If a proposed merger between Virginia Mason Health System and CHI Franciscan goes through, services provided through the Death with Dignity Act — already limited in Eastern Washington — would become harder to access, advocates say.
The act, which became law in 2009, allows terminally ill adults with less than six months to live to access medication to end their lives in Washington. It isn’t used frequently, with about 250 deaths under the act in 2018, according to a report from the state Department of Health.
Having that legal option, though, is invaluable to some dying people who see it as a way to end their life in a humane and dignified manner.
The nonprofit Virginia Mason Health System and CHI Franciscan — which is part of CommonSpirit Health, the largest Catholic health system in the United States — announced in July they had signed a memorandum of understanding to explore combining through a joint operating company. CHI Franciscan is a Catholic nonprofit health system that operates 10 hospitals in Washington.
In Yakima, Virginia Mason Memorial affiliated with the Virginia Mason Health System in 2016. Because Memorial is part of the Virginia Mason system, negotiators intend for Yakima’s only hospital to be part of the joint operating agreement.
During an Aug. 10 virtual discussion broadcast on the State of Reform website, Virginia Mason Chairman and CEO Gary Kaplan said he does not anticipate that the health system will continue to offer abortions or Death with Dignity services under the potential merger. While Virginia Mason would remain a non-Catholic institution, Kaplan said, the health system would not want to cause CHI Franciscan to be out of compliance with the Ethical and Religious Directives for Catholic Health Care Services.
Known as ERDs, the directives limit some end-of-life and reproductive health care services. Kaplan said he expects to continue offering a full range of palliative services, which include sedation and other end-of-life approaches.
The changes would take effect once the merger happens.
Services limited
Like many hospitals in states that allow physician-assisted death, Virginia Mason Memorial and Astria Sunnyside hospitals have statements saying they will not participate in the Death with Dignity Act. Health care leaders say hospitals aren’t the setting for Death with Dignity services, so discussions often happen between patients and physicians .
If the Virginia Mason-CHI Franciscan merger happens, from that point on, the only guidance employees could offer would be handing out a printed source of information, if that, said Judy Kinney, executive director of End of Life Washington. At that point, “The physician-patient relationship is really limited and interrupted,” after often lengthy planning.
“Imagine working with your primary physician for years and you have on the books that if I contract a terminal illness and have six months or less to live, I want to access Death with Dignity,” Kinney said. “You get to this point and all your doctor can say is, ‘Here’s a brochure. Good luck.’”
Along with Washington and the District of Columbia, states that allow physician-assisted deaths are California, Colorado, Hawaii, Maine, New Jersey, Oregon and Vermont. Physician-assisted dying has been legal by virtue of a state supreme court ruling in Montana since 2009, according to the Portland, Ore.-based Death with Dignity National Center, though there is no statute affirming the option.
Complicated process
Pursuing physician-aided death isn’t easy, and the Death with Dignity Act requires the patient and the patient’s family to follow several steps. The process involves completing multiple forms by the patient and two doctors, known as attending and consulting physicians. The pharmacy dispensing the medication must also complete a form within 30 days of filling the prescription.
Pursuing Death with Dignity involves research and planning. It starts with talking to a health care provider or contacting an end-of-life resource such as End of Life Washington. Volunteers with the nonprofit support patients and their families and physicians who participate.
Finding physicians and pharmacies who participate is challenging, especially in Eastern Washington. Data in the annual Death with Dignity reports shows the difference between Western Washington and the rest of the state. Of the 2018 participants, 86% lived west of the Cascades.
“As it stands, we have to find those physicians ... for 30% of our clients though there’s a law in place and implemented for 11½ years now,” Kinney said. “It’s already hard to get through the process when someone is dying. It’s already hard to find physicians who will support their patients in this moment.”
If the Virginia Mason-CHI Franciscan merger happens, “over 50% of Washington medical institutions will have religious restrictions,” she added, which will increase the challenge of finding physicians and pharmacies.
“How hard does it have to be for someone to access a law that’s in place? It’s completely unreasonable,” Kinney said.
It appears fewer people in Central and Eastern Washington know Death with Dignity is legal and available, along with the added challenge of finding providers beyond Western Washington, said Linda Estes of West Richland, a Death with Dignity advocate.
“I’ve had several people say, ‘We have it? I thought I had to move to Oregon to have it,’” Estes said. “I think it just needs to come out into the light. When people have to run around and try to find a doctor, it feels like a back-alley abortion.
“It feels like you’re doing a drug deal — and it’s completely legal.”
Estes’ father, Phillip Estes, was diagnosed with cancer and underwent multiple treatments. But the cancer grew, there was no hope of recovery and he was in pain, Linda Estes recalled in a 2018 story in the Tri-City Herald. Her father, a Harvard-educated physicist, used Death with Dignity to end his life in January 2016.
“I was really nervous to go public with my story because I know I live in a conservative side of the state. I was really afraid of the pushback and I got none,” she said. “It’s not ending life — the disease is killing him. It’s shortening suffering and I think part of the reason my dad decided to do it because he could see his family was suffering” as they were caring for him and grieving.
“He didn’t want to linger and make things worse,” Estes said.
The experience launched her advocacy. She has worked with End of Life Washington; before that ended, she recruited volunteers for the Tri-Cities and Spokane. “Our Tri-Cities volunteers would go as far out as Ellensburg, up to Moses Lake,” she said. They have since left the organization as well, she added.
“It’s a fragile model. It’s hard to recruit and train and retain volunteers with a state as big and diverse as ours,” Estes said. “I think when the law was passed, the intention was people would have access to the law no matter where they were in the state. It should not be the case that a nonprofit should have to step in and set up the network.”
Looking ahead
Though the state attorney general’s office has said it will review the proposed merger, many following it don’t expect the state to block the deal. Kinney and others are preparing for it to happen.
She and others hoped Virginia Mason would let its physicians each choose whether to provide patients with Death with Dignity options, as Swedish Health Services did after it affiliated with Providence Health & Services.
“Listening to what Gary Kaplan has been saying ... they have already crossed off Death with Dignity services. We went in with the idea of doing a Swedish deal, but it became pretty clear pretty quickly that wasn’t going to be an option,” Kinney said. “It appears that that has been decided.”
Estes worked to create a policy that Kadlec Regional Medical Center in Richland, which is affiliated with Providence St. Joseph Health, that allow physicians to participate on their own time and would state that providers are expected to give out information at patients’ request.
She knows of two physicians in the Tri-Cities area who don’t work for a Catholic organization and will take patients who are not their own. And with the rapid expansion of telemedicine due to the COVID-19 pandemic, physicians may be able to handle patients’ first oral request through telemedicine, Estes said.
They can take only so many patients, though. And some physicians prefer to see patients in person for this important and rigorous process, Estes said.
Kinney is already looking ahead, with plans for End of Life Washington to start focusing on Eastern Washington so people understand their end-of-life choices and the law, she said.
“Going forward, we’re very clear that increasing both awareness and access to Death with Dignity and end-of-life services east of the mountains is a priority for us. The board approved that as a priority,” she said.
“We’re just beginning our work and presence to build up awareness, build up resources. What goes with that will be increasing expectations that people can access the law there.”
