Death With Dignity Checklist for Patients

This checklist provides an overview of the steps involved in obtaining a prescription for life-ending medication under the Washington State Death with Dignity (DWD) law. It also outlines the law’s qualification criteria and lists current life-ending medication prescription options. An overview of End of Life Washington’s client support services is also provided.

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.


  • 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

DWD Checklist

Updated July 31, 2023

Download PDF

The checklist is available in the following languages: Arabic, Chinese, Haitian-Creole, Korean, Russian, Spanish, and Tagalog.