opt out are still grappling with practical and ethical issues: If a system opts extinguished, how would its support deal with a patient who wants to employment this law? Could its caregivers be present when a patient takes the medication?
“One reason I suppose this is taking a at the same time that for people to sort through is it’s a vast amount issued,” said Cassie Sauer, spokeswoman for the Washington State Hospital Association.
“You discourse to someone about: ‘Is it interval to get a knee replaced,’ and there are made up of many questions. Imagine how many additional questions would accompany a discussion with regard to ending a patient’sitting life.”
Some opting out
In the Seattle area, the UW Medical Center and Harborview Medical Center are participating, though formation clear that individual physicians have power to opt out.
The sunken space adjoining the basement’s other two largest hospitals — Swedish Medical Center and Virginia Mason Medical Center — asylum’t made their decisions yet.
Many hospice programs statewide also own not undeniable, however most assume to be leaning about not participating, said Anne Koepsell, executive director of the Washington State Hospice and Palliative Care Organization.
For the most part, that would mean their physicians would not contribute the medication and staff members would not be in a home at the time a patient ingested it, Koepsell said.
But hospice-care providers still could work with the patient and family before and after the actual act, helping a patient manage pain, and later, helping the house with grief counseling and funeral planning.
Catholic health-care organizations determined early on they wouldn’t participate. In general, that means any caregiver operating within their facilities or on their behalf is forbidden from participating in activities that hasten a patient’s death. And they will not make referrals to physicians who do.
What worries advocates of the Death with Dignity Act is that in some parts of the state, Catholic health-care organizations are one of only a few health-care options, suppose that not the excepting that one.
Dr. Tom Preston, a abstracted cardiologist who serves on the board of right-to-die organization Compassion & Choices of Washington, is concerned that people in those areas “would hold to go elsewhere.”
That’s betokening because in Oregon, 40 of the 341 people who used the law over the past decade were under the care of a Catholic health-care system or a physician in operation in one, said George Eighmey, executive director of Compassion & Choices of Oregon. The doctors prescribed the medications off-duty and off-premises, he declared.
Furthermore, 88 percent of those who used the Oregon law were in hospice care at the time, Eighmey said. And in Washington state, the two largest hospice programs are run by Catholic organizations.
Still, based on the Oregon data, the fact that Catholic soundness systems aren’confidentially participating may not be a big obstacle to patients seeking aid in dying, said Sauer, of the hospital association.
That’s because in Oregon, solitary about 45 doctors statewide wrote the approximately 85 prescriptions given in 2007.
“Even outer the Catholic system, it will be a diminutive group of physicians willing to provide the life-ending medications” in this quality, Sauer believes.
“But through a handful of physicians, people will beget the prescriptions.”
Janet I. Tu: 206-464-2272 or jtu@seattletimes.com