Peter Kreidler educated himself on end-of-life options, had his medical forms in order, and understood the voter initiative that gave Washington residents the right to choose doctor-aided dying. If he ever needed to, he thought, he would be able to end his life without suffering.
Not that he wanted to. A retired history teacher, Kreidler, 77, of Port Orchard, wanted to travel, learn, laugh and be with his family, friends and wife of 51 years as long as he could.
When he was diagnosed with terminal cancer in early 2021, he was devastated. But he found comfort in knowing he could have what he called “a good death,” instead of suffering intolerable pain.
Passed after a 2008 voter referendum, the Death with Dignity Act says terminally ill adults with less than six months to live may request lethal doses of medication from medical and osteopathic physicians. It’s supposed to make physician aid in dying legal and accessible to people facing terminal diagnoses.
Washington’s conscience clause, however, says individual health care providers and facilities cannot be forced to participate in medical procedures with which they have a religious objection.
Cary Evans, vice president of communications and public affairs at Virginia Mason Franciscan Health, formerly CHI Franciscan Health, said in an emailed statement that physician aid in dying is not provided at the system’s facilities. He said the health system supports “fully informing patients about options” even if services are not provided on site.
St. Michael Medical Center in Silverdale, where Kreidler was treated for metastatic melanoma, has been under the Virginia Mason Franciscan Health parent system since 2013.
Evans also said the health system provides birth control, LGBTQ+ services and medically necessary care for pregnant women even if it results in the termination of a pregnancy. The health system does not provide elective abortions, he said.
Kreidler said he tried to talk to his long-term, and beloved, physician at St. Michael about how he could, if needed, access aid in dying.
But Kreidler said his doctor told him that his own beliefs, as well as the Catholic hospital’s ethical and religious directives, prevented him from providing any assistance to Kreidler.
He did not receive a referral to a palliative specialist or any other provider who could support him.
“I want my death to galvanize people,” he said, shortly before he died Aug. 22. “I didn’t really understand that a religious hospital would deny care to people. It’s not right. It’s morally wrong and it needs to change.”
Mike Kreidler, Peter’s twin and the state’s insurance commissioner, said, “When you wind up where my brother was, when you are lying there and your death is imminent, you want to know what your options are.”
“I was shocked that there was no backstop for hospitals to provide a referral for death with dignity. They have a moral obligation to,” said Kreidler. “They shouldn’t be dictating what your options are.”
Virginia Mason Franciscan Health is part of the nation’s largest Catholic health system, CommonSpirit Health, which has 11 hospitals and 300 other health care sites throughout the Puget Sound region.
Forty-five percent of Washington state’s hospital beds are in facilities that are under religious directives, according to the Office of the Insurance Commissioner and the state Department of Health’s most current data. In four counties — Cowlitz, Whatcom, San Juan and Stevens — 100% of the hospital beds are in nonsecular, or religious, facilities.
Virginia Mason Franciscan Health and other health care systems typically grow by acquiring hospitals. That is called horizontal acquisition, said Jane Beyer, the senior health policy adviser for the Office of the Insurance Commissioner.
Increasingly, they also expand their reach by buying, creating or partnering with different specialists, such as nursing homes and radiology facilities, said Beyer.
This kind of growth, called vertical acquisition, led to a 2016 federal antitrust suit against CHI Franciscan after it partnered with two specialty clinics, The Doctors Clinic and WestSound Orthopaedics, both in Kitsap County. In the suit, which was settled, state Attorney General Bob Ferguson contended the move increased prices, decreased competition and limited patient options.
Hospital officials at St. Michael promised there would be no impact to services when the hospital was bought by CHI Franciscan and again when it changed its name in 2020.
But organizations such as the ACLU and Save Secular Healthcare Washington, which have studied the impacts of nonsecular health care, said the merger would very likely affect access to physician aid in dying.
Further, many Catholic facilities do not explicitly inform patients about their religious care restrictions, according to a 2020 Merger Watch report on the growth of religious health care in the country and information collected by the ACLU.
Judy Kinney, executive director of End of Life Washington (EOLWA), a nonprofit focused on educating people about end-of-life choices and connecting them with supportive providers, said that out of every 10 people who seek help from the organization, seven have had difficulty finding physicians who support doctor-aided dying.
In the past nine months, she said 30 Virginia Mason patients needed EOLWA’s help to access medical aid in dying directly because of the merger with CHI Franciscan.
Mike Kreidler supports legislation sponsored by Rep. Skyler Rude, R-Walla Walla, aimed at ensuring Washington residents can access physician aid in dying regardless of where they live or the religious doctrines of their health care providers.
Rude felt called to action after reading a 2019 Union-Bulletin article about the plight of Donna Coffeen and her husband. Jon Coffeen had Parkinson’s disease and had counted on being able to access life-ending medications. He was unable to, though, because he rapidly became too sick to swallow the medication on his own, which is required by the Death with Dignity Act. Rude believes that requirement is a cruel obstacle to some who may need the access most.
Jon Coffeen ultimately died after he voluntarily stopped eating and drinking, a way to hasten death.
Coffeen was unable to access aid in dying “because of what I would call barriers and opponents would call safeguards,” said Rude.
The bill, which Rude said will be reintroduced to the House Rules Committee in 2022, would reduce the 15-day waiting period between the first and second requests for medications under the Death with Dignity Act to 72 hours.
That’s important, said EOLWA’s Kinney, because close to 30% of people who requested the medications die each year within the 15-day waiting period, she said.
The current law requires that two medical or osteopathic doctors sign off on physician aid in dying. The proposed law would still require the participation of one medical or osteopathic doctor, but would allow the second medical provider to be an advanced registered nurse practitioner, physician assistant or osteopathic physician assistant.
That, as well as the proposed change that would allow the medicines to be mailed rather than picked up in person, will remove restrictions that particularly affect residents in Eastern Washington and rural areas where health care providers can be scarce or far away, said Rude.
The proposed bill would also ban health care systems from prohibiting employees from providing aid in dying services outside of work.
It would also require hospitals to submit their policies on end-of-life care and the Death with Dignity Act to the state Department of Health.
Wendy Norman, a volunteer for EOLWA who interviewed the Kreidlers before Peter’s death, said: “Part of what I think Peter was so adamant about is that he and his brother were both unaware of what they should have done ahead of time to know more. I, of course, told them they are not alone. That many smart and intelligent people don’t know they need to ask for these things and advocate for their rights for care.”
Even in places where secular health care exists, the system is so stretched and the culture so averse to conversations about death and dying, that it’s never been more important for people take action and learn about their options, she said.
Mike Kreidler said he believes “very keenly in the separation of church and state” and knows that the state’s conscience clause gives protection to religious health care providers.
“But when you sit on your hands when someone is dying and suffering in front of you and you won’t even give them information, that’s when it starts to be questionable,” he said.
Peter Kreidler was able to get life-ending medicines from physicians he connected with through EOLWA. In the end, he did not use them. But having them by his side, his brother said, provided him a sense of comfort when little else could.