Assisted suicide in Washington state is legal under the Death with Dignity Act, codified at RCW 70.245, which lets a terminally ill adult resident request a prescription for medication they can take to end their own life. The law sets strict eligibility rules, a multi-step request process stretching at least 15 days, and criminal penalties for anyone who tries to coerce or manipulate a patient. A 2023 amendment opened participation beyond physicians to physician assistants and advanced registered nurse practitioners, giving patients more options when finding a willing provider.
Who Qualifies
Every one of these conditions must be met:
- At least 18 years old.
- A current resident of Washington state.
- Diagnosed with an incurable, irreversible disease expected to cause death within six months.
- Mentally competent to make and communicate an informed healthcare decision.
Two qualified medical providers, an attending and a consulting, must independently confirm the terminal diagnosis and the patient’s competence.1Washington State Department of Health. Death with Dignity Act If either has concerns about the patient’s capacity, the law requires a referral for a psychological or psychiatric evaluation before any prescription can issue.
Since 2023, physician assistants and advanced registered nurse practitioners can serve in these roles alongside physicians, but at least one of the two providers must be a physician or osteopathic physician.2Washington State Legislature. Washington Code RCW 70.245.010 – Definitions Both roles cannot be filled by non-physician providers.
The statute does not define residency precisely. The Department of Health points to common proof such as a Washington driver’s license, voter registration, a mortgage or rental agreement, or a utility bill.3Washington State Department of Health. Frequently Asked Questions About Death with Dignity No single document is mandatory, and the list is not exhaustive. Patients who recently moved to Washington should talk with their attending provider about documentation early.
The Request Process
The law builds in multiple checkpoints, and the timeline cannot be shortened. From first request to prescription, the process takes at least two and a half weeks.
Two Oral Requests, 15 Days Apart
The patient must make two separate oral requests to the attending provider, with at least 15 days between them. The provider documents each request and confirms it was voluntary.1Washington State Department of Health. Death with Dignity Act
A Written Request With Witnesses
The patient must also submit a written request on a form that substantially follows the statutory template, signed and dated in front of two witnesses. The witnesses attest that the patient appears competent, is acting voluntarily, and is not being coerced.4Washington State Legislature. Washington Code RCW 70.245.030 – Form of the Written Request
The witness rules trip people up. The attending provider cannot be a witness at all. At least one of the two witnesses must be someone who is not related to the patient by blood or marriage, not entitled to any part of the patient’s estate, and not an owner, operator, or employee of the healthcare facility treating the patient. The second witness has no such restriction, so a family member can fill that second slot.4Washington State Legislature. Washington Code RCW 70.245.030 – Form of the Written Request The common assumption that no family can witness is wrong.
A 48-Hour Wait, Then the Prescription
After the written request is submitted, at least 48 hours must pass before the provider can write the prescription. The patient can rescind the request at any point, and the attending provider must inform them of that right.
Once the prescription is filled, the patient must self-administer the medication. No one else, not a provider, not a family member, may give it to them. This self-administration rule is one of the law’s core safeguards.
What the Medication Costs
Federal law prohibits using congressional appropriations to pay for any service furnished for the purpose of causing death, which blocks Medicare and Medicaid from covering the medication.5Office of the Law Revision Counsel. 42 US Code 14402 – Restriction on Use of Federal Funds Under Health Care Programs The cost falls on the patient out of pocket. Expect several hundred dollars at minimum, with the exact amount depending on the drug compounded. Private insurance may or may not cover it; some plans exclude it.
The same federal funding ban applies to the Department of Veterans Affairs. VA providers cannot prescribe or participate, even in states where the practice is legal. A veteran who wants to use Washington’s law has to see a non-VA provider and pay privately.
How the Death Is Recorded
A death under the Death with Dignity Act is not classified as suicide. The attending provider may sign the death certificate and lists the underlying terminal illness as the cause of death.1Washington State Department of Health. Death with Dignity Act This matters for survivors. Life insurance policies with suicide exclusion clauses cannot use the death to deny benefits, and the family avoids the legal and estate complications that a suicide classification can create.
When Providers or Facilities Refuse
No provider is required to participate. The statute states that only willing healthcare providers take part in prescribing or dispensing the medication, and a provider cannot be penalized for refusing or for choosing to participate.6Washington State Legislature. Washington Code RCW 70.245.190 – Immunities, Basis for Prohibiting Health Care Provider from Participation
Healthcare facilities, including religiously affiliated hospitals, can prohibit the process on their premises. They must publicly post that policy and notify providers with privileges there. A facility cannot stop a provider from participating at a different location on the provider’s own time. If a provider is unwilling and the patient wants to transfer care, the prior provider must hand over the relevant medical records on request.6Washington State Legislature. Washington Code RCW 70.245.190 – Immunities, Basis for Prohibiting Health Care Provider from Participation
If the first provider says no, finding another is the practical next step. Patients can ask a palliative care or hospice team for a referral, or contact advocacy organizations that maintain lists of participating providers.
Protections Against Coercion
The law treats manipulation of the process as a serious crime. Two acts are Class A felonies:
- Altering or forging a patient’s request without authorization, or concealing or destroying a patient’s rescission, with the intent or effect of causing the patient’s death.
- Exerting undue influence on a patient to request the medication, or to destroy their rescission.
A Class A felony in Washington carries up to life in prison and a fine of up to $50,000.7Washington State Legislature. Washington Code RCW 70.245.200 – Willful Alteration/Forgery, Coercion or Undue Influence, Penalties8Washington State Legislature. Washington Code RCW 9A.20.021 – Maximum Sentences for Crimes The statute also preserves civil liability for misconduct and does not shield anyone from other criminal penalties that may apply.
Providers who follow the law in good faith are protected from civil liability, criminal charges, and professional discipline. Those who skip the consulting provider’s confirmation, ignore the waiting periods, or fail to file required documentation lose that protection and can face discipline up to license suspension or revocation.6Washington State Legislature. Washington Code RCW 70.245.190 – Immunities, Basis for Prohibiting Health Care Provider from Participation If a family suspects coercion or procedural violations around a death, law enforcement and the local coroner or medical examiner can investigate regardless of what the death certificate says.
Unused Medication
Not every patient who fills the prescription takes it. Because the drugs are controlled substances, leftovers cannot go in the trash untreated. The Department of Health directs families to a pharmacy drop-off kiosk or a medication take-back program; some law enforcement agencies accept controlled substances as well. If none of those options is available, the FDA recommends removing the medication from its container, mixing it with something like used coffee grounds or cat litter, sealing it in a bag, and placing it in household trash.3Washington State Department of Health. Frequently Asked Questions About Death with Dignity Scratch out or remove the prescription label on the empty container before throwing it away.