Mary Klein, center, speaks at a news conference to urge city officials to educate doctors about the city’s “Death with Dignity” law and to ease barriers for doctors to sign up. Klein, a 70-year-old former journalist with ovarian cancer, advocated for a city law to allow doctors to prescribe fatal medication to terminally ill patients, but just two doctors have registered nearly a year into implementation and no patient has used the law. (Fenit Nirappil/The Washington Post)

Nearly a year after the District enacted a law allowing terminally ill patients to end their lives — over the objections of congressional Republicans, religious groups and advocates for those with disabilities — not a single patient has used it.

And just two of the approximately 11,000 physicians licensed to practice in the District have registered to help patients exercise their rights under the law. Only one hospital has cleared doctors to participate.

Mary Klein, a D.C. resident in the final stages of cancer who became the public face of the movement, says she hasn’t been able to find a willing doctor.

Officials with the national advocacy group Compassion and Choices blame local health officials for creating what they consider a cumbersome process that dissuades doctors from participating.

“It’s been exceptionally, exceptionally slow,” said Kat West, national director of policy and programs for Compassion and Choices. “Especially in the first year, there’s usually a lot of interest in learning a lot about these laws. That, we think, has been really dampened and discouraged in D.C. because of these administrative rules.”

The bill signed by Mayor Muriel E. Bowser (D) allows patients with less than six months to live to receive a fatal dose of drugs after making two requests at least 15 days apart. Two witnesses must attest that the requesting patient was of sound mind, and patients must take the medication without assistance. It was modeled after Oregon’s first-in-the-nation 1998 law.


Klein, left, with her wife, Stella Dawson, at their home in the District in October 2016. Klein has had difficulties finding a doctor to help her end her life in hospice, if she finds she is facing intense pain. (Photo by Francis Ying/Kaiser Health News)

D.C. health officials added requirements when implementing the law, which was approved in late 2016 and took effect in July, including psychological evaluations for patients, registration for doctors and online training for patients and doctors.

Advocates fear doctors may not want to end up on a government registry, even though their names aren’t publicly disclosed.

“They don’t want to be known as the doctor who gives out death prescriptions,” said Omega Silva, a retired physician in the District and a Compassion and Choices volunteer.

The group has been talking to local health officials about revisiting these rules, and D.C. Council members are considering changes.

Health officials imposed the requirements in response to concerns that patients could be pressured into an early death. The practice is especially controversial among African Americans, who make up nearly half of the D.C. population, because of a historical distrust of the health-care system.

At a hearing before the D.C. Council on Monday, D.C. Health Director LaQuandra Nesbitt said she resented advocates who suggest she was trying to impede the law. She said the department notified all 11,000 licensed physicians that the law was in place, and suggested aid-in-dying advocates should have done more outreach to the medical community.

“I’m not a gatekeeper to the patients. The program is launched,” Nesbitt said. “I don’t interfere in a patient-physician relationship.”

Before the law was passed, the city estimated that 10 people a year would exercise its provisions. Compassion and Choices says 11 people have called its hotline about using the law.

But there doesn’t seem to be much interest from doctors.

No local practicing physician testified in favor of the measure, and several opposed it, during debate before the D.C. Council.

“The physician community was not out there advocating for it, so I don’t think there should have been an assumption that there would have been a lot of physicians signing up,” said Pia Duryea, a spokeswoman for the Medical Society of the District of Columbia, which stayed neutral on the bill. “We haven’t had any doctors call us up and say, ‘I really want to sign up, and I think the process is too cumbersome.’ ”

The practice was also slow to take root in the six other states that allow it. (Hawaii will become the seventh after the governor signed an assisted-suicide law this week.) The first publicly known death from the assisted-suicide law in Vermont, home to fewer people than the District, happened nearly 18 months after the law took effect.

“It’s just going to be a slow process to adapt to a new way of thinking,” said Peg Sandeen, executive director of the Death With Dignity National Center.

“Even those who say go ahead and pass the law — they don’t want to participate in it,” said G. Kevin Donovan, the director of the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center who opposed the law. “They want other people to do it for other patients. It’s very difficult for a physician to directly send their patients to death because everything in their training is to try and do what’s good for their patients.”

In the District, Sibley Memorial Hospital is the only hospital to publicly say its doctors may participate.

MedStar Georgetown and Providence, which are affiliated with the Catholic Church, oppose it. Kaiser Permanente and the rest of the MedStar network are crafting policies for their doctors, representatives said. Howard University Hospital has no policy, and representatives of George Washington University Hospital and the city-owned United Medical Center did not respond to requests for comment.

Advocates suspect that physicians may have been reluctant to register because they expected interference from Congress, which can overturn D.C. laws and dictate the city’s spending. An attempt to overturn the law failed last year. President Trump’s budget proposal blocked the District from spending money to implement the law, but the provision didn’t end up in the final budget.

Last week, Klein, the cancer patient and advocate for the law, and more than a dozen volunteers lobbied city officials to launch an education campaign and ease barriers to access.

After a three-and-a-half-year battle with ovarian cancer, Klein is preparing to begin hospice treatment. A 70-year-old former journalist, Klein wants the option to use life-ending drugs if she’s facing intense pain.

One of her doctors didn’t want to discuss the matter, she said. Another seemed skeptical.

“Every doctor wants their patient to survive forever, even though they know that’s not possible forever,” Klein said. “It isn’t a situation where I’m going to pressure doctors to do this compassionate option. What I’m trying to do is find doctors I can have a real conversation with, who are open to considering this.”

Klein said she briefly considered traveling to a country where she could more easily end her life.

“I really love D.C. This is my city. I’m really proud to be a resident here, and I want to stay here until my final time comes,” said Klein, who lives in Northwest Washington with her wife and dog. “And if I’m not able to access this medication in time, then my deep hope is other terminally ill patients who want it will be able to access it.”