OLYMPIA, Wash. — Since the enactment of physician-assisted suicide in Washington last March, confusion has arisen over statistics, the interaction between government agencies and assisted suicide organizations and the role of medicine.

Non-governmental organizations seem to be taking over as “handlers” of the message and statistics — and as self-appointed hand-holders of those about to die. The question remains as to whether anyone in an official government capacity is looking out for potential abuses to the elderly and sick or watching for misrepresentation of the facts.

Since the state’s Death With Dignity Act went into effect, pharmacies have reported giving life-ending drugs to 32 patients, according to the Washington State Department of Health. The department received 19 reports of deaths as of Sept. 24 among those who had requested drugs.

Christie Spice, registrar and director for health statistics for the state, said the attending physician has 30 days to submit an attending physician’s after-death reporting form.

“The stats we publish on our website reflect the current number of forms the department has received,” she said. An annual report will go into more details about how many of these deaths were actually caused by taking prescription drugs to end lives.

The health department site, which is updated weekly, listed 30 attending physicians’ forms turned in, 32 forms from consulting physicians, as well as consultation forms sent by psychiatrists or psychologists for three patients, when the Register went to press.

At a press conference held at the beginning of September, Robb Miller, executive director of Compassion & Choices of Washington, reported that according to their records, 14 people have actually died from assisted suicide, while another four people “who had requested the medications but elected not to take them” died of natural causes.

When asked if there existed any working relationship between the state office and Compassion & Choices, Donn Moyer, media relations manager with the Department of Health, said: “We’re not going to be able to explain what an advocacy group says or does. We’re not connected to that group (Compassion & Choices) and, to my knowledge, don’t know anything about their clients or tracking methods.”

Presently, Compassion & Choices of Washington has 58 clients, according to Miller. “Some of those do not intend to use the (Death With Dignity Act), but of those who do intend to, 10 presently have the medications,” he explained. He added that his organization has given support and information to more than 2,000 patients, families, physicians, pharmacists and other medical professionals.

‘A Tragedy’

Compassion & Choices supplies a “support volunteer” to be present at each death. Recalling those who died, Miller stated that “none of these clients died alone, all have died at home, and all were receiving hospice care.”

Hospice nurse Eileen Geller, president of True Compassion Advocates, said recently that “all of Washington’s assisted-suicide deaths are a tragedy.” She emphasized that although “29 vulnerable ill people have requested lethal, life-ending drugs, thousands of other Washingtonians have received the message that they, too, are expendable.”

She added that, in light of the present health-care debate, and Washington’s own “draconian health-care cuts, this news is especially disturbing.” As far as the accuracy of either the health department statistics or Compassion & Choices’ numbers, she believes that with the way the law is written, the true statistics of those dying from assisted suicide may never be known.

In response to Miller’s remarks that all Compassion & Choices clients have been under hospice care, Geller says that this reality has taken a toll on those in hospice work.

Hospice workers “are suffering from a complicated grief, experiencing severe emotional and spiritual distress, caused by the trauma of being forced to participate in the legalized medical suicide of vulnerable, ill, and possibly depressed, patients.

“Nurses, pharmacists, physicians, and health-care professionals across the state are worried that they, too, will be forced to stand by as ‘suicide-support volunteers,’ provided by Compassion & Choices, assist in legally sanctioned medical suicides of their ill and vulnerable patients.”

She was not optimistic for the future, saying: “In Oregon, where assisted suicide is also legal, the per-year rate of physician-assisted suicide actually tripled over the first 10 years and is continuing to trend upward. At the same time, Oregon’s senior suicide rate has increased steadily. The state now has one of the highest rates of senior citizen suicides in the country.”

With increasing frequency, in fact, it has been reported that patients in Washington state, with mild or moderate illness, are refusing even basic treatment so they can meet the loosely defined criteria contained in the Death With Dignity Act — which states a patient must have six months or less to live (with or without treatment). This would then allow them to get a lethal prescription. Hospices have received phone calls from representatives of Compassion & Choices trying to pressure them to accept nonterminal patients in order to qualify people as “hospice appropriate” so they can take a legally prescribed drug overdose.

Trying to find trustworthy medical practitioners and medical institutions is becoming increasingly difficult, as well. Even hospitals, which officially “opted out” of participating in physician-assisted suicide, are becoming unwilling, and possibly unknowing, participants through those who practice medicine in their facilities.

In a recent article in the online American Thinker, Rita Marker, executive director of the International Task Force on Euthanasia and Assisted Suicide, writes about an incident at a training session in Mount Vernon, Wash. It is a regularly scheduled event for law enforcement officers who deal with crisis and hostage negotiating.

Marker reported in “Dial 911 for Assisted Suicide?” that at the event social worker Amber Ford, who works for a local hospital’s oncology department, discussed the suicide risk among cancer patients. “Ford explained that assisted suicide, like hospice care, was among the alternatives available to cancer patients” and proceeded to pass out brochures on the services provided by Compassion & Choices. Her employer, Skagit Valley Hospital, was among medical centers around the state that had announced it would not be participating in physician-assisted suicide.

According to Marker, if hospital staff are involved in assisted-suicide cases, but are doing so off the premises, technically the hospital is not breaking the law, and maintains its “opted out” status.

Philip Nitschke

But Compassion & Choices may not be the only organization providing its services to the elderly, sick and handicapped.

Exit International, founded by the Australian euthanasia advocate and physician Philip Nitschke, has suggested a possible move to the city of Bellingham, hoping to establish a U.S. branch of the organization.

Bellingham is near the border with British Columbia. As the Canadian Parliament debates legalizing assisted suicide, Exit International may be hoping to “kill two birds with one stone.”

“Bellingham had several advantages,” Nitschke explained in a recent e-mail. “It is close to Canada, particularly Vancouver, where we have a number of members.”

He noted that Washington legislation “is helpful to us and has not limited the interest and questions coming in to Exit from people in this state.”

This is in stark contrast to reactions to his activities in England, Australia and Canada, where authorities have attempted to prevent the spread of his message and death devices, most recently banning an Exit International event at a library in Vancouver, B.C.

The Australian physician remains undeterred, stating that his organization has found that: “As the population ages, [many] people are interested in developing their own personal end-of-life plans ‘in case things go bad.’” He referred to these interested individuals as the “well elderly” who have become “our core activity.”

He stated that the organization’s long-term plans “depend on the reaction and interest of our upcoming Exit U.S./Canada tour.” Although a scheduled stop in Bellingham has been canceled, he said, “We hope to put things in place for a U.S./Canadian gathering for 2010, to [work on] reliable end-of-life options,” referring to this initiative as “ExiTech.”

Alex Schadenberg, executive director of Canada’s Euthanasia Prevention Coalition, who also serves as chairman of the Euthanasia Prevention Coalition International, recently expressed his concern about the “social consequences related to Philip Nitschke actively campaigning in the United States and possibly Canada.”

He said that Nitschke has successfully moved “the pendulum of social acceptance by moving public opinion on [who accesses] assisted suicide [to include] people who are either tired of living or those not terminally ill but experiencing a loss of abilities.” In the eyes of the general public, this will turn mainstream euthanasia lobbying into a socially acceptable position, Schadenberg feared.

He explained that Nitschke has not really been very successful in Australia because “the Australian government has rejected his antics, placing barriers around his suicide counseling, his distribution of materials, and his promotion of his so-called ‘peaceful pill’” used for committing suicide.

The Australian physician has promoted various “self-deliverance” devices, including the “exit bag” (a plastic bag with drawstring), and the COGenie (a machine incorporating a face mask and supply of carbon monoxide gas). He is now pushing the use of Nembutal, a drug used by veterinarians to euthanize ailing animals.

Nitschke believes that assisted-suicide devices and drugs “should be available for anyone, including troubled teens,” Schadenberg stated. “Hopefully, the Washington state authorities will also keep a close eye on his operation and shut him down when vulnerable, depressed people are victimized by his philosophy.”

Elenor Schoen writes from

Shoreline, Washington.