Initiative 1000 (I-1000) of 2008 established the

U.S. state In the United States, a state is a constituent political entity, of which there are 50. Bound together in a political union, each state holds governmental jurisdiction over a separate and defined geographic territory where it shares its sove ...

Washington Washington commonly refers to: * Washington (state), United States * Washington, D.C., the capital of the United States ** A metonym for the federal government of the United States ** Washington metropolitan area, the metropolitan area centered o ...

's Death with Dignity Act ( RCW 70.245), which legalizes medical aid in dying with certain restrictions. Passage of this

initiative In political science, an initiative (also known as a popular initiative or citizens' initiative) is a means by which a petition signed by a certain number of registered voters can force a government to choose either to enact a law or hold a ...

made Washington the second U.S. state to permit some

terminally ill Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer, dementia or advanced h ...

patients to determine the time of their own death. The effort was headed by former Governor

Booth Gardner William Booth Gardner (August 21, 1936 – March 15, 2013) was an American politician who served as the 19th governor of Washington from 1985 to 1993. He also served as the ambassador of the GATT. A member of the Democratic Party, Gardner previ ...

. The measure was approved in the November 4, 2008 general election. 1,715,219 votes (57.82%) were cast in favor, 1,251,255 votes (42.18%) against. There were 2,966,474 votes total. 30 of the state's 39 counties voted in favor of the initiative. In 1991, the similar

119 was rejected by Washington voters by a margin of 54 percent to 46 percent. I-119 would have allowed doctors to prescribe a lethal dosage of medication, and also to administer it if the terminally ill patient could not self-administer. Unlike that initiative, I-1000 requires the patient to ingest the medication unassisted. The initiative is based on Oregon Measure 16, which

Oregon Oregon () is a U.S. state, state in the Pacific Northwest region of the Western United States. The Columbia River delineates much of Oregon's northern boundary with Washington (state), Washington, while the Snake River delineates much of it ...

voters passed in 1994 but was not implemented until 1997. At that time, Oregon was the only other state to have enacted similar legislation. In 2013, Vermont became the third state to enact similar legislation. In 2016, California became the fourth state to enact similar legislation. All states on the West Coast now have similar legislation.

Specific provisions in the initiative

The official ballot summary for the measure, slightly amended following a February 2008 court challenge, is, "This measure would permit

competent Competence may refer to: *Competence (geology), the resistance of a rock against deformation or plastic flow. *Competence (human resources), a standardized requirement for an individual to properly perform a specific job *Competence (law), the me ...

, adult Washington residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician. The measure requires two oral and one written request, two physicians to diagnose the patient and determine the patient is competent, a waiting period, and physician verification of an informed patient decision. Physicians, patients and others acting in good faith compliance would have criminal and civil immunity." Provisions in the law include: * The patient must be an adult (18 or over) resident of the state of Washington * The patient must be mentally competent, verified by two physicians (or referred to a mental health evaluation) * The patient must be terminally ill with less than 6 months to live, verified by two physicians. * The patient must make voluntary requests, without

coercion Coercion () is compelling a party to act in an involuntary manner by the use of threats, including threats to use force against a party. It involves a set of forceful actions which violate the free will of an individual in order to induce a des ...

, verified by two physicians * The patient must be informed of all other options including

palliative Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...

and hospice care * There is a 15-day waiting period between the first oral request and a written request * There is a 48-hour waiting period between the written request and the writing of the prescription * The written request must be signed by two independent witnesses, at least one of whom is not related to the patient or employed by the health care facility * The patient is encouraged to discuss with family (not required because of confidentiality laws) * The patient may change their mind at any time and rescind the request * The attending physician may sign the patient's death certificate which must list the underlying terminal disease as the cause of death

Supporters

The campaign was run by a coalition that includes former Washington governor,

. aid-in-dying advocates from Oregon, the

Death with Dignity National Center Death with Dignity National Center is a 501(c)(3) nonpartisan nonprofit organization, headquartered in Portland, Oregon, that has led the legal defense of and education about Death with Dignity laws throughout the United States for more than 25 ...

Compassion & Choices Compassion & Choices is a nonprofit organization in the United States working to improve patient autonomy and individual choice at the end of life, including access to medical aid in dying. Its primary function is advocating for and ensuring acce ...

, Compassion & Choices of Washington, Compassion & Choices of Oregon. The name of the official political advocacy group working on the campaign was changed from "It's My Decision" to "YES on 1000". State Senator

Darlene Fairley Darlene Cook Fairley (born 1943) was a member of the Washington State Senate from 1995 to 2011 representing the 32nd District. In the Senate, she chaired the Government Operations and Elections Committee. Fairly earned in B.S. in Political Scienc ...

, who chairs the Death with Dignity Disabilities Caucus, said that "as a matter of personal control and autonomy, it makes sense to let patients themselves decide what kind of medical care they want to receive and how long they want to suffer with a terminal illness." State Representative

Jamie Pedersen Jamie D. Pedersen (born September 9, 1968) is an American lawyer and politician serving as a member of the Washington State Senate, representing the 43rd district since 2013.American Medical Student Association The American Medical Student Association (AMSA), founded in 1950 and based in Washington, D.C., is an independent association of physicians-in-training in the United States. AMSA is a student-governed national organization.They have a membership ...

, the American Medical Women's Association, the Lifelong AIDS Association, the

ACLU The American Civil Liberties Union (ACLU) is a nonprofit organization founded in 1920 "to defend and preserve the individual rights and liberties guaranteed to every person in this country by the Constitution and laws of the United States". ...

, the National Women's Law Center, the Washington Chapter of the

National Association of Social Workers The National Association of Social Workers (NASW) is a professional organization of social workers in the United States. NASW has about 120,000 members. The NASW provides guidance, research, up to date information, advocacy, and other resources ...

, and the Washington State Public Health Association. The Washington State Psychology Association was neutral on I-1000, but found that "patients choose aid in dying because of a desire for

autonomy In developmental psychology and moral, political, and bioethical philosophy, autonomy, from , ''autonomos'', from αὐτο- ''auto-'' "self" and νόμος ''nomos'', "law", hence when combined understood to mean "one who gives oneself one' ...

and the wish to avoid loss of

dignity Dignity is the right of a person to be valued and respected for their own sake, and to be treated ethically. It is of significance in morality, ethics, law and politics as an extension of the Enlightenment-era concepts of inherent, inaliena ...

and control, not because of a poor mental state, lack of resources or social support," and "the law has had a positive effect in terms of significant improvements in palliative care." The ''Newcastle News'' endorsed the measure in an October 7, 2008, editorial. "Some opponents of I-1000 will refer to the life-death option as assisted suicide, but this has no resemblance to suicide. It is a humane end to a life that is already ending," the editorial said.

Opposition

The Coalition Against Assisted Suicide opposed the measure. It included doctors and nurses, disability rights advocates and organizations,

hospice Hospice care is a type of health care that focuses on the palliation of a terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life. Hospice care prioritizes comfort and quality of life b ...

workers, minorities,

right-to-life The right to life is the belief that a being has the right to live and, in particular, should not be killed by another entity. The concept of a right to life arises in debates on issues including capital punishment, with some people seeing it as ...

organizations, the

Catholic Church The Catholic Church, also known as the Roman Catholic Church, is the List of Christian denominations by number of members, largest Christian church, with 1.3 billion baptized Catholics Catholic Church by country, worldwide . It is am ...

and other

Christian Christians () are people who follow or adhere to Christianity, a monotheistic Abrahamic religion based on the life and teachings of Jesus Christ. The words ''Christ'' and ''Christian'' derive from the Koine Greek title ''Christós'' (Χρι� ...

organizations, and politicians. The organization held that the danger of making doctors the agents of a patient's death far outweighed any advantages to assisted suicide, or safeguards in the initiative's text. They felt that legalization of assisted suicide would put pressure on minorities, the disabled, and the poor. Actor

Martin Sheen Ramón Antonio Gerardo Estévez (born August 3, 1940), known professionally as Martin Sheen, is an American actor. He first became known for his roles in the films ''The Subject Was Roses'' (1968) and ''Badlands'' (1973), and later achieved wid ...

appeared in television ads opposing Initiative 1000. There has been some debate over one of Sheen's statements: persons with depression can be given a lethal dose without prior professional assessment. According to the Washington Death with Dignity act, "Medication to end a patient's life in a humane and dignified manner shall not be prescribed until the person performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment." This issue has been explored in the field of medical ethics.

Results

References

{{reflist, 2

External links

Official Washington State Department of Health page on the DWDA
with Annual Reports
Ballotpedia entry on Washington Initiative 1000

In support

Yes! on I-1000 CommitteeDeath With Dignity National Center

In opposition

Coalition Against Assisted Suicide