By Diane Urbani de la Paz
Peninsula Daily News
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"She was a very brave person to do this," Ginger Peterhansen, Fleming's close friend, said Friday, the day after Fleming became the first person in Washington state to die using the state's new Death with Dignity Act.
Fleming had been diagnosed about four weeks ago with stage 4 pancreatic cancer, a disease that all too often kills its victims in a few months after a period of escalating pain.
On Thursday night, Fleming was in her apartment at The Vintage, a Sequim complex for seniors, when she took a lethal dose of barbiturate pills, prescribed by a doctor, that would end her pain and her life.
Her daughter, a doctor and her dog -- a Chihuahua named Seri -- were by her side.
Though the drugs were prescribed by a physician, under the new law the sick person must self-administer them.
The pills would put her to sleep in five to 10 minutes.
In half an hour she would die, said Tom Preston, a cardiologist who reviewed Fleming's requests for the lethal prescription to ensure that she met the requirements of the Death with Dignity Act.
The law, which almost 60 percent of Washington voters approved last November, went into effect in March.
Preston is the medical director for Compassion & Choices of Washington, a Seattle-based patients' rights advocacy group that reported Fleming's death Friday morning and issued a statement it said came from Fleming.
She was quoted in the statement:
"I am a very spiritual person, and it was very important to me to be conscious, clear-minded and alert at the time of my death.
"The powerful pain medications were making it difficult to maintain the state of mind I wanted to have at my death.
"And I knew I would have to increase them."
'Choice of death'
So instead of continuing to take the painkillers prescribed following her cancer diagnosis -- drugs she said would have robbed her of her alertness -- Fleming made the choice to end her life.
The statement said she was grateful that Washington's law provided her "the choice of a death that fits my own personal beliefs."
She went through the steps required by the law -- two spoken requests, submitted to the state 15 days apart, then a written request witnessed by two people, one of whom was Peterhansen, on May 15.
The form, "Request to end my life in a humane and dignified manner," is provided by the state Department of Health.
Fleming's request was then sent to a consulting physician and finally to the doctor who wrote the prescription.
At first, Fleming didn't tell many people about her intentions, for fear that opponents might turn her into a cause cĂ©lĂ®bre, Peterhansen said.
"She didn't realize she would be the first one in Washington," Peterhansen said.
"She was always a little scared that the wrong people would find out.
"But that didn't change her mind."
Talked about decision
Peterhansen watched her friend decline rapidly after her diagnosis in early April.
Fleming's pain had been growing more intense, Peterhansen said.
She and her friend spent many hours together in those final weeks, talking about the decision.
Terminal cancer had taken away the years Fleming, who had been a social worker in Fresno County, Calif., would have lived out after retirement in Sequim.
She knew she had no choice in this, Peterhansen said.
But Fleming was "very glad to have had a choice to end her life her way, on her terms, and not just be waiting in pain."
Terms of the law
Washington's law applies only to people age 18 or older, who are able to exercise sound judgment and have been diagnosed with six months or less to live.
As of Friday, lethal drugs have been dispensed to six Washington residents, according to the state Department of Health.
Physicians have 30 days to file documents reporting deaths under the law.
The names of doctors who prescribe the lethal medications are kept confidential, said Robb Miller, executive director of Compassion & Choices of Washington.
Advocates such as Miller worry that "an overzealous opponent might do something untoward," such as harassing the doctor or others close to the patient.
Janet Flatley of Port Angeles, an opponent of the Death with Dignity law who spoke at a pre-election forum in Sequim last year, called Fleming's act "a tragedy."
The new law, she added, "empowers doctors to do what they're not called to do," which is to help patients die.
"I don't see any good that can come out of it."
Death with dignity advocates urge the use of "aid in dying" and "life-ending medication" rather than "assisted suicide."
The Death with Dignity Act, is about choice -- and that was what Washington's voters endorsed at the polls, Miller said.
"The opposition really got their message out there.
"But the voters made it possible for [Fleming] to die peacefully, on her own terms, in her own home, not sedated to unconsciousness or lying in a coma," he said.
"I'm grateful she was able to use this option."
Doctors have been helping people die "since the beginning of time," Miller added.
And, he added, "there is no way for someone who is not 100 percent committed to get through the process."
'A form of comfort care'
To the advocates at Compassion & Choices, Fleming's decision was a courageous one that may help others understand the doctor-patient relationship at this point in history.
"Physicians have two duties -- to prolong life and to relieve suffering," Miller said.
In Fleming's case, "this was a form of comfort care."
Fleming "couldn't give herself more time. The choice was not to live to 76 or 86," added Preston.
"The choice was to linger on, heavily sedated."
Preston said hopes people suffering with terminal illnesses will seek information, sooner rather than later, about their options.
"The Death With Dignity Act allows a physician to help his patients maintain as much control and dignity as they can at the end of life," he said.
"People should make inquiries and start the process as early as is reasonable.
"There are a lot of people who are at the end now and cannot find a doctor willing to work with them.
"It's much better to take the steps earlier in the illness, to be prepared if and when one needs this."
Of course this is a sad and difficult subject, Preston acknowledged again.
"We don't like to face death," he said.
"This is dealing with death. We're improving: We're talking about it."
Sequim-Dungeness Valley reporter Diane Urbani de la Paz can be reached at 360-681-2391 or at firstname.lastname@example.org.