When Washington passed the Death With Dignity Act in 2008, the Seattle Cancer Care Alliance, along with other medical institutions, had a lot to think about. For one thing, was it even appropriate to talk to patients about it?

“We do view our mission as curing cancer,” explained Elizabeth Loggers, an oncologist who is the center’s medical director for palliative care. “How do you do this in a way that doesn’t scare people?”

A new study by Loggers, set to be published Thursday in the New England Journal of Medicine, describes how the cancer-treatment center navigated that tightrope and how it played out over the past few years among its patients.

According to Loggers’ study, which is the first to describe a large institution’s implementation of the law, the heated debate among physicians and staff in the early days has given way to a quieter understanding. In part, that’s because so few people — both cancer-center patients and Washington residents in general — choose to take their own lives under the law.

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The law, which took effect in March 2009, allows patients with a diagnosed medical condition to request life-ending medication from their physicians. The patient must have less than six months to live, among other provisions.

Initially, Loggers said, the institution held town hall-style meetings for staff, where there was considerable debate over whether to even allow physicians to write the life-ending prescriptions. A survey at the center showed 38 percent of doctors were either undecided or unwilling to participate, Loggers reported in her study. Another 25 percent wouldn’t write the prescription but would agree to be the consulting physician.

Ultimately, the institution decided it would participate.

“You can’t be an oncologist for very long without honestly facing the fact that not everyone can be cured of their cancer,” Loggers said. “In this situation, you are ethically obligated to provide exceptional care for people who are dying of their illness.”

Under the policy the center ultimately developed, physicians who are opposed may opt out.

The next hurdle was how the law would be implemented. Among the questions:

• Would there be material in waiting rooms describing the program? (No. Too disturbing for some patients.)

• Could doctors bring it up or must they wait for the patient to broach the topic? (Doctors are not prohibited from doing so.)

• And how would the center help guide patients and their families through the process? (A social worker is assigned.)

According to the study, only a small number of Cancer Care Alliance patients — 114 in the first 21 months — even talked with their physician about using the law. Of those, 74 either decided not to pursue it or died before carrying through. Doctors refused to provide a prescription to one patient because he would not agree to take the medication privately.

Forty patients received a prescription, and 24 of them died after ingesting it, the study said. That’s about 2.4 percent of annual patient deaths there.

Those deaths by Cancer Care Alliance patients represent about 15 percent of the state’s total Death With Dignity deaths (255) in the same time frame.

The study says among the center’s patients, the average time to death was 35 minutes, although one patient lingered until the next day.

To Loggers, the study revealed some positives: Most patients who asked about the law had discussed it with family members. Those who use it are dying in their own homes, which is what most Americans want — but don’t necessarily get — according to surveys.

“While I understand the controversy around this,” Loggers said, “I also believe that these patients are experiencing a high-quality death, as they define it.”

Maureen O’Hagan: 206-464-2562 or mohagan@seattletimes.com