Nancy Niedzielski, MBA, BA, is a representative for End-of-Life Washington, an organization that works to elevate the standards of end-of life care. She explained that End of Life Washington helps patients in areas that nurses may already be familiar with:

• Making decisions about what they want at the end of life
• Talking to loved ones about dying and their wishes
• Establishing advance directives, durable power of attorney, and other documentation
• Talking to physicians about hospice, palliative care, and pain management
• Finding hospice providers
• Understanding all options to achieve peaceful death, including Washington’s Death With Dignity Act (DWDA) 

Medical Aid in Dying

DWDA allows a terminally ill adult who meets a set of established criteria to request and receive a prescription for medication that he or she may choose to take to bring about peaceful death. Niedzielski encouraged nurses to use the appropriate terminology for the process: medical aid in dying (MAID). “Words matter,” she urged.

In addition to Washington State, Oregon, California, Montana, Colorado, Maine, Vermont, New Jersey, Hawaii, and Washington, DC, have varying laws that permit MAID. Many other states are considering legislation.

To qualify for Washington state’s DWDA, a patient must:

• Be 18 years or older
• Be a Washington state resident
• Be terminally ill with less than six months to live
• Have a confirmed prognosis/diagnosis
• Be able to self-administer
• Be mentally competent

Patients and physicians must follow a particular process and timeline, and the physician is responsible for reporting requirements. The process varies by state, but in Washington, it involves:

• First a verbal request, then a written request that is signed by two witnesses
• Physician recommendation that patient discuss it with family
• A 15-day wait period, then a third request (verbal)
• With the third request, the medications are prescribed.

Importantly, a patient may rescind his or her requests, and the DWDA protects life insurance coverage. Healthcare providers also are protected, and an employer cannot prohibit employees from helping patients off premises or off hours.

Communicating End-of-Life Wishes

Niedzielski said that about 70% of people do not have an advance directive in place. She encouraged nurses to create their own and support their patients to do the same. An advance directive should be signed by witnesses, notarized, and updated regularly.

She reviewed several types of advance directives, as well as their pros and cons:

• Natural Death Act healthcare directive
• The Five Wishes
• End-of-Life Washington’s advance directive
• Alzheimer’s and dementia advance directive

In addition to an advance directive, Niedzielski said that each person should select a primary healthcare agent and an alternate, then communicate with them clearly about their end-of-life wishes.

A healthcare agent should be someone who:

• Will support your wishes
• Can talk candidly about medical issues
• Can handle conflicts with family and doctors 
• Can be a strong advocate
• Is older than 18 years
• Lives nearby or who can travel quickly

“It’s important to know all your healthcare options and to put your wishes in writing through an advance directive, regardless of age or health,” Niedzielski said. “Our goals at End-of-Life Washington are simple: that no one dies alone, that no one dies in pain, and that no one pays a fee for our services.”