Empowering End-of-Life Choices: How Our Partners in WA Are Supporting Hospice and Death with Dignity Access 

By Peg Sandeen, Chief Executive Officer 

Last month, End of Life Washington unveiled a new resource for those seeking hospice services aligning with their values: the Washington Hospice Map. Choosing the right hospice service can be very difficult, as there are many factors to consider—there isn’t always transparency on the part of hospice as to the particularities of their services, and the decision is typically made when a family is experiencing a health crisis or a protracted health decline. On top of these challenges, choosing a hospice is not something a family does frequently—rarely more than once or twice in a lifetime—so everything about it can be unfamiliar. 

The Importance of Hospice Supporting Medical Aid in Dying 

As one of the flagship statewide service providers in the Death with Dignity movement, End of Life Washington deeply understands these issues. Over the last three decades, they have worked with countless families who are navigating these important healthcare decisions and they have provided guidance to hospices who are looking to support patients seeking medical aid in dying (MAID) while under the care of hospice services. 

We know that hospice is important to those seeking MAID. In the most recent Washington annual report (2023) describing MAID usage patterns, the Washington State Department of Health reports that 86% of those seeking Death with Dignity were also enrolled in hospice. This data point has remained consistent year-on-year, and we know that hospice is an important piece of overall end-of-life care for those seeking MAID.

The hospice industry has had a mixed reaction to Death with Dignity through the years, with most hospices being reluctant to embrace MAID when it first became available. Over time, some hospices have become more supportive and welcoming, but it can be hard to find a good hospice fit, especially when MAID is part of the terminally ill person’s final wishes. It is not uncommon for a hospice to maintain a relationship with a person seeking MAID, but then require hospice staff to not be present during ingestion. In other cases, a particular hospice policy may prevent a hospice medical director from participating in MAID as the attending or consulting physician.

Expanding Access to Death with Dignity: How Washington’s Hospice Map is Driving Change

End of Life Washington has been working hard to help support patients overcome these challenges since MAID first became available in the state in 2008. The Hospice Map is an important resource, and I asked the Medical Director at End of Life Washington, Dr. Jess Kaan, to help us understand the importance of the Hospice Map to her patients.

Peg Sandeen: What are terminally ill individuals looking for in choosing a hospice and how is this Map an important resource for them? 

Dr. Kaan: Many terminally ill people who are choosing a hospice want to know that the hospice they choose will support their values, and will allow them to access all of their legal rights. In states that have medical aid in dying (MAiD) laws, this means that many people want a hospice that will allow them to have the option of MAiD, and will provide those services alongside all of the other end-of-life care that they provide. By incorporating MAiD services, hospices are truly offering comprehensive end-of-life care.

Peg Sandeen: What are the unique challenges related to hospice do those seeking MAID encounter? 

Dr. Kaan: The perspective of hospice and palliative care providers has changed greatly in the past few decades, as more MAiD laws have come into effect across the nation. Initially there was (and still is in some areas) this idea that MAiD represented a failure of palliative care—that if palliative care providers were doing their jobs right, nobody would want access to MAID. Many hospice providers and staff were very against MAiD initially and refused to participate, luckily though, that is all changing. We now have data to show that is not the case, many people want the option of MAiD regardless of how comfortable their hospice team is helping them to be. So incorporating the option of MAiD into hospices is important to broaden the discussion of what the person values at the end of their life. Every person gets to define for themselves what is quality of life, suffering, dignity, and a good death. “Aid in dying is not the failure of palliative care, but rather the success of autonomy” is a phrase I recently read in the Journal of Aid-in-Dying Medicine (Issue 2, Vol 1, p 113), and this rings true.

Peg Sandeen: Aside from this Map, what else does End of Life Washington do to increase hospice support for those seeking MAID? 

Dr. Kaan: We at End of Life Washington want everyone to experience the support and benefit of hospice care, not only for themselves, but also for their loved ones. We highly encourage all people who contact us for support with accessing MAiD to enroll in hospice. We also partner with and support our hospice colleagues so that we can all work together to support people at the end of life with whatever they are needing. 

In addition to this Map as a tool for guiding people to a hospice that best meets their needs and values, we also hope it will demonstrate opportunities to hospices that do incorporate MAiD into their services, as it shows areas of the state without this option. We will actively support Certificate of Need applications for hospices that wish to offer MAiD services in these areas. Additionally, we welcome partnerships with hospices looking to begin or expand their MAiD services—our team is ready to provide training, guidance, and support. 

If you or a family member live in the state of Washington, you’ll find this Hospice Map useful when the time comes to engage hospice services. We thank our colleagues for putting this valuable resource into practice and joining us in propelling the Death with Dignity movement forward.  

Did you also know we have a committed social work team here to answer your questions? While we do not provide clinical services, nor can we give you medical advice or confirm whether you qualify for Death with Dignity, we can provide you with information about end-of-life options, including MAID, and help connect you with local resources in your state. For more information, please reach out to us for support.