Washington State was the second US state to legalise assisted suicide after a ballot initiative. The law commenced in March 2009.
The latest data release from the Washington Department of Health for the 2015 calendar year highlights and reinforces concerns. This is particularly important for Victorians where a recent Parliamentary Report recommended a form of legislation that would make it lawful for a doctor to prescribe a lethal dose.
Washington's so-called Death with Dignity Act allows adult residents in the state with six months or less to live to request lethal doses of medication from a physician. Like in Oregon, the doctor is required to report all deaths under the act to the Health Authority, not, as Andrew Denton recently said on national television, to the coroner.
A snap shot of 2015:
Doctors made out 213 lethal prescriptions - an increase of 22% on the previous year.
Reported deaths from assisted suicide were up 31.7% on the previous year - more than three times the deaths than in 2010 (first full year of operation).
(note: The differential between filled prescriptions and recorded deaths means that there remain something like 285 unused doses of lethal drugs unaccounted for in the community since the law began. There is no effective control over prescriptions.)
Concerns raised by people with their doctor in relation to requests for assisted suicide show, once again, that pain or fear of pain is a lower order concern, only being mentioned in 35% of cases.
Higher order concerns include: Loss of autonomy and Less able to engage in activities making life enjoyable (both at 86%) and perceptions of loss of dignity (69%). Fears of being a burden on family, friends/caregivers was evident in more than half of cases (52%), and Financial implications of treatment more than doubled from the previous year and were mentioned in 13% of cases in 2015.
In 2009 only 2% of deaths noted financial concern. The increase to 13% could be read to reflect the outworking of the global financial crisis that began in 2007 and the continuing financial difficulties in the USA economy. If this is the case then it serves to amplify the effective possible abuse of those who can least afford quality care.
Fears of being a burden may have a correllation to financial concerns (even though they are not precisely the same thing): In 2009 fears of being a burden were mentioned in 23% of cases, more than doubling in 2015 to 49%.
In all of the above concerns routinely recorded and reported to the Health Department, any or all concerns may have been mentioned by the individual and thus recorded on their files. It is impossible to know whether the absence or remedy of any of these underlying concerns would have changed the person's mind about suicide.
A sense of being a burden may come from or be reinforced by others; family members in particular. It may also simply be a sentiment seeking to somehow spare family members the very real strain that supporting a loved one who is dying may entail. But what cannot be denied is that a sense of being a burden was a factor in nearly half of the cases in 2015.
Those who somehow believe that, given supposedly appropriate 'safeguards' that every decision to be made dead is somehow done in a clinical and analytical manner, excluding any emotional baggage such as a sense of being a burden, are playing a dangerous game with people's lives.
In only 4% of cases in 2015 was the person referred for expert evaluation by a psychiatrist.
In 25% of cases, no medical personel were present at the death. No-one will ever know whether or not the person ingested the lethal drug voluntarily or under duress. This brings to 226 the number of deaths in Washington, under the law since 2009, where nothing is known about whether the person chose freely to ingest the substance or not. A clear failure in the law to protect people from abuse.
There are clearly problems with the Washington law as there are with the Oregon law. Given these experiences one can expect that similar observations will be made in time about the more recent laws in Vermont, California and Canada.
You can read the full report and reports from previous years HERE.