Washington has become the second state to approve a Death With Dignity Act allowing physician-assisted suicide. Hawaii has come close to doing the same since a gubernatorial panel recommended it 10 years ago and should give serious consideration to the issue in the coming legislative session.

Like the Oregon law, the Washington proposition contains safeguards limiting eligibility to state residents who are mentally competent, have obtained assessment by two physicians that they have six months or less to live, wait 15 days and then affirm their decision orally and in writing. It was approved last Tuesday by 59 percent of those who voted on the issue.

A 1998 proposal by blue-ribbon panel appointed by then-Gov. Ben Cayetano and including the late A.A. Smyser, the Star-Bulletin's contributing editor, recommended approval of legislation less stringent than the Oregon law, which received 60 percent of voters' approval and went into effect the previous year. A bill more resembling the Oregon law was approved by the Hawaii House in 2002 but defeated by a three-vote margin in the Senate.

In last year's Legislature, the bill was rejected by the House Health Committee by a 6-1 vote, with Rep. Della Belatti the sole supporter and four members not voting. Rep. Josh Green, a Big Island doctor who chaired the committee and is newly elected to the Senate, led the opposition.

In Oregon, 341 people have died from lethal doses of medication provided by physicians in the 11 years that the law has been in effect - about one in 1,000 deaths per year, according to the state's health department. In other states, terminally ill patients commonly have access to potentially lethal medication that they may take in overdose on their own, according to Dr. Timothy E. Quill, director of palliative care at the University of Rochester and a leading expert on end-of-life issues.

In the absence of a Death With Dignity law, terminally ill patients may rely on “;last resorts,”; which Quill wrote in last month's Journal of Clinical Oncology include “;the secret practice of physician-assisted death”; that might exceed Oregon's rate of legal doctor-assisted deaths.

Those methods include administering aggressive pain management that might result in death although that is not the primary intention, allowing a patient to voluntarily stop eating and drinking, agreeing to a patient's request to forgo or discontinue life-sustaining therapies or sedating the patient to the point of unconsciousness, a last resort endorsed this year by a panel of the American Medical Association.

The notion that the lack of a Death With Dignity law saves lives fails to take those end-of-life options into account. The Oregon and now Washington laws recognize those realities and apply a humane system of dealing with the issue.