In recent years, states with laws allowing physician-assisted suicide have vied with each other to prove that concerns about a “slippery slope” on this issue are absolutely valid.

 

Waiting periods giving patients time to reconsider their decision have been shortened or, for some patients, eliminated; the list of illnesses deemed “terminal” has expanded to include chronic conditions like diabetes and even psychiatric conditions like anorexia; qualifications for the medical professionals have changed to include nurses and physician assistants; and the psychological evaluation that these professionals may request can be done by a social worker or medically untrained “mental health counselor.” (In both Oregon and Washington, fewer than 1% of patients even receive any such evaluation.)[i]

 

In 2008, my home state of Washington became the second state to legalize physician-assisted suicide through its “Death with Dignity Act” (DWDA). As in Oregon, supporting organizations emphasized the many “safeguards” against abuse and coercion to win voters’ approval. They are now working to eliminate those safeguards, bypassing the voters to lobby our very liberal legislature.

 

Late in 2022, the legislature found that, in hundreds of cases, doctors had been violating the law. The state health department’s annual reports accurately state: “To comply with the act, attending medical providers and pharmacists must file documentation with the department.” Medical providers must submit the following: their own signed form reporting that the patient is terminally ill with a life expectancy of six months or less, is capable of informed decision-making, and is free from coercion or undue influence; a signed form from a second provider, confirming these judgments, and the patient’s own witnessed and signed request for the drugs. Providers who do not comply can be disciplined by the state medical board, and prosecuted for the felony of assisting a suicide.

 

The health department reports that it has never received 309 written requests by the patient, 262 compliance forms from the attending provider, or 304 consulting provider’s forms. Yet it still lists these among cases in which the lethal drugs were dispensed “under the terms of the law.” The department generally knows of these cases only because pharmacists filling the prescriptions do generally submit their forms, identifying provider and patient. But after issuing each annual report the department destroys these forms, shielding providers from scrutiny.[ii]

 

Armed with this deeply troubling information, the legislature in 2023 responded by… weakening and eliminating safeguards against abuse. For example, the 2008 Act required a 15-day waiting period between a patient’s first oral request, and a second oral request that is then committed to writing; the lethal drugs can only be prescribed or provided at least 48 hours after the written request is signed. In 2023 the latter period was eliminated entirely, and the 15 days were reduced to seven.[iii]

 

This year, efforts to “expand” continue. Ten legislators introduced House Bill 1876, to reduce the seven days to zero for some patients. The two oral requests, the written request, the provision of the lethal drugs, and the patient’s death can all take place within minutes of each other, following immediately after an understandably very upsetting terminal diagnosis. The “right to rescind a request,” the only “right” explicitly called this by the DWDA, will remain on the books but will be absolutely meaningless for these patients since time to reconsider will not exist.

 

Experience in Oregon is instructive. Beginning in 2020, it eliminated its 15-day waiting period for patients expected to die before the end of that period. In that first year, 20% of patients obtaining the lethal drugs (75 out of 370) received the exemption. This rose to 21% (81 out of 383) in 2021, 25% (109 out of 431) in 2022, and 28% (154 out of 560) in 2023. In each of these years, the time from the first request to death was either as low as one day or none. And the duration in weeks of the physician-patient relationship was as low as zero in all four years.

 

Now Washington’s HB 1876 would eliminate the waiting period if the attending medical provider (doctor, physician’s assistant, or registered nurse) thinks the patient may die in less than seven days. Of course, such a prediction will be a self-fulfilling prophecy, as it authorizes immediate provision of lethal drugs. These providers can congratulate themselves on excellent predictive skills.

 

But HB 1876 adds two other circumstances when death can be induced immediately. One is that the provider thinks the patient may not retain the ability to “self-administer” the drugs seven days later. Again, that prediction will never be proved wrong if it triggers the drugs’ immediate ingestion; and the bill allows no one (not even the consulting provider who gave the “second opinion” earlier) to question that prognosis.

 

The other circumstance is that the patient is experiencing “irremediable pain or suffering” that “cannot be reasonably managed or significantly alleviated by available treatment.” This last loophole is especially pernicious, for two reasons.

 

First, it is well established that the legalization of physician-assisted suicide is generally followed by a decline in the availability of effective pain control and other palliative care. After Oregon’s law took effect at the end of 1997, for example, the Journal of Palliative Medicine reported: “The frequency of family reports of moderate or severe pain or distress in Oregon decedents increased – from 30.8% in 1996-1997 to 48% in 1999-2002 … represent[ing] the increased suffering of over 5,000 additional decedents and families.”[iv] So the legislature would create a vicious circle: Legalization of assisted death reduces interest in and competence regarding alleviation of pain and suffering; increased suffering is used to justify streamlining assisted death; this expansion in turn leads to more pain and suffering; and so on. The state’s 2023 decision to reduce medical qualifications for those prescribing the drugs will also make optimum palliative care less “available.” More generally, why would an overworked healthcare professional spend the time and trouble to learn the latest advances in palliative care, when the state has helpfully authorized a far easier and quicker “solution”?

 

The other consideration is that “unbearable suffering” has already been used, most egregiously in the Netherlands, to expand assisted suicide and euthanasia far beyond cases of terminal illness, to end the lives of infants born with disabilities, and of seniors who say they are “tired of living.”[v] The kinds of suffering that Washington patients generally cite as reasons for requesting lethal drugs are also experienced by people who, due to illness or accident, find themselves with serious but non-terminal disabilities. In 2023, patients said they were “less able to engage in activities making life enjoyable” (83%); losing “autonomy” (81%); losing “dignity” (57%); and losing “control of bodily functions” (46%). 51% said they are becoming a “burden” on family, friends or caregivers. Present or possible future “inadequate pain control” was a concern to only 41% -- though even this has risen from 25% in 2009, as the law’s priorities take hold of the medical profession.[vi]

 

Such emotional, existential, and spiritual suffering is just as real and unbearable as physical pain and is equally related to the patient’s weakening physical condition. But there is no medical “treatment” for it. It requires encouragement, companionship, and the exploration of possibilities for meaning and enjoyment in one’s new situation. From medical providers dedicated to a quicker death, to whom the patient is a stranger, that kind of assistance will likely be “unavailable.”

 

If such suffering would now qualify as the reason for causing a quick death, it is also in considerable tension with the Act’s original limitation to “terminal” illness and a six-month prognosis. If ending a short life of suffering is good, it is logical to claim that ending a long life of suffering is even better. Once the contradiction between the two standards is eliminated, we will be where the Netherlands is.

 

Thankfully, HB 1876 was vigorously opposed citing concerns like these, most effectively by disability rights advocates, and did not make it out of committee this year. Such proposals will return, here and in other states, proving that the slippery slope is real and warning other states not to step onto it.

 

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[i] R. Doerflinger, “Assisted Suicide: Slippery Slope or Hidden Agenda?”, Sebastian’s Point, 17 February 2022, SP/02/17/22/as-hidden-agenda/Doerflinger | societyofstsebastian.

[ii] R. Doerflinger, “Lethal Non-Compliance with Washington’s ‘Death with Dignity Act’,” On Point Issue 92, Charlotte Lozier Institute, December 20, 2022, at https://www.printfriendly.com/p/g/9MNFaW. The figures reported here update the 2022 article by including new data from 2022 and 2023.

[iii] R. Doerflinger, “‘Access’ Undermining Choice in the Agenda for Assisted Suicide,” Journal of Bioethics in Law & Culture, Vol. 6, Issue 2 (Spring 2023), https://www.societyofstsebastian.org/spring2023-assisted-suicide-doerflinger.

[iv] E. Fromme et al., “Increased Family Reports of Pain or Distress in Dying Oregonians: 1996 to 2002,” Journal of Palliative Medicine  7 (2004): 431-42 at 437, 439, https://dredf.org/wp-content/uploads/2012/08/Oregon_Pall_Care_Study.pdf. Cited with other documentation in R. Doerflinger, “The Effect of Legalizing Assisted Suicide on Palliative Care and Suicide Rates: A Response to Compassion and Choices,” On Point Issue 13, Charlotte Lozier Institute, March 2017, https://lozierinstitute.org/the-effect-of-legalizing-assisted-suicide-on-palliative-care-and-suicide-rates/.

[v] Secretariat of Pro-Life Activities, U.S. Conference of Catholic Bishops, Assisted Suicide and Euthanasia: Beyond Terminal Illness (April 28, 2017), https://www.usccb.org/issues-and-action/human-life-and-dignity/assisted-suicide/to-live-each-day/upload/suicidenonterminal2014edits.pdf.

[vi] Washington State Department of Health, 2023 Death with Dignity (November 2024), https://doh.wa.gov/sites/default/files/2025-01/422-109-DeathWithDignityAct2023.pdf, Table 6.

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