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Walla Walla Valley advocate says changes to Death with Dignity law will help families

Walla Walla Union-Bulletin - 4/17/2023

Apr. 16—Donna Coffeen, a Walla Walla Valley resident, believes people should have the right to face death on their own terms.

Washington state's Death with Dignity Act, which allows mentally competent, terminally ill adults with six months or fewer to live to request medication to end their life, gives that option to some, she said.

The law was a beacon for her husband, Jon Coffeen, who was diagnosed with Parkinson's disease in 2003, but it wasn't a viable option as his symptoms worsened. Instead, Jon voluntarily decided to stop eating and drinking at the end of his life in 2018.

Since Jon's death, Donna has been sharing his story to encourage changes that would make the law more accessible to families facing similar barriers to Death with Dignity.

"Depending on where you live, depending on what illness you have, depending on the rate of your disease, there are many barriers," she said. "Each one of those can be a barrier to somebody and prevent them from using the existing law."

Recent changes adopted by the Legislature and signed into law by Gov. Jay Inslee on Thursday, April 6, were momentous steps to remove some of those barriers, Donna said.

Senate Bill 5179 does not change who qualifies for the Death with Dignity option, but it does make it easier for those who qualify to access local providers and prescriptions, said state Rep. Skyler Rude of Walla Walla.

Rude has been working to update the law since 2019, when he first connected with Donna. SB 5179 is the counterpart to his House Bill 1281, which included the same changes.

"This bill directly responds to 16th District constituent experiences," Rude said in a news release. "I want to thank Donna Coffeen for bringing her family's experience on this issue forward."

Stepping into advocacy

Donna said she saw the need for changes to the Death with Dignity law when it became clear the option wasn't available for her husband, but she didn't see herself as the one advocating for the changes at first.

"When you're caregiving and you've got all the things that life's handing you, that doesn't seem like that's on your plate to take care of," she said.

That changed the night Jon died, Donna said.

"I thought to myself, if there's ever an opportunity for me — if something comes to me, that seems like something that's in my wheelhouse to do — I'd be interested in helping if it's just as simple as telling our story so that somebody understands," she said.

Donna met with a Union-Bulletin reporter in 2019, a year after Jon's death, for an interview about an unrelated topic. When the conversation turned to the anniversary of his death, that became the story and led to an entry into advocacy, Donna said.

The day the piece was published, Rude reached out to Donna to set up a time to talk. Three months later, she was testifying before the House Health and Wellness Committee, she said.

"I was a willing person, but the opportunities made themselves for me," she said.

Changes and impact

Washington voters approved the Death with Dignity Act by ballot initiative in 2008. About 30 of the state's 39 counties, including Walla Walla County, supported the initiative.

Under the law, two physicians must confirm that an individual qualifies and is making an informed, voluntary decision. Patients must self-administer the prescribed medication.

Originally, the patient would make an oral request and a written request with 15 days in between, and the physician would wait 48 hours after the written request to write the prescription.

SB 5179 shortened the request waiting period to seven days and removed entirely the 48-hour waiting period for the prescription.

Though physicians and osteopathic physicians were the only health care professionals allowed to make determinations in the original law, SB 5179 expanded that to include nurse practitioners and physician assistants. The two medical providers may not have a direct supervisory relationship.

The bill also opened up mail delivery of the prescription as an option, with a signature from the patient required upon receipt.

Finally, the bill requires the state Department of Health to post hospitals' policies for end-of-life care to its website. Hospice services' policies must also be posted.

Health care providers are not required to participate in the provisions of the act, but employers may no longer prohibit an employee from participating while outside of their employment relationship and premises, according to the bill.

Opponents of the legislation say the bill weakened safeguards used to protect patients from harm, opening patients to the risk of manipulation by family or caregivers and giving them a smaller window of opportunity to change their mind. Some said the law gives more power to the medical professionals and not the patients.

But Donna sees the changes as necessary for opening the option to people who do qualify but can't access the services locally.

Though Jon's symptoms affected his ability to swallow, meaning he'd be unable to self-administer the medication, he faced other barriers to Death with Dignity as well.

Donna said he couldn't find a local physician to help — the option wasn't allowable at the Catholic-based Providence St. Mary Medical Center. Because of Jon's worsening condition, it wasn't realistic or feasible to travel to get the determination and prescription.

Both the changes to health care professional requirements and the option of mail delivery could have made a difference in his case and will make a difference for other families, Donna said.

That said, she understands there must be restrictions so the law is not abused.

"I don't want to make it easy for people to make a snap decision under pressure that isn't really their decision," she said. "Certainly, I don't want that to happen, but in the process of trying to keep those things in place, I think we've kind of over done it, which has limited accessibility."

Rude agreed, saying there are still protections in place.

"The bill maintains important safeguards to ensure the law is not misused," he said.

Next steps

Though the recent changes were an important step, Donna said she still believes there's more work to be done.

"There are huge numbers of people who will never be able to use the law as it exists — and we made a good, huge step right here with what was changed — but I would like to see those choices broadened so that almost everybody will have a choice in the end," Donna said.

She said the cost of the medication is prohibitive, and there are some insurance companies that won't cover it and some pharmacies that won't keep it in stock. She also wants officials to review the medication and method of delivery to give options to people, similar to Jon, whose symptoms affect their ability to swallow or keep the medication down.

Aside from advocating for policy, Donna said she would like to volunteer to offer support to area families with a loved one experiencing end-of-life services and care.

"I would have so, so much liked to have had someone here holding my hand as we went through it, saying, 'This is the best way to do this,'" she said.

Jon's legacy

Donna said she has found meaning in her work to expand access to the Death with Dignity Act.

"I don't believe you can erase the pain, but it helps add meaning," she said. "It's been a very healing thing for me to work on this and feel that I may be helping prevent another family from suffering at the same level we did."

When she first testified in support of changes to Death with Dignity in 2020, she brought a small container of Jon's ashes to spread on the steps of the Capitol. At the signing of the bill on April 6, she wore a necklace that contained his ashes.

"I wanted to feel that this was being done as part of his legacy," she said.

Incidentally, the day the bill was signed into law marked 46 years since Donna and Jon's first date: "That felt like an amazing coincidence."

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