According to the "2018 Death With Dignity Act Report," issued last month by the Washington State Department of Health, 203 residents committed suicide with the help of a doctor in 2018 — an increase of 25% over 2017, and more than five-and-a-half times the figure for 2009, the year Washington's Death with Dignity Act went into effect.
In 2018, a total of 267 patients requested and were prescribed lethal medication, 86% of whom lived west of the Cascades. Of the recipients, 203 are known to have died after ingesting the drug cocktail. Of the remaining 64 patients, 29 died without taking the medication, while the ingestion status of 19 is listed as "unknown."
Washington has long been a proving ground for the right-to-die movement. In 1991, local lobbyists succeeded in getting the Washington Physician-Assisted Death Initiative (Initiative 119) onto the ballot, making the Evergreen State the first in the nation to decide the issue by popular vote. The measure failed to pass, with 54% of the electorate voting against it.
But by 2008, public opinion had shifted. After more than a decade and a half of campaigning, right-to-die activists introduced the state's Death with Dignity Act to state voters. On Nov. 4, 2008, the measure was approved, with 58% of the electorate backing it.
With that, Washington became the second state to legalize assisted suicide. Since 1997, a total of nine U.S. states — California, Colorado, Hawaii, Maine, Montana (by court order), New Jersey, Oregon, Vermont and Washington — as well as the District of Columbia have legalized assisted suicide.
In the first few years after legalization, two powerful sedatives — pentobarbital and secobarbital (Seconal) — were typically prescribed to patients intent on killing themselves.
But in 2010, pharmaceutical companies began restricting access to pentobarbital, owing to unease over the drug's use as a lethal injection agent in the United States.
Then in 2015, secobarbital manufacturer Valeant Pharmaceuticals raised the price of the drug beyond the capacity of most Americans to pay for it.
In response, doctors in Washington began experimenting with a new breed of lethal cocktails. As documented by The Atlantic, grisly consequences sometimes followed:
[A]n advocacy organization called End of Life Washington briefly advised prescribing a drug mixture with the sedative chloral hydrate to about 70 patients. "We know this is going to put you to sleep, and we're pretty sure it's going to kill you," Robert Wood, a medical director at the organization, says they told the patients. It worked, but with a tragic catch: In a few cases, the chloral hydrate burned people's throats, causing severe pain just at the time they expected relief.
A 2017 Seattle Times article detailed the ramifications further:
The first Seconal alternative turned out to be too harsh, burning patients' mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case. "[Twenty percent] of the cases were three hours or more before death, which we think is too long," said Robert Wood, a retired HIV/AIDS researcher who volunteers with the advocacy group End of Life Washington, in an email. "The longest was 31 hours, the next longest 29 hours, the third longest 16 hours and some eight hours in length."
The Washington data mirror those of Oregon, which show a steady increase in assisted suicide deaths. Since the procedure was legalized in 1997, nearly 1,500 Oregonians have killed themselves with help from their doctor.