In the fall of 1991, voters in Washington state were asked to consider a public initiative that sought to legalize physician-assisted death: Initiative 119. Drafted by Washington Citizens for Death with Dignity, the initiative was intended to amend the existing state natural death act in several ways:

1) expand the definition of “terminal condition” to include patients in irrevers ible coma or persistent vegetative state;

2) specifically name “artificial nutrition and hydration” as life-sustaining medical procedures that could be refused or withdrawn;

3) legally allow mentally competent patients with certifiably terminal conditions to request and receive “aid-in-dying” from their physician as a medical service.

The first two proposed amendments were widely acknowledged as timely and appropriate; a coalition of medical, religious, and community organizations had been actively working on such additions for several years. It was the proposal to legalize “aid-in-dying,” however, that represented a radical shift in the conduct of physicians towards their patients and a dramatic shift in social policy.