Of the 103 who received prescriptions last year, 94 are known to have died. Seventy of these died after taking the medication. Nineteen died without taking the medication. In five deaths, it is not known whether or not they took the medication. For the remaining 9, it is not known if they have died.

Under the Act, physicians can prescribe–but not administer–lethal doses of medications to adult Washington State residents with terminal illnesses who are expected to have no more than six months to live.

Of the 70 patients who died after taking the medications, 93 percent were at home and 83 percent were enrolled in hospice care at the time.

Number of Death with Dignity Participants and Known Deaths, 2009-2011

Participation in the program increased 16 percent in 2011 from 2010.

Under Washington’s Death with Dignity Act, the Department of Health collects information from patients and providers who choose to participate, monitors compliance with reporting requirements, and produces an annual report.

Among the findings for 2011:

• Those who died were between the ages of 41 and 101.

• More than 90 percent lived west of the Cascades.

• 78 percent had cancer.

• 12 percent had neuro-degenerative disease, including Amyotrophic Lateral Sclerosis (ALS).

• 10 percent had other illnesses, including heart and respiratory diseases

Of the 94 participants in 2011 who died, their end-of-life concerns include:

• Loss of autonomy, 87 percent

• Loss of dignity, 79 percent

• Loss of the ability to participate in activities that make life enjoyable, 89 percent

Since the law went into effect in 2009, 255 terminally ill patients have received the prescriptions.

To learn more:

• Read the report (http://www.doh.wa.gov/dwda/forms/DWDA2011.pdf)

• Additional information about the Washington State Death with Dignity Act (http://www.doh.wa.gov/dwda/) is on the agency website.

End of life resources

• Washington State Living Will Registry: www.doh.wa.gov/livingwill.
• AHRQ: Advance Care Planning: Preferences for Care at the End of Life.
• American Bar Association’s Commission on Law & Aging: Consumer’s Tool Kit for Health Care Advance Planning.
• Aging with Dignity: Five Wishes.
• National Hospice and Palliative Care Organization: Caring Connections.
• AARP: Advance Directives – Planning for the Future.
• AARP: Talking about your final wishes.
• National Long-term Care Ombudsman Resource Center: Helpful Contacts.
• Washington State Hospice and Palliative Care Organization: www.wshpco.org.

“Overall, 55 patient records were electronically viewed by 43 employees. It’s still unclear how many of those ultimately may be found to have had legitimate reasons for looking at patient medical records and may be cleared of wrongdoing.”

For the full story go to the Everett Herald story: Everett Clinic fires 13 for snooping

By Kristian Foden-Vencil, Oregon Public Broadcasting

This story is part of a reporting partnership between Oregon Public Broadcasting,  and Kaiser Health News.

Helen Hobbs, 93, lives in an assisted living facility in Lake Oswego. (Photo by Kristian Foden-Vencil/Oregon Public Broadcasting).

Terri Schmidt, an emergency room doctor at Oregon Health and Science University, can’t forget the day an elderly man with congestive heart failure came into the hospital from a nursing home.

Helen Hobbs, 93, lives in an assisted living facility in Lake Oswego. (Photo by Kristian Foden-Vencil/Oregon Public Broadcasting).

The man hadn’t filled in a medical directive form, so, by law, Schmidt had to provide all the medical care possible.

“I intubated the man. I did very aggressive things. It didn’t feel right at the time,” says Schmidt. “There was just this sense in my mind that this is a 92-year-old very elderly person with bad heart failure. And about 15 minutes later, when I was able to get ahold of the family.  They said, ‘You did what?  We talked about this! He didn’t want it. We had a big conversation in his room about a week ago.’”

Oregon has been in the forefront of trying to make sure a person has as much control over the end of his or her life as possible. The state pioneered a form known as a POLST, for Physician Orders for Life-Sustaining Treatment, that has been adopted by 14 states and is being considered in 20 more. The form offers many more detailed options than a simple “do not resuscitate” directive.

That’s good for Helen Hobbs, who is 93 and lives in an assisted living facility in Lake Oswego. Age has bent Hobbs low and she uses a walker, but she is very clear-headed on this topic.

“You know, death is part of your life. You know you’re going to get there someday so let’s make it as pleasant as possible,” Hobbs said. “I mean, would you like to stay in an unconscious condition for years while people kept you alive with feeding and hydration tubes? No.”

Hobbs outlined her end-of-life medical decisions a couple of years ago, after a serious surgery. She used Oregon’s form. It is signed by her doctor, so it’s legally enforceable.

Reading it, Hobbs says she likes the fact that it offers a lot of different options.

“Yeah, I did want antibiotics in case of infection. I don’t want CPR if I’m in cardiac arrest. I don’t want to be tied down with tubes,” Hobbs says. “You know there’s no point in prolonging it. I mean, death can be natural and it’s not that bad.”

Administrators at her senior residence advised Hobbs to keep her POLST form in a plastic tube in her freezer, so EMTs will know where to find it.

Other nursing homes tell residents to keep their forms under the sink or on the fridge. It’s not exactly a perfect system.

Consider the case of Wanda Pucket from Eastern Oregon. Despite being 85 and close to death, she was airlifted to the hospital; given extensive surgery; and kept alive in the intensive care unit for days.

Pucket had a form outlining her wishes not to be resuscitated, but nobody knew where it was. Her family couldn’t be reached before the extraordinary measures were taken.

Pucket’s daughter Kaye Hanni estimates the whole thing cost taxpayers close to $100,000.

“She would be so upset if she knew that kind of money was spent on her,” Hanni says. “Yes, we want to be humane and yes, we want people to treat us with respect. But is respect that kind of aggressive care?”

To avoid situations like Pucket’s, the Oregon legislature set up a database several years ago to deal with the problem of inaccessible POLST forms.

Now EMTs and doctors can access the state database to see if someone wants to be resuscitated.

That database is beginning to generate some interesting facts about the medical interventions people want as they die, according to Dr. Susan Tolle of the Oregon Center for Ethics in Health Care.

“We have really learned that this is not a black and white process,” Tolle says. “Less than 10 percent of people wanted to refuse all treatment. A majority want some things and not other things.”

Tolle avoids the topic of whether these detailed end-of-life instructions save money; she is wary of starting another “death panels” debate. But the database has allowed the state to quantify the policy by some measures.

“What we found was that if people marked ‘comfort measures only’ and ‘do not resuscitate’ and did not want to go back to the hospital…there was a 67 percent reduction in life sustaining treatments, primarily hospitalization and emergency room visits,” says Tolle.

Still, you don’t have to look far to find people who don’t like the forms. Christian Brugger is a professor of moral theology at the Saint John Vianney Seminary in Denver.

“I’ve heard often that elderly patients can feel pressured by the medical community or by their family, not to be a burden,” says Brugger. “I think those kinds of pressures are very hard to calculate. And we want to be very careful that we don’t put those kinds of pressures on the elderly.”

Brugger says giving a family member, or friend, a durable power of attorney is a much better solution to this delicate issue.

But Helen Hobbs says she filled in her POLST form to make sure her son doesn’t have to make difficult decisions as her life ends. She was grateful her husband had made his decisions known before he died.

“When somebody’s unconscious and not going to get better, it’s kind of silly to put them on a feeding tube,” Hobbs says, recalling how she refused that option for her husband. She was at peace with the decision. “We had talked about it together many times and neither one of us wanted that kind of treatment.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The Daily Beast: How Karen Handel’s Komen Resignation Boosts Her Political Prospects

Even if you put politics and ideology completely aside, Karen Handel had to resign from Susan G. Komen for the Cure. It’s hard to think of the last time an employee did so much damage to such a respected brand in so little time. … But while Komen will sustain long-term damage, Handel probably will be just fine. Yes, she’s lost her position as Komen’s vice president for public policy. But Handel has long had political aspirations, and she’s now a right-wing cause célèbre. When she ran for the Georgia Republican gubernatorial nomination two years ago, she was attacked for being insufficiently anti-abortion. That’s unlikely to happen again. “It’s kind of hard to criticize her now,” Joel McElhannon, a Georgia-based GOP strategist, told the Associated Press (Michelle Goldberg, 2/8).

TIME: New Criteria May Change Alzheimer’s Diagnosis

Recently revised guidelines for diagnosing Alzheimer’s disease would reclassify nearly all patients who are currently diagnosed with mild or very mild Alzheimer’s as having mild cognitive impairment (MCI), a new study finds. The change may be confusing for doctors and misleading for patients and their families, says Dr. John Morris, a neurologist at Washington University in St. Louis. Reporting in the journal Archives of Neurology, Morris finds that 99.8 percent of patients now diagnosed with very mild Alzheimer’s dementia would actually be considered to have MCI, according to the latest guidelines. Among patients with mild Alzheimer’s, 92.7 percent would be reclassified as having MCI (Alice Park, 2/8).

KHN summarized other news coverage on Alzheimer’s this week: Obama Administration Pledges $156 Million For Alzheimer’s Research And Care (2/8).

American Medical News: The Limits Of Treating Loved Ones

It was a busy day for the cardiologist. Between juggling patients, he received a phone call from his mother. She said she had heartburn and complained that none of the usual over-the-counter medications had helped. So the cardiologist quickly called in a prescription for her for an acid blocker and went back to seeing patients. Later that afternoon, his mother called again — this time from an emergency department. The doctors there said she had a heart attack. … Professional ethics policies have long warned about the perils of physicians treating themselves or family members. … Yet medical board officials say such rules are commonly violated by well-meaning physicians, either knowingly or unknowingly (Carolyne Krupa, 2/6).

Scientific American Mind: Thinking About Mortality Changes How We Act

The thought of shuffling off our mortal coil can make all of us a little squeamish. But avoiding the idea of death entirely means ignoring the role it can play in determining our actions. Consider the following scenario: … It’s the middle of the night when you are suddenly awakened from a deep sleep by the sound of screams and the choking smell of smoke. … [S]ome thoughts of death shore up our beliefs, and other types of reflection make us reexamine them. Which kind leads to a better life? For their experiment, Blackie and Cozzolino recruited volunteers aged 17 to 76 and primed them in different ways (Wray Herbert, 2/6).

The New Yorker: Out The Window

Today is January, midmonth, midday, and mid-New Hampshire, and the writer sits in his blue armchair looking out the window. He is eighty-three. He teeters when he walks, he no longer drives, he looks out the window and watches birds come to his feeder. … The cow barn forty yards away was built in 1865, and he gazes at it every day of the year. His mother turned ninety in the Connecticut house where she had lived for almost sixty years, and she spent her last decade looking out the window. She died in a nursing home one month short of ninety-one. A year later, Jane, the writer’s wife, at forty-seven, was dying of leukemia (Donald Hall, 1/23).

Newsweek/Chicago Tribune: Life With Trig: Raising A Special-Needs Child

Families of children with special needs are bonded by a shared experience of the joys, challenges, fears, and blessings of raising these beautiful children whom we see as perfect in this imperfect world. … When I discovered early in my pregnancy that my baby would be born with an extra chromosome, the diagnosis of Down syndrome frightened me so much that I dared not discuss my pregnancy for many months. All I could seem to muster was a calling out to God to prepare my heart for what was ahead. My prayers were answered beyond my shallow understanding of what true joy could be (Sarah Palin, 2/9).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Here is a full transcript of President Barack Obama’s remarks, as provided by the White House. He took no questions from the press corps.

THE PRESIDENT: Hello, everybody. (Laughter.) I was actually going to say good morning. But I guess it’s afternoon by now.

As part of the health care reform law that I signed last year, all insurance plans are required to cover preventive care at no cost. That means free check-ups, free mammograms, immunizations and other basic services. We fought for this because it saves lives and it saves money –- for families, for businesses, for government, for everybody. That’s because it’s a lot cheaper to prevent an illness than to treat one.

We also accepted a recommendation from the experts at the Institute of Medicine that when it comes to women, preventive care should include coverage of contraceptive services such as birth control. In addition to family planning, doctors often prescribe contraception as a way to reduce the risks of ovarian and other cancers, and treat a variety of different ailments. And we know that the overall cost of health care is lower when women have access to contraceptive services.

Nearly 99 percent of all women have relied on contraception at some point in their lives –- 99 percent. And yet, more than half of all women between the ages of 18 and 34 have struggled to afford it. So for all these reasons, we decided to follow the judgment of the nation’s leading medical experts and make sure that free preventive care includes access to free contraceptive care.

Whether you’re a teacher, or a small businesswoman, or a nurse, or a janitor, no woman’s health should depend on who she is or where she works or how much money she makes. Every woman should be in control of the decisions that affect her own health. Period. This basic principle is already the law in 28 states across the country.

Now, as we move to implement this rule, however, we’ve been mindful that there’s another principle at stake here –- and that’s the principle of religious liberty, an inalienable right that is enshrined in our Constitution. As a citizen and as a Christian, I cherish this right.

In fact, my first job in Chicago was working with Catholic parishes in poor neighborhoods, and my salary was funded by a grant from an arm of the Catholic Church. And I saw that local churches often did more good for a community than a government program ever could, so I know how important the work that faith-based organizations do and how much impact they can have in their communities.

I also know that some religious institutions -– particularly those affiliated with the Catholic Church -– have a religious objection to directly providing insurance that covers contraceptive services for their employees. And that’s why we originally exempted all churches from this requirement -– an exemption, by the way, that eight states didn’t already have.

And that’s why, from the very beginning of this process, I spoke directly to various Catholic officials, and I promised that before finalizing the rule as it applied to them, we would spend the next year working with institutions like Catholic hospitals and Catholic universities to find an equitable solution that protects religious liberty and ensures that every woman has access to the care that she needs.

Today, we’ve reached a decision on how to move forward. Under the rule, women will still have access to free preventive care that includes contraceptive services -– no matter where they work. So that core principle remains. But if a woman’s employer is a charity or a hospital that has a religious objection to providing contraceptive services as part of their health plan, the insurance company -– not the hospital, not the charity -– will be required to reach out and offer the woman contraceptive care free of charge, without co-pays and without hassles.

Now, I’ve been confident from the start that we could work out a sensible approach here, just as I promised. I understand some folks in Washington may want to treat this as another political wedge issue, but it shouldn’t be. I certainly never saw it that way. This is an issue where people of goodwill on both sides of the debate have been sorting through some very complicated questions to find a solution that works for everyone. With today’s announcement, we’ve done that. Religious liberty will be protected, and a law that requires free preventive care will not discriminate against women.

We live in a pluralistic society where we’re not going to agree on every single issue, or share every belief. That doesn’t mean that we have to choose between individual liberty and basic fairness for all Americans. We are unique among nations for having been founded upon both these principles, and our obligation as citizens is to carry them forward. I have complete faith that we can do that.

Thank you very much, everybody.