These questions and answers contain general information about the effect of Initiative 1000, the state's Death with Dignity Act. Refer to the official act for specific details under this law.
- What is the Death with Dignity Act?
- The Death with Dignity Act allows terminally ill adults seeking to end their life to request lethal doses of medication from medical and osteopathic physicians. These terminally ill patients must be Washington residents who have less than six months to live.
- Who can request medication under this act?
Only a qualified patient may make a written request for medication that they will self-administer to end their life. A qualified patient must be:
- At least 18 years of age.
- Competent - in the opinion of a court or in the opinion of the patient’s attending qualified medical provider or consulting qualified medical provider, psychiatrist, or psychologist, a patient has the ability to make and communicate an informed decision to health care providers, including communication through persons familiar with the patient’s manner of communicating if those persons are available.
- A resident of Washington State.
- Diagnosed with a terminal disease - an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.
- How do you prove residency in Washington?
- Common documents that prove residency in Washington State include, but are not limited to a driver’s license, voter registration, a mortgage or rental agreement, or a utility bill.
- How can a qualified patient make a written request for medication under this act?
A qualified patient can make a written request using the Request for Medication to End My Life in a Humane and Dignified Manner form (DOH 422-063) or a form very similar. The qualified patient must physically sign and date their written request in the presence of at least two witnesses. The witnesses must declare that to the best of their knowledge and belief the patient is competent, acting voluntarily, and is not being coerced to sign the request.
- Who can be a witness?
- Only one of the two witnesses may be a relative of the qualified patient by blood or by law or entitled to any portion of the estate upon death.
- Only one of the two witnesses may own, operate, or be employed at a health care facility where the qualified patient is receiving medical treatment or is a resident.
The patient's attending qualified medical provider at the time the request cannot be a witness.
- Who can write a prescription for medication under the act?
Only a qualified medical provider authorized by the Act may write a prescription for medication.
- Who is a qualified medical provider under the Act?
A qualified medical provider includes:
- Physician licensed under chapter 18.57 RCW or 18.71 RCW.
- Physician Assistant licensed under chapter 18.71A RCW.
- Advanced Registered Nurse Practitioner licensed under chapter 18.79 RCW.
- Does a qualified medical provider or pharmacist have to participate in the Act?
No, participation is entirely voluntary. The Act does not require health care providers to provide prescriptions or medications to qualified patients.
- Does the qualified medical provider have to be present at the time the qualified patient self-administers medication under this Act?
No, the Act does not require a qualified medical provider to be present.
- How can an individual submit a complaint about a provider who violates the Act?
The Division of Health Systems Quality Assurance reviews all complaints against health care providers in Washington. You can contact the Complaint Intake Office at: 360-236-4700 or HSQAComplaintIntake@doh.wa.gov.
- Are qualified patients required to notify their families of this decision?
No, the Act does not require qualified patients to notify their family. The attending qualified medical provider must recommend that the patient notify next of kin of their request for medication.
- Does the qualified patient have to make an oral request for medication?
Yes, the qualified patient must make two oral requests in addition to a written request. The qualified patient must wait at least seven days after the first request to make the second request. When the qualified patient makes the second oral request, the attending qualified medical provider must offer the patient an opportunity to change their mind.
- Can the patient withdraw the request for medication under this act?
Yes, a qualified patient may withdraw the request at any time and in any manner. The attending qualified medical provider cannot write a prescription for medication under the Act without first offering the qualified patient an opportunity to change their mind.
- How long must a qualified patient wait before receiving the prescription under this act?
The qualified patient must wait at least seven days.
- What forms does the attending qualified medical provider have to submit to the Department of Health?
The attending qualified medical provider must submit the following completed forms within 30 calendar days of writing a prescription for a lethal dose of medication:Request for Medication to End My Life in a Humane and Dignified Manner form (DOH 422-063), or in substantially the same form as described in the Act; Attending Qualified Medical Provider Compliance form (DOH 422-064); Consulting Qualified Medical Provider Compliance form (DOH 422-065); and Psychiatric/Psychological Provider Compliance form (DOH 422-066), if an evaluation was performed.
The attending qualified medical provider must submit the completed Attending Qualified Medical Provider After Death Reporting form (DOH 422-068) within 30 calendar days of a qualified patient's ingestion of lethal medication obtained under the terms of the act, or death from any other cause, whichever comes first.
If the attending qualified medical provider is permitted by law to dispense medication and does so under the Act, they must also submit a copy of the Pharmacy Dispensing Record Form (DOH 422-067) within 30 calendar days of dispensing medication.
- Does the pharmacist have to file a report after they dispense the medication?
Yes. The dispensing health care provider must submit the completed Pharmacy Dispensing Record Form (DOH 422-067) within 30 calendar days of dispensing the prescribed medication.
- How does an individual dispose of unused medication?
Medications prescribed for Death with Dignity are controlled substances. If the qualified patient did not take a medication dispensed under the Act, it must be disposed of properly.
You can return unused medications to a pharmacy kiosk or give it to a “medication take back program.” Visit the Home - MED-Project to find safe disposal options near your zip code.
Some law enforcement agencies accept controlled substances for disposal. Ask your local law enforcement if they accept unused medications for disposal.
If you cannot give the medications to a pharmacy, “medication take back program”, or your local law enforcement agency then follow the Food and Drug Administration (FDA) recommendations for disposing of medications:
- Follow all specific disposal instructions on the drug label or patient information that comes with the medication.
- Do not flush prescription drugs down the toilet unless the instructions say that's okay.
- If no instructions are given, throw the drugs in the household trash after taking them out of their original containers and mixing them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who may intentionally go through trash. Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag. The info is online at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm.
- Before throwing out an empty medicine container, scratch out or remove all identifying information on the prescription label. This will help protect patient identity and the privacy of personal health information.
- What are the responsibilities of the Department of Health?
The Department of Health collects reported forms, ensures the quality of the data, and publishes an annual statistical report. The department's Center for Health Statistics collects all the forms sent by qualified medical providers, psychiatric/psychological providers, and pharmacists.
Staff reviews these forms and if any are inadequate or incomplete, they will contact the provider or pharmacist. The information collected by the agency is not a public record and will only be released as summarized data in the annual statistical report. The department adopted rules on provider and pharmacist reporting requirements.
The Department of Health is not able to help a potential participant with accessing care or authorized to remove any requirements of the Act.
- Are life, health, accident insurance or annuity policies affected by making or rescinding a request for medication under this act, or by ingesting medication to end a patient's life?
No. The Act states that “the sale, procurement, or issuance of any life, health, or accident insurance or annuity policy or the rate charged for any policy shall not be conditioned upon or affected by the making or rescinding of a request, by a person, for medication that the patient may self-administer to end his or her life in a humane and dignified manner. A qualified patient's act of ingesting medication to end his or her life in a humane and dignified manner shall not have an effect upon a life, health, or accident insurance or annuity policy.”
- Are there any protections for health care providers that participate in the Act?
Yes. The Death with Dignity Act only provides health care providers immunity from civil and criminal liability and disciplinary action for good faith compliance.
A professional organization or association, or health care provider, may not subject a person to censure, discipline, suspension, loss of license, loss of privileges, loss of membership, or other penalty for participating or refusing to participate in good faith compliance with this Act.
A patient's request for or provision by an attending qualified medical provider of medication in good faith compliance with this Act does not constitute neglect for any purpose of law or provide the sole basis for the appointment of a guardian or conservator.
- Can a health care facility prohibit its providers or pharmacists from participating?
Yes. The Act allows a health care provider, including a health care facility, to prohibit another health care provider from participating on their premises if the prohibiting provider has given notice, in writing, to all health care providers with privileges to practice on the premises and to the general public of the prohibiting provider's policy regarding participation.
- Can a qualified medical provider or pharmacist participate in the Act while working outside of their positions with a health care facility that prohibits participation?
Yes. A health care facility cannot prohibit a health care provider from participating in the Act while acting outside the course and scope of the provider's capacity as an employee or independent contractor.
The Act also does not allow a health care facility to prohibit a patient from contracting with the attending and consulting qualified medical providers working outside the course and scope of the provider's capacity as an employee or independent contractor.
- If a health care facility prohibits its providers or pharmacists from participating in the Act, can the provider or pharmacist still provide information about the Act to patients who request it?
Yes, facilities cannot stop providers or pharmacists from:
- Making an initial determination that a patient has a terminal disease and informing the patient of the medical prognosis,
- Providing information about the Washington Death with Dignity Act to a patient upon the request of the patient,
- Providing a patient, upon the request of the patient, with a referral to another provider, or
- Working with a patient outside of the course and scope of the provider's capacity as an employee or independent contractor of the facility.
- If a physician does not want to participate, does the act require a referral to a provider who will?
- How can I find a provider that participates in Death with Dignity?
The Department of Health cannot provide the names of health care providers who participate in Death with Dignity. We suggest you talk with your health care provider. You can find information about end-of-life care for patients and families on the Washington State Hospital Association and End of Life Washington websites.