Linda Tidwell firmly believes her ailing mother would have grasped at the chance to use Oregon’s Death with Dignity Act to hasten her death from lung cancer.

“She died in 1995 in Seaside, and there had been talk about a physician-assisted death becoming law in Oregon,” Tidwell, a Kalama resident, said last week. “She kept saying, ‘I wish they’d hurry up so I could use it.’ She said her doctor told her he would help her when and if it came into effect.”

Tidwell, 62, a smoker like her mother had been, has been diagnosed with the early stages of emphysema. Though not anywhere near a terminal stage, she said she wants a choice when and if the time comes.

She may get the chance her mother never had.

Washington’s Initiative 1000 — officially known as Death with Dignity Act and patterned after the Oregon law — goes into effect Thursday. The law, approved in November by 58 percent of voters, allows terminally ill adults seeking to end their life to request lethal doses of medication from physicians.

But Tidwell — and other local people who share her opinion — might have a tough time finding a local physician willing to write out a prescription for a patient-administered lethal medication.

“I’m not going to help someone end their life,” said Dr. Richard Kirkpatrick of Kirkpatrick Family Care in Longview. “I’m old-fashioned. I’m not going to overdose you on purpose.”

Kirkpatrick said he and other physicians know there are patients who have “helped along” their deaths.

“I have had patients who took themselves off their ventilator or who have taken extra medication,” he said. “We’ve all had patients who died when they shouldn’t have and others who lived longer than we thought possible. I feel it’s up to God and the patient. I’m not qualified to make that decision.”

Kirkpatrick said he’ll let the other doctors in his clinic make up their own minds, according to their conscience, but most of them are “vehemently” against the measure, he said.

Kaiser Permanente’s policy allows physicians to “opt not to participate in actions relating to the act,” said David Northfield, media relations manager for Kaiser. “however, we would find someone who would participate.”

Catholic-based PeaceHealth, which owns St. John Medical Center and other healthcare clinics in Longview, states in a written policy: “Our choice is clear: We will not offer treatments with the specific intent to end a life.”

That doesn’t mean, however, that PeaceHealth won’t ease a dying patient’s pain or help them and their family prepare for death.

“Catholic health care does not believe in hastening the dying process,” said Kristin Keough Forte, regional director of spiritual care and ethics for PeaceHealth. “But we don’t believe in prolonging it, either.”

Keough Forte said a better plan than preparing for a physician-assisted death is for terminal patients and their families to talk frankly about what to expect and ask “what do you think a good death would be?”

“Anytime someone’s looking at stopping cancer treatment or coming off the ventilator, we’ll discuss the level of comfort care needed and help walk them through the decision-making process,” Keough Forte said.

“Preparing the family, including children as to what to expect and answering their fears and questions is much better than just saying, ‘Here, take this pill,’ “ Keough Forte said.

If a PeaceHealth patient were to ask about physician-assisted death (or physician-assisted suicide, as PeaceHealth calls it), the doctor likely would ask why the patient is interested in that method, Keough Forte said.

“It’s not that our physicians will say, ‘Sorry, we can’t do that.’ ” she said. “They can say, ‘Why are you asking?’ and try to explore what’s really bothering the patient. We’ll try to find out what the real concern is, whether it’s pain management, being a burden on the family or depression.”

Ideally, Keough Forte said, patients should prepare documents such as living wills or powers of attorney when they are diagnosed with a potentially terminal disease, such as emphysema, even though it could be years before death is near.

“We encourage people to think about in advance what their wishes might be, so families have that information,” she said. “It helps that they have it in writing and also that they’ve had the discussion.”

Tidwell said she and her husband, Jim, who was treated for lymphoma in 2006 and has since been in remission, have done just that, partly for peace of mind but also for financial consideration.

“Jim’s treatment that wasn’t covered by our insurance cost us more than $50,000,” Tidwell said. “We’re just about ready to retire. We have to think about that. I don’t want to leave him totally broke, and he doesn’t want to leave me broke either.”

‘We’ll have a physician for them'

Patients who can’t find a physician to prescribe a lethal medication may turn to Compassion and Choices of Washington, a nonprofit advocate of the Death with Dignity Act, based in Seattle.

“We know there are probably people waiting in the wings to use the act. We’ve gotten a lot of calls since the initiative passed in November, said Terry Barnett, president of Compassion and Choices Board of Directors. “We just don’t know where people are in their decision-making.”

Barnett said a large number of doctors around the state supported the initiative, which passed substantially in almost every county in the state.

“If someone comes and they are terminally ill and meet the other criteria, we’ll have a physician for them,” he said.

Compassion and Choice was formed following the defeat in 1991 of Measure 119, which would have allowed doctors to administer lethal injections to the terminally ill.

“Our caseworkers and volunteers have counseled patients and families to seek excellent end-of-life care and effective pain and symptom management, while upholding their right to seek aid in dying to avoid intolerable suffering,” according to its Web site.

“If someone comes and they are terminally ill, we’ll have physicians meet with them if they don’t have one to assess their medical conditions,” Barnett said. “We set them up with case managers who will provide emotional support as long as they need or want it. We have a wide range of professionals we can access — doctors, pharmacists, hospices. We do want to be known to be the place for people to go who need aid in dying.”

In Oregon, very few choose assisted suicide

Since Oregon’s Death with Dignity Act became law in 1998, 341 people have used physician-assisted death, according to the Oregon Public Health Division. That figures out to 11 deaths per 10,000 deaths.

“Based on those figures and our county population and number of deaths per year, I think we’ll have maybe one or two physician-assisted deaths in a 10-year period,” said Greg Pang, executive director of Community Home Health & Hospice in Longview.

Community Hospice approved its policy on physician-assisted death last week.

“We won’t hasten or prolong death,” Pang said. “But we won’t reject a patient who is under hospice care if they have that wish. We will not assist them, we won’t talk to the physician on their behalf and we won’t hand them the medication” for ending their lives.

According to local Hospice policy, which is modeled after Oregon hospices, patients cannot be at the Hospice Care Center when they take the lethal medication, nor can any hospice staff or volunteers be with the patient at their home at the time of physician-assisted death, even if a patient requests it.

“We, of course, will provide support services up until that time and offer grief and bereavement follow-up with the family afterward,” Pang said.

For Tidwell’s mother, the pain was unbearable

Tidwell said it took her mother about a year from the time she was diagnosed until she died just three weeks before her 65th birthday. “She did receive some treatment, but then they said it wouldn’t do any good. She weighed about 142 pounds when she was diagnosed. At her death, she weighed 60 pounds.”

Tidwell said her mother was on drugs at the end to deal with the pain, but “you could tell, even with the morphine, she was in a lot of pain.”

“I know I’m probably going to die that way, and I want to choose when,” Tidwell said. “I don’t want somebody else telling me how to handle my life. Doctors are there to help heal us. Why can’t they help us transition us to the next life?”

Assisted suicide in Oregon: The numbers

Since Oregon’s Death with Dignity Act became law in 1998, 341 people have used physician-assisted death, according to the Oregon Public Health Division.

In 2007, 45 Oregon doctors wrote 85 prescriptions for lethal medications. Of those, 46 patients took the medications, 28 died of their underlying disease and 13 were still were alive at the end of 2007.

Most of the patients were between 55 and 84 years old (80 percent) and lived in the Portland Metropolitan area (55 percent). Most died at home (90 percent) and were enrolled in hospice care (88 percent).

Patients’ most frequently mentioned end-of-life concerns were: loss of independence (100 percent), quality of life (86 percent) loss of dignity (86 percent) and concerned about inadequate pain control (33 percent).

Secobarbital was the barbiturate ingested by 82 percent of individuals in 2007. Pentobarbital, a more expensive formulation, was used 18 percent of the time. Nine grams has been the standard dose.

Sources: Oregon Public Health Division, Oregon Hospice Association

What some pharmacists are saying

Here’s a sample of how some local pharmacies are readying for Washington’s Death with Dignity Act, which goes into effect Thursday.

“Kaiser Permanente complies with the Death with Dignity in Oregon, but has no position on whether the law is appropriate. That will also be the case once Washington’s version goes into effect,” said David Northfield, media relations manager for Kaiser. “Kaiser Permanente physicians and pharmacists can opt not to participate in actions relating to the act. In both cases we would find someone who would participate.”

“We will fill those prescriptions, but it is up to each individual pharmacist as to whether he or she will fill it,” said Melinda Merrill, spokeswoman for Fred Meyer stores.

“Our policy is to allow pharmacists to make the choice and to do everything to take care of the customer, including finding another pharmacist in the store or in another store, if needed,” said Cheryl Slavinsky, Rite Aid director of public relations. “In most cases, the prescription must be delivered to the customer’s choice of pharmacy and filled there.”

The spokesman for Olympic Drug in Longview, which is owned by Hi-School Pharmacy, did not return a Daily News call.

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