Ballot Title: INITIATIVE Measure 1000; Fiscal Impact Statement for Initiative 1000 ;The law as it presently exists; Statement For ; Statement Against

Initiative Measure No. 1000 concerns allowing certain terminally ill competent adults to obtain lethal prescriptions.
This measure would permit terminally ill, competent, adult Washington residents, who are medically predicted to have six months or less to live, to request and self-administer lethal medication prescribed by a physician.
Should this measure be enacted into law?
Fiscal Impact Statement for Initiative 1000
Initiative 1000 would require health care providers writing a prescription or dispensing medication under this act to file a copy of the dispensing record with the Washington State Department of Health. The Department would be required to create and make available to the public an annual statistical report of information collected. The Department would adopt rules on the process for collecting this information. One-time rule-making costs are estimated at $60,000. Ongoing data collection and reporting costs are estimated at $19,000 per biennium. Total costs for the 2009–11 biennium are $79,000.
Assumptions for Fiscal Analysis of Initiative 1000
The Department of Health will incur one-time costs in fiscal year 2010 for rulemaking. This includes the cost of conducting three rule-making hearings across the state, associated staff and related expenses, meeting room rentals, Office of Attorney General services, travel, printing and postage. Rule-making costs are estimated at $60,000.
Starting in fiscal year 2010, the Department of Health would have ongoing costs for staff required to collect and report the data identified in section 15 of this act. Staff and associated costs are estimated at $19,000 for the 2009–11 biennium.
The law as it presently exists:
Under existing Washington law, it is a crime for any person, including a physician, to knowingly assist another person in attempting suicide. Knowingly causing or aiding another person to attempt suicide is a class C felony. Washington’s Natural Death Act states that nothing in that Act shall be construed to condone, authorize, or approve mercy-killing or physician-assisted suicide, or to permit any affirmative or deliberate act or omission to end life other than to permit the natural process of dying. Death certificates are required to state the cause of death within the best knowledge or belief of the attending physician or medical attendant, or the health officer, coroner, or prosecuting attorney having jurisdiction. A physician or other medical license holder who is convicted of a felony related to the practice of the person’s profession is subject to professional discipline, including license suspension or revocation.

The effect of the proposed measure, if approved:
This measure would allow a terminally ill, competent, adult Washington resident who is medically predicted to have six months or less to live, to request and self-administer lethal medication prescribed by a physician. The attending physician with primary responsibility for care of the patient would be required to determine that the patient has an incurable, irreversible disease expected to cause death within six months; that the patient is competent; that the patient has demonstrated Washington residency; that the request is voluntary; and that the patient is making an informed decision. A second, consulting physician, would be required to confirm that the patient is terminally ill, competent, and has made an informed and voluntary decision. The measure defines competent as having the ability to make and communicate an informed decision to health care providers. The measure defines an informed decision as a qualified patient’s decision to request and obtain a lethal prescription, based on an appreciation of the relevant facts and after being fully informed by the attending physician of his or her diagnosis, prognosis, the risks and probable result of ingesting the medication, and feasible alternatives.The attending physician would be required to recommend that the patient notify the patient’s next of kin, but the patient would not be required to do so. If the attending or consulting physician believes the patient’s judgment may be impaired by a psychiatric or psychological disorder or depression, the physician would be required to refer the patient to a psychiatrist or psychologist for counseling. Lethal medication could not be prescribed until the counselor determines that the patient’s judgment is not impaired. Immediately before writing the prescription, the attending physician would be required to verify that the patient is making an informed decision.The measure would require a patient to make one written and two oral requests to the attending physician for the lethal medication. The patient would have the right to rescind the request at any time, and in any manner, regardless of his or her mental state. The physician would be required to offer the patient an opportunity to rescind the request when the second oral request is made. A 15-day waiting period between the first and second oral requests would be required, and a 48-hour waiting period between the written request and the writing of the prescription would be required. The measure would require that the written request of the patient be substantially in a form contained in the measure. The form includes a statement that the patient is of sound mind and is making a voluntary request, has a terminal disease, has been informed of the likely effect of taking the lethal medication and feasible alternatives, that the patient understands the right to rescind the request at any time, and an indication of whether the patient’s family has been informed.Two persons would be required to witness the patient’s written request and to attest that, to the best of their knowledge, the patient is competent, acting voluntarily, and not being coerced. The measure would require that one witness not be a relative; not be the patient’s attending physician; not be entitled to a portion of the patient’s estate; and not own, operate, or be employed by a health care facility where the patient is a patient or resident. If the patient is an inpatient at a health care facility, one witness would be required to be designated by the facility. The measure would require attending physicians to document compliance with its requirements.Persons participating in good faith compliance with the measure, including being present when a qualified patient takes the prescribed lethal medication, would not be subject to criminal or civil liability, or professional disciplinary action. Any person who willfully alters or forges a request for lethal medication without the patient’s authorization, conceals or destroys a rescission with the intent to cause the patient’s death, or coerces or exerts undue influence on a patient to request lethal medication or destroy a rescission, would be guilty of a class A felony. Provisions in wills, contracts, or agreements purporting to affect the ability to make or rescind a request for lethal medication would be invalid. Life, health, or accident insurance or annuity policies, and rates charged for them, could not be conditioned on or affected by making or rescinding a request for lethal medication. A qualified patient’s ingestion of lethal medication would have no effect on a life, health, or accident insurance or annuity policy. The measure would not require a health care provider or facility that is unable or unwilling, to provide a prescription for lethal medication. If a health care provider or facility is unable or unwilling to carry out a qualified patient’s request for lethal medication, and the patient transfers his or her care to a new provider, the prior provider would be required to transfer a copy of the patient’s relevant medical records to the new health care provider, upon the patient’s request. With advance notice, a health care facility that chooses not to participate under this measure may prohibit other health care providers from participating on the facility’s premises. The measure would not prevent a health care provider from participating in the measure while acting outside the provider’s capacity as an employee or independent contractor. In addition, the measure would not authorize a health care provider or facility to sanction a physician or counselor for making an initial determination that a patient has a terminal disease; informing the patient of the medical prognosis; providing information about the measure at the patient’s request; or providing information regarding this measure or a referral to another physician at the patient’s request. State reports would refer to practices under the measure as obtaining and self-administering life-ending medication, and not as suicide or assisted suicide. The patient’s death certificate would be required to list the underlying terminal disease as the cause of death.The state Department of Health would be required to annually review all records maintained under the measure and to adopt rules for collecting information relating to compliance with the measure. Health care providers that prescribe or dispense lethal medication under the measure would be required to file a report with the Department of Health. Information collected by the Department of Health would not be public. The Department of Health would be required to annually produce a public statistical report of collected information.
YES ON I-1000: IT'S MY DECISION
A YES vote FOR I-1000 allows mentally competent, terminally ill adults with six months or less to live to receive – under strict safeguards – a prescription for life-ending medication. This choice belongs exclusively to the terminally ill individual. Government, politicians, religious groups and others should not dictate these personal decisions.
TEN YEARS OF DIGNITY IN OREGON
I-1000 mirrors an Oregon law that has been in place for over 10 years. The Oregon law was upheld by the U.S. Supreme Court and approved twice by voters.
Earlier this year, The Oregonian newspaper wrote that the law “helped elevate end-of-life care” and that “in a decade of experience with the law, no abuses have shown up.” The Seattle Times added that “those it affects, and their families, will be thankful for its passage.”
Independent studies of Oregon’s Death with Dignity law prove that the safeguards protect patients, prevent misuse and coercion, and allow mentally competent, terminally ill patients the option of a peaceful, dignified death. People with terminal cancer and AIDS would have the right to decide whether to end their intolerable suffering.
SAFEGUARDS WORK
There are multiple safeguards in Washington’s death with dignity law. These safeguards include independently witnessed oral and written requests, two waiting periods, mental competency and prognosis confirmed by two physicians, and self-administration of the medication. Only the patient – and no one else – may administer the medication.
YES ON I-1000: DEATH WITH DIGNITY
I-1000 asks, “Who should decide these difficult end-of-life questions?” We say the decision belongs with the patient and their family, and no one else.
For more information, visit www.yeson1000.org or call (206) 633-2008.
I-1000 legalizes assisted suicide in Washington. The law is flawed and dangerous.
I-1000 IS DANGEROUS FOR PEOPLE WHO CANNOT AFFORD HEALH CARE.
Adding I-1000 to our broken, profit-driven health care system puts Washingtonians at risk – anyone with limited access to health care or inadequate health insurance. In Oregon, patients have been denied chemotherapy but offered assisted suicide instead.
I-1000 HAS NO REAL SAFEGUARDS.
I-1000 requires almost no government oversight, with no penalties for abuse. It overrides our disclosure laws and requires doctors to falsify death certificates.
I-1000 endangers vulnerable people. Its supposed “safeguards” are inadequate:
• Depressed and mentally ill people can be given lethal drug overdoses.
• Spouses and children need never be told a loved one is being given a lethal drug overdose.
• There is no protection against coercion or financial pressures.
OUR STATE'S LEADING PHYSICIANS' ORGANIZATION, THE WASHINGTON STATE MEDICAL ASSOCIATION, STRONGLY OPPOSES I-1000.
Proponents say I-1000 provides a choice when dying, but for those who are not wealthy, it could be a choice made by insurers and state bureaucrats; they will have the choice to steer patients toward assisted suicide rather than provide actual end-of-life care.
DISABILITY COMMUNITY LEADERS OPPOSE I-1000.
Recent medical advances assure pain can be controlled and no one need suffer at the end of life. I-1000 is not needed.
Dangerous assisted suicide laws have been rejected in 24 states, including here in Washington in 1991. It’s time to reject assisted suicide, again.
VOTE “NO” ON I-1000. IT'S JUST TOO DANGEROUS.
For more information, visit www.noassistedsuicide.com or call (206) 337-2091.
Rebuttal of Statement Against
Suffering, terminally ill adults should have the right to make their own end-of-life choices.
Opponents of I-1000 – funded largely by one religious group – want to impose their views on everyone.
Independent studies of Oregon’s law show no abuse (www.oregon.gov.gov/DHS).
No one is forced to use it.
I-1000 has the same safeguards as Oregon’s law.
The Washington Public Health Association, American Medical Women’s Association, thousands of doctors, nurses, disabled people, clergy, citizens and patients endorse I-1000.
Rebuttal of Statement For
The truth: Assisted suicide in Oregon isn’t dignified. And its safeguards don’t work.
Credible studies show end of life suffering has increased, not decreased in Oregon. Depressed and confused people have been coerced into assisted suicide there.
No wonder the Oregonian calls the law: “rigged to avoid finding answers.” (3/8/05)
I-1000 offers even fewer protections than Oregon’s law. Washington’s voters do want to decide difficult end-of-life questions themselves.
That’s why they’ll vote NO on I-1000.
Statement Prepared By
GOVERNOR BOOTH GARDNER (D); GOVERNOR DANIEL J. EVANS (R); TOM PRESTON, MD; DOROTHY H. MANN, PhD, M.P.H.; REV. BRUCE PARKER, D. Min.; LINDA N. OLSON, Ph., RN.
Statement Prepared By
MARGARITA PRENTICE, State Senator and nurse; CYNTHIA MARKUS, MD, President, Washington State Medical Association; DUANE FRENCH, disability rights leader, Not Dead Yet – Washington; ROSE CRUMB, RN, hospice nurse, founder Volunteer Hospice of Clallam County; DAVID CORTINAS, publisher of LaVoz Hispanic Newspaper; LINDA SEAMAN, MD, FAAHPM, board certified hospice and palliative medicine.