2021 Death
with Dignity
Act Report
July 15, 2022
Chapter 70.245 RCW
Disease Control & Health Statistics
Center for Health Statistics
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Publication Number
DOH 422-109
For more information or additional copies of this report:
Disease Control and Health Statistics
Center for Health Statistics
PO Box 47814
Tumwater, WA 98504
Phone: 360-236-4324
Fax: 360-753-4135
Email: CHS.Dat[email protected]
Published by:
Washington Department of Health
Disease Control and Health Statistics
Center for Health Statistics
Umair Shah, MD
Secretary of Health
Contents
Executive Summary ......................................................................................................................... 1
Overview of Death with Dignity Act ............................................................................................... 2
Death with Dignity Act Participation Data ...................................................................................... 3
Participation Over Time .......................................................................................................... 3
Participation Demographics .................................................................................................... 4
Participation by County ........................................................................................................... 6
Underlying Illness .................................................................................................................... 6
End of Life Concerns................................................................................................................ 7
Lethal Medication and Timing ................................................................................................ 8
Participant Outcomes ........................................................................................................... 10
Participant Documentation ................................................................................................... 11
Appendix A .................................................................................................................................... 11
Role of Department of Health (DOH) in monitoring compliance ......................................... 11
Confidentiality ....................................................................................................................... 12
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |1
Executive Summary
Washington State’s Death with Dignity Act allows adult residents in the state with six months or
less to live to request lethal doses of medication from a physician. This report provides
information about people who participated in the program between January 1, 2021, and
December 31, 2021. The data in this report comes from documentation that the Washington
State Department of Health (DOH) received as of May 26, 2022.
In this report, a participant is defined as someone who was dispensed medication under the
terms of the law (see Appendix A).
A total of 400 individuals were dispensed the medication in 2021.
• 186 different physicians prescribed the medication.
• 62 different pharmacists dispensed the medication.
DOH received death certificates for 387 participants and After Death Reporting Forms for 348
participants.
• 387 participants are known to have died.
o 291 died after taking the medication.
o 44 died without having taken the medication.
o For the remaining participants, it is unknown if they took the medication before
dying.
Out of the 291 that died after taking the medication:
• 91% were enrolled in hospice care when they took the medication.
• 95% had some form of health insurance.
• 88% died at home or in a private residence.
Demographics of participants (as shown in death certificates, 387 participants):
• The average age of participants was 75 years.
• 92% of participants were White, and 5% were Asian.
• 88% of participants lived west of the Cascade Mountains
1
.
1
Based on death certificate information. Counties west of the Cascades: Clallam, Clark, Cowlitz, Grays Harbor,
Island, Jefferson, King, Kitsap, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Skamania, Snohomish, Thurston,
Wahkiakum, and Whatcom.
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |2
Overview of Death with Dignity Act
The Washington State Death with Dignity Act, chapter 70.245 RCW, was passed by voter
initiative on November 4, 2008, and became law on March 5, 2009. The law allows terminally ill
adults seeking to end their lives in a humane and dignified manner to request lethal doses of
medication from medical and osteopathic physicians. These terminally ill patients must be
Washington residents who have an estimated six months (180 days) or less to live. More
information on the Death with Dignity Act is available on the Department of Health website
(http://www.doh.wa.gov/dwda/).
The Department of Health (DOH) defines a program participant as someone who was dispensed
medication under the terms of the law. DOH identified program participants based on one of
the following types of documentation:
• A valid prescription date for the lethal medication on the Pharmacy Dispensing Form
(used before 2019).
• A valid prescription date on either the Attending Physician’s Compliance Form or the
After Death Reporting Form.
• An After Death Reporting Form showing they took the lethal medication and a death
certificate.
Under the Death with Dignity Act, the Department of Health collects information from
healthcare providers, reviews this information for compliance with reporting requirements,
contacts the healthcare provider if the information is incomplete or inadequate, and produces
this annual statistical report.
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |3
Death with Dignity Act Participation Data
Participation Over Time
Figure 1 shows the known number of participants and deaths for 2009 through 2021, as of May
26, 2022. The status of the remaining participants in prior years is still unknown. These
participants may have died, but DOH has not received documentation of the deaths.
Figure 1: Number of Death with Dignity participants and known deaths, 2009-2021
2
2
Participants prior to 2019 were counted based on receipt of the pharmacy dispensing form. Deaths prior to 2019
were counted based on registered death certificates. The dotted line represents a change in inclusion criteria.
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |4
Participation Demographics
Table 1: Death with Dignity Act Participation, 2021
3
Based on death certificate information.
4
Based on death certificate information.
5
Based on death certificate information.
6
Data represented with a “<” is suppressed to protect participant confidentiality.
7
Based on death certificate information.
Participant Characteristic
Number
Percent (%)
Sex
3
Male
214
55.0
Female
173
45.0
Total
387
100.0
Age (years)
4
18-54
23
6.0
55-64
52
13.0
65-74
118
30.0
75-84
106
27.0
85+
88
23.0
Total
387
100.0
Marital Status
5
Married
189
49.0
Divorced
85
22.0
Widowed
81
21.0
Never married
<50
6
<10.0
Other/unknown
<10
<5.0
Total
387
100.0
Education
7
Some College/College Degree
300
77.5
Some High School/High School
Degree
85
22.0
Other/Unknown
2
0.5
Total
387
100.0
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |5
8
Based on death certificate information.
9
Counties west of the Cascades: Clallam, Clark, Cowlitz, Grays Harbor, Island, Jefferson, King, Kitsap, Lewis, Mason,
Pacific, Pierce, San Juan, Skagit, Skamania, Snohomish, Thurston, Wahkiakum, and Whatcom.
10
Counties east of the Cascades: Adams, Asotin, Benton, Chelan, Columbia, Douglas, Ferry, Franklin, Garfield,
Grant, Kittitas, Klickitat, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens, Walla Walla, Whitman, and Yakima.
11
Data are collected from After Death Reporting Forms.
12
Based on death certificate information.
Participant Characteristic
Number
Percent (%)
Residence
8
West of Cascades
9
341
88.0
East of Cascades
10
46
12.0
Total
387
100.0
Insurance Status
11
Insured
330
95.0
Uninsured
18
5.0
Total
348
100.0
Race
12
White
358
92.0
Asian
19
5.0
Other
10
3.0
Total
387
100.0
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |6
Participation by County
Figure 2: Participation by county, 2021
Underlying Illness
Table 1: Death with Dignity Act participants' underlying illness(es), 2021
Illness Reported
13
Number
Percent (%)
Cancer
267
73.2
Heart and/or vascular disease
31
8.5
Neurodegenerative
30
8.2
Respiratory disease
29
7.9
Other illness(es) only
8
2.2
Total
14
365
--
13
Data are collected from the Attending Physician Compliance Form. Please note that a patient may have multiple
diagnoses, so illnesses are not necessarily mutually exclusive. “Other illness only” indicates that a diagnosis was
reported without an obvious diagnosis of a cancer, respiratory disease, cardiac disease, or neurodegenerative
condition.
14
More than one illness may be reported. Total illnesses therefore can exceed the total number of participants.
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |7
End of Life Concerns
Table 2: End of life concerns of participants who died, 2021
End of Life Concerns
15
Number
Percent (%)
Less able to engage in activities making life
enjoyable
293 85.0
Loss of autonomy
295 85.0
Loss of control of bodily functions
172 50.0
Burden on family, friends, or caregivers
194 56.0
Loss of dignity
251 73.0
Financial implications of treatment
<10
16
<5.0
Inadequate pain control or concerns about
pain control
160 46.0
Total
17
348 --
15
Data are collected from the After Death Reporting Form.
16
Data represented with a “<” is suppressed to protect participant confidentiality.
17
Participants may report more than one concern. Total concerns therefore can exceed the total number of
participants.
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |8
Lethal Medication and Timing
Table 3: Lethal Medication and Timing, 2021
Number
Percent (%)
Time between first oral request and death
18
0-14 days <10
19
<5.0
15-30 days 126 36.0
31-60 days 97 28.0
61-90 days 28 8.0
91-120 days 17 5.0
More than 120 days 67 19.0
Not Known <10 <5.0
Total 346 100.0
Time between ingestion and loss of
consciousness
20
0 to 5 minutes 139 48.0
6 to 10 minutes 65 22.0
10 to 20 minutes <50 <10.0
More than 20 minutes <10 <5.0
Not known 55 19.0
Total 291 100.0
18
Based on Pharmacy Dispensing Report
19
Data represented with a “<” is suppressed to protect participant confidentiality.
20
Based on After Death Reporting Form
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |10
Participant Outcomes
Figure 3: Outcome of Death with Dignity Act participants, 2021
21
21
Death of a participant is established when DOH receives the After Death Reporting Form or a registered death
certificate.
387 participants died
347 after death
reports received
40 participants without
after death report
291 took
lethal
medication
44 did not
take lethal
medication
13 unknown
400 participants
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |11
Participant Documentation
Table 5 shows the documentation that DOH received for Death with Dignity participants as of
May 26, 2022. DOH has not yet received all documentation for 2021 participants.
Table 5: Documentation Received for 2021 Participants
Form
Number
Written Request to End Life Form
354
Attending Physician Compliance Form
365
Consulting Physician Compliance Form
353
Psychiatric Evaluation From
<10
Pharmacy Dispensing Form
380
After Death Reporting Form
348
Death Certificate
387
Total Participants
400
Appendix A
Role of Department of Health (DOH) in monitoring compliance
To comply with the act, attending physicians and pharmacists must file documentation with
DOH. Two independent physicians (an attending physician and a consulting physician) must
confirm patient eligibility. Within 30 days of writing a prescription for medication under this act,
the attending physician must file the following forms with DOH:
• Written Request for Medication to End Life Form (completed by the patient)
• Attending Physician Compliance Form (completed by the attending physician)
• Consulting Physician Compliance Form (completed by the consulting physician)
A psychiatric or psychological evaluation is not required under the terms of the law. However, if
the attending or consulting physician requests an evaluation, the psychiatrist or psychologist
must complete a Psychiatric/Psychological Consultant Compliance Form and the attending
physician must file this form within 30 days of writing the prescription.
WASHINGTON STATE DEPARTMENT OF HEALTH
2021 Death with Dignity Act Report |12
If the attending or consulting physician (or the psychiatrist or psychologist, if a referral is made)
determines that a patient does not meet the qualifications to receive a prescription for
medication under chapter 70.245 RCW, no forms must be submitted to DOH.
Within 30 days of dispensing medication, the dispensing pharmacist must file a Pharmacy
Dispensing Record Form.
Within 30 days of a qualified patient’s death from taking a lethal dose of medication obtained
under the act, or death from any cause, the attending physician must file an Attending
Physician After Death Reporting Form.
To receive the immunity protection provided by chapter 70.245 RCW, physicians and
pharmacists must make a good faith effort to file required documentation in a complete and
timely manner.
DOH staff contact health care providers for documentation when all required paperwork is not
submitted.
Confidentiality
The Death with Dignity Act requires that DOH collect information and make an annual statistical
report available to the public (RCW 70.245.150). The law also states that, except as otherwise
required by law, the information collected is not a public record. That means it is not subject to
public disclosure. To comply with that statutory mandate, DOH will not disclose any
information that identifies patients, physicians, pharmacists, witnesses, or other participants in
activities covered by the Death with Dignity Act.
The information presented in this report is subject to the Department of Health Agency
Standards for Reporting Data with Small Numbers.
22
Small numbers can potentially lead to
participant identification. DOH suppresses some data fields to protect confidentiality.
22
https://www.doh.wa.gov/Portals/1/Documents/1500/SmallNumbers.pdf
