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Washington Death with Dignity Act

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Initiative 1000
Washington Death with Dignity Act
Results
Choice
 Votes %
Yes 1,715,219 57.82%
No 1,251,255 42.18%
Total votes 3,071,587 100.00%
Source: Washington Secretary of State[1]

Initiative 1000 (I-1000) of 2008 established the U.S. state of Washington's Death with Dignity Act (RCW 70.245[2]), which legalizes medical aid in dying with certain restrictions. Passage of this initiative made Washington the second U.S. state to permit some terminally ill patients to determine the time of their own death. The effort was headed by former Governor Booth Gardner.

The measure was approved in the November 4, 2008 general election. 1,715,219 votes (57.82%) were cast in favor, 1,251,255 votes (42.18%) against. There were 2,966,474 votes total.[3] 30 of the state's 39 counties voted in favor of the initiative.[4]

In 1991, the similar initiative 119 was rejected by Washington voters by a margin of 54 percent to 46 percent. I-119 would have allowed doctors to prescribe a lethal dosage of medication, and also to administer it if the terminally ill patient could not self-administer.[5] Unlike that initiative, I-1000 requires the patient to ingest the medication unassisted.[6]

The initiative is based on Oregon Measure 16, which Oregon voters passed in 1994 but was not implemented until 1997. At that time, Oregon was the only other state to have enacted a medical aid in dying law.[7] As of 2026, 13 states and Washington, D.C. have enacted similar legislation.[8]

Specific provisions in the initiative

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The official ballot summary for the measure, slightly amended following a February 2008 court challenge, is, "This measure would permit terminally ill, competent, adult Washington residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician. The measure requires two oral and one written request, two physicians to diagnose the patient and determine the patient is competent, a waiting period, and physician verification of an informed patient decision. Physicians, patients and others acting in good faith compliance would have criminal and civil immunity."[9]

Provisions in the law include:

  • The patient must be an adult (18 or over) resident of the state of Washington
  • The patient must be mentally competent, verified by two health care providers (or referred to a mental health evaluation). While the original language of the Death with Dignity Act required patients to be evaluated by two physicians, the law was amended in 2023 to allow advanced practice registered nurses and physician assistants to serve as a patient's attending and/or consulting provider[10]
  • The patient must be terminally ill with less than 6 months to live, verified by two providers
  • The patient must make voluntary requests, without coercion, verified by two providers
  • The patient must be informed of all other options including palliative and hospice care
  • There is a 7-day waiting period between the first oral request and a written request. Originally a 15-day waiting period, this provision was amended in 2023[11]
  • There was previously a 48-hour waiting period between the written request and the writing of the prescription; this was repealed in 2023[12]
  • The written request must be signed by two independent witnesses, at least one of whom is not related to the patient or employed by the health care facility
  • The patient is encouraged to discuss with family (not required because of confidentiality laws)
  • The patient may change their mind at any time and rescind the request
  • The attending provider may sign the patient's death certificate which must list the underlying terminal disease as the cause of death

Supporters

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The campaign was run by a coalition that includes former Washington governor, Booth Gardner.[13][14] aid-in-dying advocates from Oregon, the Death with Dignity National Center, Compassion & Choices, Compassion & Choices of Washington, Compassion & Choices of Oregon. The name of the official political advocacy group working on the campaign was changed from "It's My Decision" to "YES on 1000".

State Senator Darlene Fairley, who chairs the Death with Dignity Disabilities Caucus, said that "as a matter of personal control and autonomy, it makes sense to let patients themselves decide what kind of medical care they want to receive and how long they want to suffer with a terminal illness."

State Representative Jamie Pedersen, chair of LGBT for 1000, said, "people facing terminal illnesses gain peace of mind from knowing that their end-of-life choices will be respected. Everyone deserves that respect and can appreciate its importance." Organizations that supported I-1000 include the American Medical Student Association, the American Medical Women's Association, the Lifelong AIDS Association, the ACLU, the National Women's Law Center, the Washington Chapter of the National Association of Social Workers, and the Washington State Public Health Association.

The Washington State Psychology Association was neutral on I-1000, but found that "patients choose aid in dying because of a desire for autonomy and the wish to avoid loss of dignity and control, not because of a poor mental state, lack of resources or social support," and "the law has had a positive effect in terms of significant improvements in palliative care."

The Newcastle News endorsed the measure in an October 7, 2008, editorial. "Some opponents of I-1000 will refer to the life-death option as assisted suicide, but this has no resemblance to suicide. It is a humane end to a life that is already ending," the editorial said.[15]

Opposition

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The Coalition Against Assisted Suicide opposed the measure. It included doctors and nurses, disability rights advocates and organizations, hospice workers, minorities, right-to-life organizations, the Catholic Church and other Christian organizations, and politicians.[who?]

The organization held that the danger of making doctors the agents of a patient's death far outweighed any advantages to assisted suicide, or safeguards in the initiative's text. They felt that legalization of assisted suicide would put pressure on minorities, the disabled, and the poor.

Actor Martin Sheen appeared in television ads opposing Initiative 1000.[16] There has been some debate over one of Sheen's statements: persons with depression can be given a lethal dose without prior professional assessment. According to the Washington Death with Dignity act, "Medication to end a patient's life in a humane and dignified manner shall not be prescribed until the person performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment."[17] This issue has been explored in the field of medical ethics.[18]

Results

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Washington Initiative 1000 (Approved)[19]
Choice Votes %
Referendum passed Yes 1,715,219 57.82
No 1,251,255 42.18
Total votes 3,071,587 100.00
Registered voters/turnout 3,630,118 84.61

By county

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County results
County[20] Yes No Margin Total votes
# % # % # %
Adams 2,008 44.35% 2,520 55.65% -512 -11.31% 4,528
Asotin 5,391 55.92% 4,249 44.08% 1,142 11.85% 9,640
Benton 35,493 49.30% 36,499 50.70% -1,006 -1.40% 71,992
Chelan 16,226 51.59% 15,225 48.41% 1,001 3.18% 31,451
Clallam 22,976 60.67% 14,894 39.33% 8,082 21.34% 37,870
Clark 101,043 56.44% 77,975 43.56% 23,068 12.89% 179,018
Columbia 1,172 53.08% 1,036 46.92% 136 6.16% 2,208
Cowlitz 24,675 55.77% 19,573 44.23% 5,102 11.53% 44,248
Douglas 7,231 48.06% 7,816 51.94% -585 -3.89% 15,047
Ferry 1,914 56.01% 1,503 43.99% 411 12.03% 3,417
Franklin 8,329 42.97% 11,054 57.03% -2,725 -14.06% 19,383
Garfield 591 44.04% 751 55.96% -160 -11.92% 1,342
Grant 12,408 45.69% 14,749 54.31% -2,341 -8.62% 27,157
Grays Harbor 17,553 60.52% 11,450 39.48% 6,103 21.04% 29,003
Island 24,338 58.80% 17,052 41.20% 7,286 17.60% 41,390
Jefferson 14,242 72.15% 5,497 27.85% 8,745 44.30% 19,739
King 572,504 64.54% 314,576 35.46% 257,928 29.08% 887,080
Kitsap 71,474 58.17% 51,407 41.83% 20,067 16.33% 122,881
Kittitas 9,834 56.10% 7,695 43.90% 2,139 12.20% 17,529
Klickitat 5,917 59.52% 4,025 40.48% 1,892 19.03% 9,942
Lewis 17,413 50.70% 16,933 49.30% 480 1.40% 34,346
Lincoln 2,828 48.42% 3,013 51.58% -185 -3.17% 5,841
Mason 17,122 61.05% 10,923 38.95% 6,199 22.10% 28,045
Okanogan 9,274 56.20% 7,227 43.80% 2,047 12.41% 16,501
Pacific 6,888 64.12% 3,854 35.88% 3,034 28.24% 10,742
Pend Oreille 3,359 51.80% 3,125 48.20% 234 3.61% 6,484
Pierce 173,531 53.54% 150,571 46.46% 22,960 7.08% 324,102
San Juan 7,742 75.32% 2,537 24.68% 5,205 50.64% 10,279
Skagit 31,636 57.20% 23,670 42.80% 7,966 14.40% 55,306
Skamania 3,354 62.43% 2,018 37.57% 1,336 24.87% 5,372
Snohomish 174,968 55.82% 138,504 44.18% 36,464 11.63% 313,472
Spokane 112,164 51.70% 104,796 48.30% 7,368 3.40% 216,960
Stevens 10,868 49.19% 11,227 50.81% -359 -1.62% 22,095
Thurston 76,939 61.70% 47,752 38.30% 29,187 23.41% 124,691
Wahkiakum 1,410 62.20% 857 37.80% 553 24.39% 2,267
Walla Walla 12,349 50.80% 11,958 49.20% 391 1.61% 24,307
Whatcom 56,354 57.62% 41,452 42.38% 14,902 15.24% 97,806
Whitman 9,664 56.00% 7,593 44.00% 2,071 12.00% 17,257
Yakima 32,037 42.30% 43,699 57.70% -11,662 -15.40% 75,736
Totals 1,715,219 57.82% 1,251,255 42.18% 463,964 15.64% 2,966,474

See also

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References

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  1. ^ "November 6, 2018 General Election Results, Initiative Measure No. 1631 concerns pollution". Secretary of State. State of Washington. 27 November 2018. Archived from the original on 20 February 2019. Retrieved 20 February 2019.
  2. ^ "Chapter 70.245 RCW, The Washington death with dignity act". Washington State Legislature.
  3. ^ "November 4, 2008 General Election". Washington Secretary of State. November 13, 2008. Archived from the original on February 23, 2009. Retrieved November 13, 2008.
  4. ^ "November 4, 2008 General Election". Secretary of State of Washington. Archived from the original on 2009-05-07. Retrieved 2009-03-17.
  5. ^ "Right-to-die initiative making its way to state ballot". The Wenatchee World. July 14, 2008. Archived from the original on February 7, 2009. Retrieved October 8, 2008.
  6. ^ Ostrom, Carol M. (September 21, 2008). "Initiative 1000 would let patients get help ending their lives". The Seattle Times. Archived from the original on September 24, 2008. Retrieved October 8, 2008.
  7. ^ "State of Oregon: Oregon Department of Human Services". www.oregon.gov. Archived from the original on May 10, 2005.
  8. ^ "States Where Medical Aid in Dying is Authorized". Compassion & Choices. Retrieved 21 February 2026.
  9. ^ "Initiative Measure 1000 "The Washington Death with Dignity Act"" (PDF). Secretary of State of Washington. 2008-01-24. Archived (PDF) from the original on 2008-10-09. Retrieved 2008-10-12.
  10. ^ "Engrossed Substitute Senate Bill 5179 (2023)" (PDF). Washington State Legislature. Retrieved 21 February 2026.
  11. ^ "Engrossed Substitute Senate Bill 5179 (2023)" (PDF). Washington State Legislature. Retrieved 21 February 2026.
  12. ^ "Engrossed Substitute Senate Bill 5179 (2023)" (PDF). Washington State Legislature. Retrieved 21 February 2026.
  13. ^ The Times, Editor (2008-01-17). "My life does not belong to the state or the church". Seattle Times. Archived from the original on 2009-02-07. Retrieved 2008-10-20. {{cite news}}: |first= has generic name (help)
  14. ^ The Daily News, Editor (2008-01-22). "Gardner revives discussion about assisted suicide". Longview, Washington: The Daily News. {{cite news}}: |first= has generic name (help)
  15. ^ Newcastle News, Editor (2008-10-07). "Death with Dignity initiative promotes a humane choice". Newcastle, Washington: Newcastle News. Archived from the original on 2008-12-28. Retrieved 2008-10-20. {{cite news}}: |first= has generic name (help)
  16. ^ "Martin Sheen to appear in ads against I-1000". Yakima Herald. September 29, 2008. Retrieved October 9, 2008.{{cite news}}: CS1 maint: deprecated archival service (link)
  17. ^ "Washington Death with Dignity Act, Page 4, Section 6" (PDF). Archived (PDF) from the original on 2010-07-06. Retrieved 2010-07-07.
  18. ^ A Rudnick (2002). "Depression and competence to refuse psychiatric treatment". Journal of Medical Ethics. 28 (3): 151–155. doi:10.1136/jme.28.3.151. PMC 1733573. PMID 12042398.
  19. ^ Reed, Sam (November 4, 2008). "Initiative Measure 1000 concerns allowing certain terminally ill competent adults to obtain lethal prescriptions". Secretary of State of Washington. Archived from the original on April 4, 2025. Retrieved November 16, 2025.
  20. ^ Reed, Sam (November 4, 2008). "Initiative Measure 1000 concerns allowing certain terminally ill competent adults to obtain lethal prescriptions - County Results". Secretary of State of Washington. Archived from the original on September 13, 2025. Retrieved November 16, 2025.
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In support

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In opposition

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Further reading

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