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Compassion in Dying, Issue 3

Compassion in Dying is a nonprofit organization created to support the right of terminally ill patients to choose to die without pain, without suffering, and with personal assistance, if necessary, to intentionally hasten death.


  1. Progress Is Underway for Terminally Ill Patients in Washington and New York States
  2. Director's Report
  3. Surviving Family Members as Friends of the Court
  4. Guidelines and Safeguards for Intentionally Hastened Death

Progress Is Underway for Terminally Ill Patients in Washington and New York States

The decision in Compassion et. al. vs. Washington on May 3 was a major victory for the cause of death with dignity. Plaintiffs consisting of Compassion in Dying, three terminally ill patients, and four physicians had filed a lawsuit challenging the constitutionality of the Washington State law on assisted suicide, as it applies to mentally competent terminally ill adult patients seeking to hasten their deaths.

The plaintiffs were represented by Kathryn Tucker of Perkins Coie, one of the most prestigious law firms in the Pacific Northwest. The ACLU of Washington filed an Amicus brief on behalf of the Northwest AIDS Foundation, the Seattle AIDS Support Group, Gray Panthers of Seattle, Older Women's League, the Hemlock Society of Washington State, the Seattle chapter of the National Organization of Women, Humanists of Washington, Temple DeHirsch Sinai, the Seattle chapter of the National Lawyers Guild, Local Six of the Service Employees International Union, and the Northwest Women's Law Center.

Judge Barbara Rothstein's decision elated those who believe in patient choice. In overturning the state statute, she declared:

"The liberty interest protected by the Fourteenth Amendment is the freedom to make choices according to one's individual conscience about those matters which are essential to a personal autonomy and basic human dignity. There is no more profoundly personal decision, nor one which is closer to the heart of personal liberty, than the choice which a terminally ill person makes to end his or her suffering and hasten an inevitable death.

From a constitutional perspective, the court does not believe that a distinction can be drawn between refusing life-sustaining medical treatment and physician-assisted suicide by an uncoerced, mentally competent, terminally ill adult."

The Rothstein decision has been appealed by Washington State to the Ninth Circuit Court of Appeals in San Francisco. The party losing at the Circuit Court will likely seek review in the U. S. Supreme Court.

On July 19, a similar case, Quill et. al. vs. Koppell, was filed challenging the comparable laws in the State of New York. Compassion has accepted responsibility for costs of the litigation, and Kathryn Tucker of Perkins Coie, with assistance of local counsel at a New York firm, is representing us.

Director's Report

What are my rights in determining how I choose to die?
How can I know that my wishes will be followed?
If I do become terminally ill, what can I do to avoid unnecessary suffering?

These are the three most frequent questions on people's minds when they think about a serious illness which might result in death.

Almost all states today provide for a Living Will or Directive to Physicians. These are the documents filled out in advance which instruct doctors to discontinue artificial life supports in terminal illness where life cannot be saved. All states also permit appointment of a Health Care Proxy or person with Health Care Power of Attorney to make decisions about continuing or ending treatment.

Samples of whatever documents apply should be available from every hospital and nursing home, as well as state medical associations and departments of health.

Signing these forms and having a copy on file with one's physician is the first step to communicate that we expect our wishes to be honored. We must insist that a signed copy of our Living Will be included in our medical record in the doctor's office, with another copy available in the event of hospitalization.

It is very important to have several serious conversations with our primary physician about our personal beliefs in regard to the end of life. Our physicians should know that our views are deeply held and consistent over time. They must also be willing to concur with our legally expressed desires to refuse treatment.

Increasingly, terminal patients want control over the timing of death, and if our physician will not prescribe strong sleeping aids such as secobarbital to have if needed, we may need to find a new physician willing to help us gradually build up a supply of medications.

The majority of terminally ill patients can experience a relatively comfortable death without extreme pain and without mental or spiritual degradation. Unfortunately, we see many cases of prolonged suffering where people have not planned in advance. We should all see that our questions are answered and take the steps necessary to assure that we will have the option of a dignified end to our days. This contributes greatly to a fuller and more productive life.

--Ralph Mero

Surviving Family Members as Friends of the Court

Ten surviving family members provided written testimony in support of Compassion's case in the U.S. Court of Appeals for the Ninth Circuit. Their stories express horror at having seen loved ones die in torment and suffering. Some of these patients had been promised help in dying by their doctors only to be refused when the end was near. Family members related the following expressions of anguish and helplessness:

". . .my 80-year-old father was diagnosed as having terminal abdominal cancer. He went to his doctor with two requests: not to prolong things, and to keep him as pain free as possible. His doctor agreed. However when the time came, the doctor did neither. And so my father, to whom dignity was very important, lay dying, diapered, moaning in pain, begging to die. I called the doctor's office, crying, begging him to relieve Dad's pain. He refused, saying morphine could kill him."

"Daniel's biggest fear was that of losing his mind. He wanted to die before he lost his mind. Daniel had reached the final stages of AIDS. He sought help from the medical community but didn't receive any. So when he felt his mind was leaving him, he opted for a unique solution . . .withholding his insulin and letting himself die of insulin shock. It was a very long five days of convulsions, dementia, violent outbreaks, and a total loss of self-dignity."

We have received hundreds of letters from desperate people such as these. As one who provided a statement for this Amicus Brief wrote,

"(Daniel) might have been spared some of his greatest pain and retained his dignity if he and his physician had received help from a compassionate code of laws."

Guidelines and Safeguards for Intentionally Hastened Death


  • Eligibility is limited to adult, mentally competent patients who are terminally ill.
  • Patient's condition must cause severe, intolerable suffering.
  • Patient must understand condition, prognosis, and alternatives.
  • Independent physician must examine patient, review records, and consult with primary care physician to verify eligibility.

Quality of care

  • Request for hastened death must not result from inadequate comfort care.
  • Request must not be motivated by economic concerns or lack of health insurance.

Process of requesting assistance

  • Request must originate with the patient.
  • All requests will be kept confidential.
  • Any indication of uncertainty cancels the process.
  • Requests cannot be made through advance directives.

Mental health considerations

  • Professional evaluation may be required to rule out emotional distress.
  • Patient must understand and take responsibility for the decision.

Family and religious considerations

  • Family must give its approval.
  • Spiritual or emotional counseling may be arranged.


  • Patient must provide three signed written requests.
  • There must be a 48-hour waiting period between second and third requests.
  • Compassion representatives meet in person with patient and family.
  • Terminal prognosis and patient's decision-making capacity are verified by an independent physician.
  • Physician may call for evaluation by a qualified mental health professional.
  • Physician ascertains that request for assistance does not result from inadequate care or pain management.
  • Any sign of indecision on the part of the patient, or opposition by the immediate family, cancels the process.
  • Lead contact person is appointed as part of the team to review case and alternatives.
  • Review team meets regularly to confirm eligibility and if assistance is warranted.
  • The patient may request that Compassion be present at the time of death.
  • Actual means of hastening death is prescribed by patient's physician and varies according to underlying condition.
  • If requested, ongoing emotional support will be provided for survivors.
  • To maintain dignity, patient's identity will not be disclosed.

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This article was provided by Compassion in Dying.