When 85-year-old Richard Levy was diagnosed with lung cancer and underwent surgery to remove part of his lung, it was a losing battle. Imaging showed the cancer was spreading fast — it was already wrapped around his spine, causing excruciating pain throughout his body. His doctors told Levy he had less than six months to live, and he was referred to in-home hospice care. However, neither the skilled nurses who attended to him nor the medication he was put on could ease his pain.

Several months later, after consulting with his wife, Midge, son, Joe, and his doctor, Levy opted to use the Washington Death with Dignity law, passed in 2008, to end his life as soon as possible in a peaceful and dignified matter. However, the law required him to undergo a 15-day waiting period before taking the final step. What ensued was anything but peaceful or dignified. While Richard stayed home as he wished, Midge and Joe watched him fight agonizing pain with the strongest levels of opioids the doctors were able to prescribe. He struggled to move, eat, sleep, shower, or even have a basic conversation. Every day felt longer and became a countdown to the end.

Finally, after the waiting period, the family gathered around Levy, said their final goodbyes, and he took the medicine as prescribed. He fell asleep within two minutes and died peacefully 20 minutes later.

“The law was designed to provide peace of mind for both the patient and their family,” says Judy Kinney, executive director of End of Life Washington. “Too many people who meet the criteria and are taking steps to follow through on the law’s current provisions are not able to access the peace of mind and body autonomy that the law was designed to provide in a timely manner.”

To help meet this need, End of Life Washington relies on about 20 volunteer physicians who see hundreds of clients, Kinney says. They are working to increase that, she says, “so that each of us is confident that, should we become terminally ill, we could access information about, if not actual aid-in-dying services, when we see our medical provider.”

4 steps to dying with dignity

1. Know and honor your choices. “We find that what makes the dying process less scary is having agency over how that’s going to happen,” Kinney says. “That means everything from stopping treatment to pursuing all treatment options, from dying at home to hospice care. There’s no right or wrong; it’s all about personal choice.”

2. Talk to the people you love. Let your loved ones or caregivers know what your choices are and what your values are, so they can help you honor them.

3. Ask your physician if you can count on their support. “One of our greatest challenges is the growing number of medical systems that do not support patient requests to access medical aid-in-dying,” Kinney says. About 45% of Washington’s health care systems are run by nonsecular organizations that do not condone Death with Dignity. As a result, seven out of 10 EOLWA clients need help finding the two providers required by law to access medical aid in dying. The time needed to find two supportive providers contributes to only one in four EOLWA clients dying within the 15-day waiting period required by law.

There also are equity challenges surrounding access to end-of-life options, Kinney says. Limited integration of medical aid-in-dying in health care systems contributes to some communities having even less access. For example, the Washington State Department of Health indicates that 96% of people accessing medical aid in dying live west of the Cascades, and 98% of them are white.

4. Surround yourself with people who will support your decision. This includes friends, loved ones, health care providers, and support groups. The EOLWA design is the first in the nation to include support at no charge from a volunteer throughout the entire process.” The client is never alone,” Kinney says, “because no one should ever die alone.”

End of Life Washington advocates for excellent end-of-life care, patient-centered care and expanded choice at the end of life.