Five Washington patients with terminal illnesses ingested lethal doses of medication prescribed for them by physicians under their state's new death-with-dignity law, approved by 58% of voters in a November 2008 ballot initiative. At this article's deadline, 14 patients had made written requests for life-ending prescriptions, according to a Web site updated weekly by the Washington State Dept. of Health. Thirteen lethal prescriptions had been dispensed by pharmacies. In two of these cases, a mental health professional was consulted and filed a compliance form. The psychiatric referral is required if the attending or consulting physician has doubts about the patient's mental competence. The Washington law, which took effect March 5 and is virtually identical to Oregon's first-in-the-nation law, makes physician-assisted suicide available to patients who have been judged terminally ill by two doctors. Patients must make an oral request and a witnessed written request. Another oral request must be made 15 days later. Physicians must tell patients about options such as hospice and palliative care. Doctors may refuse to participate and are not obligated to refer patients elsewhere. At least two of the five patients who died worked with the nonprofit Compassion & Choices of Washington to make use of the state law. The second patient did not want any information released publicly, but 66-year-old Linda Fleming -- diagnosed with stage IV pancreatic cancer -- allowed the organization to release details of her case after she died in May. "It was very important to me to be conscious, clear-minded and alert at the time of my death," Fleming said in the Compassion & Choices statement. "The powerful pain medications were making it difficult to maintain the state of mind I wanted to have at my death. And I knew I would have to increase them. I am grateful that the Death with Dignity law provides me the choice of a death that fits my own personal beliefs." More deaths in Oregon The Washington deaths join more than 400 patients who have died since 1998 under the Oregon Death With Dignity Act. Last year marked a high for both the number of patients who received lethal prescriptions, 88, and the number of patients -- 60 -- who died after ingesting the medications, according to a report from the Oregon Dept. of Human Services In 2007, 85 prescriptions were ordered, and 49 patients took the lethal medications. Kenneth R. Stevens, MD, is vice president of Physicians for Compassionate Care Education Foundation, which opposes doctor-aided dying. He said he was troubled that patients in only two of the 60 cases were referred for a mental-health evaluation. He also alleged that because so many of the cases, 88% in 2008, are facilitated by Compassion & Choices of Oregon, patients may not receive truly informed consent from a physician who "tells them their life has value." Doctor-assisted suicide is legal in Montana, Washington and Oregon. George Eighmey, executive director of Compassion & Choices of Oregon, called the comment "offensive" and said his organization works to "encourage people to be enrolled in hospice care and palliative care because we don't want them to make the decision to use death with dignity based upon pain or some suffering that can be addressed. "We always give [patients] the full range of options," Eighmey said. Montana is the third state where doctor-assisted suicide is legal, after a lower-court state judge ruled in December 2008 that patients with terminal illnesses have a constitutional right to physicians' aid in dying. No patients have completed physician-assisted suicide yet under the ruling, which took effect immediately. The state is appealing the decision in the case, Baxter v. Montana, to the state's Supreme Court. Oral arguments are expected to be scheduled for some time in the fall. In June, a variety of groups filed friend-of-the-court briefs in favor of upholding the decision, among them the American Medical Student Assn. and the American Medical Women's Assn. Neither the Montana Medical Assn. nor the AMA has plans to participate in the case. AMA policy "strongly opposes any bill to legalize physician-assisted suicide" because the practice is "fundamentally inconsistent with the physician's role as healer." The full and original article can be found here: