Death With Dignity Checklist for Patients

Do You Qualify?

• Resident of Washington (contact us) for more information if you are out-of-state)
• 18 years of age or older
• Mentally competent to make an informed decision at the time of your request
• Terminally ill with life expectancy of 6 months or less
• Able to self-ingest/self-administer the medications

Requirements of the Law

• An Attending Provider (AP) who writes the prescriptions
• A Consulting Provider (CP) who verifies the diagnosis and prognosis
• Two oral requests for DWD with a minimum of 7 days between
• A written request for life-ending medications (Download Request for Medication form)

Step-by Step Instructions

• Make a clear request to use the WA Death with Dignity law to a Medical Doctor (MD), Doctor of Osteopathy (DO), Advanced Registered Nurse Practitioner (ARNP) or Physician Assistant (PA), and be sure it is recorded in your medical chart.
• Identify and see an MD, DO, ARNP, or PA who is willing to act as the Attending (Prescribing) Provider.
• Identify and see an MD, DO, ARNP, or PA who is willing to act as the Consulting Provider.
• After seeing the AP, complete the written request for medications and return it to the AP. Note: Be sure it is witnessed by two people at the time of signing.
• At least 7 days after the first oral request was recorded, make a second oral request for DWD to the Attending Provider.

Medications

• DDMAPh – a compounded mixture of digoxin, diazepam, morphine, amitriptyline and phenobarbital (approximate cost $750)
• Medications are mixed in 2 ounces of liquid and ingested

End of Life Washington Services

• Our volunteers can help you find supporting health care providers
• Our services are free to our clients
• Our volunteers can be there for you and your loved ones should you decide to take aid-in-dying medications, so your final moments are burden-free for everyone present
• Submit an online support request or call us at 206.256.1636, option 1