Ed note: Here’s an email notice sent out by co-Executive Directors of End of Life Washington
Today, March 5th, 2024, marks 15 years since Medical Aid in Dying became available in Washington State. Initiative 1000, otherwise known as The Washington Death with Dignity Act, passed on November 4, 2008, and went into effect that following spring. This is a day to celebrate – the first day Washingtonians were able to exercise their right to use Medical Aid in Dying, and a landmark day for bodily autonomy in Washington State.
Earlier this year, we were going through old archives with two founding and foundational members of this organization, Midge Levy and Arline Hinckley. Sifting through old newsletters, we found a piece by Robb Miller, the executive director of End of Life Washington at the time, titled “How We Won I-1000″. The piece, included below, outlines Robb’s perspective on why I-1000 was so successful at the polls. As we enter 2024, we want to reflect on what’s changed during these last 15 years of access to Medical Aid in Dying in Washington and set our sights on what’s to come.
The population of Washington has changed. Our population has grown at twice the rate of the rest of the United States, with over 1.3 million more people residing here than in 2009. Of those new residents, the fastest growing group has been people 65 and older, growing over 62 percent in the last 15 years. As our population grows, I am grateful to be living in a state with some of the best end-of-life care and support in the nation.
Using this law, even with 15 years of progress behind us, remains difficult. People go to great lengths to access these medications and they often receive significant support to do so. For comparison, in 2009, the aid-in-dying medications were dispensed to 63 individuals, compared to 2022 where 452 received medications. Each year we see more requests for support, and we hear the same from our healthcare partners; more people want access and need support accessing this law.
Last year, we updated the Death with Dignity Act, to include more qualified medical providers, improve medication delivery, and shorten the waiting period. The changes are not yet a year old, and we are seeing improved access and opportunities. The waiting period from a person’s initial request to them receiving a prescription has been shortened from 15 days to 7; Advanced Registered Nurse Practitioners (ARNPs and Physician Assistants (PAs) are now allowed to participate as prescribing or consulting providers on a person’s request to use medical aid-in-dying; providers are allowed to file their required paperwork electronically instead of by mail; and a person’s life-ending medication can now be picked up by a trusted person instead of the dying patient needing to receive their medication directly from the pharmacist. All these changes have helped people across the state find peace in times of great suffering, while preserving the strong safeguards in the law that prevent abuse.
As access has been improved, barriers to access continue to grow. Since 2009 we have seen a steady increase in hospitals merging with restrictive institutions. These restrictive systems limit access to end-of-life services, and the mergers mean that more providers across the state are barred by their employers from supporting their patients in accessing their full end-of-life rights. Since the law was passed 15 years ago there have been big healthcare mergers between Swedish and Providence (2012) and CHI Franciscan and Virginia Mason (2022). As a result of these mergers, more than 50% of the hospital beds in Washington State are provided by restrictive systems and patients in those beds are not able to access this care without substantial effort and external support.
What remains unchanged is the support and dedication of excellent social workers, physicians, volunteers, nurses, hospice staff, and clergy. People across the state, then and now, are working to improve end-of-life care. We have deep reverence for the helpers who make access to this law possible – thank you.
As we reflect and look ahead this year, there is so much to celebrate. Thank you for being part of this community and for your commitment to end of life options. The right to choose at the end of life has come so far in this state, and yet it feels like we need your commitment to autonomy and care more now than ever. This work isn’t easy; every step forward takes all our effort and collaboration. This truly cannot happen without you. We are so glad you’re here with us and we look forward to seeing what we can achieve together over the next 15 years.