As Washington's Death with Dignity Act takes effect today, hospitals both locally and statewide vary on whether they'll take part.

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University of Washington Medicine health system and Group Health Cooperative have opted in.

Swedish Medical Center is, for the most part, opting out.

Virginia Mason Medical Center’s hospital will not be participating, though its outpatient clinics can.

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As Washington’s Death with Dignity Act takes effect today, hospitals both locally and statewide vary in terms of whether they’ll take part.

Washington voters approved Initiative 1000 — the Death with Dignity Act — in November. Modeled closely on a decade-old Oregon law, it allows physicians to prescribe lethal doses of medication to terminally ill patients determined to have six months or less to live.

The act allows health-care facilities and individual health-care providers not to participate.

Since the law passed, health-care facilities have been scrambling to come up with policies.

Now, it appears that about a third of the state’s hospitals seem to be opting out, said Cassie Sauer, spokeswoman for the Washington State Hospital Association. That means caregivers operating in their facilities or on their behalf are forbidden from helping a patient die, and their pharmacies may not dispense the medications.

About a third of the hospitals are participating, meaning they’re letting each individual doctor, pharmacist and caregiver decide whether to take part.

And about a third seem to be somewhere in the middle, Sauer said. That could mean a hospital might forbid doctors and pharmacists from prescribing and dispensing lethal medications on its premises. But the hospital could let its doctors prescribe a lethal dose to an outpatient.

“I’m surprised by the middle ground,” Sauer said. “I thought people would be all in or all out. I think people are finding a third way.”

For UW Medicine — which includes the UW Medical Center and Harborview Medical Center — and Group Health Cooperative, opting in means allowing each doctor to decide whether to participate.

Swedish will not allow providers to participate on Swedish premises and will not allow its pharmacies to fill prescriptions for life-ending medications.

But it will give referrals to other providers and pharmacies if the patient requests it. Physicians can also choose whether or not to participate when they’re not in Swedish facilities.

Virginia Mason will not provide Death with Dignity services in its inpatient hospital. But individual providers in Virginia Mason’s outpatient clinics — which includes a cancer institute — can choose whether to participate. Virginia Mason pharmacies will not dispense the lethal medications but its pharmacy staff may tell providers who will.

Regardless of how hospitals and other facilities decide, patients and families that want to use the law should be able to find a doctor who will work with them, said Terry Barnett, president of Compassion and Choices of Washington, the right-to-die organization that was behind much of Initiative 1000.

The organization is providing a model letter that patients can give to their doctors to start a conversation and can refer patients to participating physicians. That policies vary widely points to the law’s complexity and controversial nature.

Opponents have formed a grass-roots group called True Compassion Advocates and are planning to demonstrate at the UW Medical Center today.

They want to show that there are still advocates for “life-affirming choices that don’t include ending the life of the patient who needs care,” said spokeswoman Eileen Geller.

“Let’s not underestimate that this is still a very controversial issue in the United States,” said Paul Root Wolpe, director of Emory Center for Ethics in Atlanta.

It’s also one that’s making headlines in other states.

In December, Montana became the third state to allow physician-assisted death when a district-court judge ruled that the state’s constitutional guarantees of privacy and dignity mean terminally ill patients have a right to “die with dignity.”

The state has appealed that decision.

And late last month, four members of the Georgia-based Final Exit Network were arrested in a sting operation and charged with assisted suicide in the death of a cancer patient.

“Perhaps we’ll end up with a patchwork of states, with some allowing physician-assisted suicide and some not allowing it,” Wolpe said. “Right now, it’s too volatile to really know.”

Janet I. Tu: 206-464-2272 or

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