Abstract
Decision making as the end of life nears is of crucial importance for both patients and professionals and, in the USA, ethical-legal frameworks have been created to facilitate patient choices. The "Living Wills", and "Physician Orders for Life-Sustaining Treatment" are documents intended to assist patients in EOL decision making. The most prominent ethical principle behind these documents is respect for the "personal autonomy" of patients. This strong desire for "autonomy" has led citizens, first in Oregon and most recently (November, 2008) in Washington State to pass legislation entitled the "Death with Dignity Act." This framework moves beyond the former right of patients to withhold or to stop unwanted life support to a more aggressive right for patients expected to die within six months to request a lethal prescription that enables them to end their lives by self-administering the medication. This author interviewed health care professionals at the University of Washington in the fields of medicine, nursing, ethics, law and spiritual care to gain an understanding of this context. It appears that since the passage of Oregon's law, in 1998, there have been significant improvements in palliative care for dying patients in both states. Thus, Washington's Death with Dignity Act seems to reflect the strong desire of some, to control the timing and circumstances of their death, a factor more prominent than pain control and symptom management.
