Choosing when to die was "truly what she wanted to do," says friend

With hands twisted by arthritis, Linda Fleming was no stranger to pain.

But the 66-year-old Sequim woman met the limits of her endurance when she was diagnosed last month with terminal pancreatic cancer.

Rather than die in agony or spend her final days in a drug-induced haze, Fleming swallowed a fatal dose of barbiturates in her apartment Thursday night — becoming the first person in Washington to end her life under the state's new "Death with Dignity" law.

Family members, her beloved Chihuahua, Seri, and a physician were with her when she died, according to Compassion & Choices Washington, the organization that sponsored the measure adopted by Washington voters in November.

Fleming's friend and neighbor, Sharon Lake, came out on her porch at the Vintage apartment complex for senior citizens when she heard medics and police arrive.

"They told me: 'Linda is gone,' " said Lake, who had signed legal documents weeks earlier witnessing Fleming's decision.

"It was very hard on me, but I know this is truly what she wanted to do," Lake said.

At first, Fleming didn't tell many people about her intentions, for fear that opponents might turn her into a cause célèbre, said her friend Virginia Peterhansen. "She didn't want people picketing in her yard."

But Fleming did discuss her situation with representatives from Compassion & Choices, and left behind a 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," she wrote. "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."

She said she was grateful that Washington's law provided her "the choice of a death that fits my own personal beliefs."

One opponent of the law called Fleming's death a "sad day" and criticized her choice as "egotistical."

"It's saying: 'I want to go out of life on my own terms, even though the vast majority of us accept the natural conclusion of our lives,' " said Chris Carlson, of the Coalition Against Assisted Suicide, one of the groups that raised $1.6 million to fight the measure.

Supporters raised $4.9 million, making the initiative the costliest on last year's ballot.

Retired Seattle cardiologist Dr. Tom Preston, medical director for Compassion & Choices, said Fleming's experience shows that the law can work as intended to give dying patients another option.

"The prescribed medication gives patients peace of mind that they can take control of their dying if suffering becomes intolerable," he said.

Peterhansen watched her friend decline rapidly after her diagnosis in early April.

Fleming had loved walking all over town and on Dungeness Spit, Peterhansen said. She had recently bought a car — a 1982 Oldsmobile station wagon — and was looking forward to delving more into pottery and contra dancing.

"She was allowing herself to enjoy things," Peterhansen said.

But the cancer and pain drugs dulled her mind, and the disease made it hard to swallow and left her with stomach pain. She couldn't keep down her food and began to lose weight.

Pancreatic cancer is one of the deadliest forms, and the disease usually progresses quickly and relentlessly.

"It can be very painful," said Preston, who during his years as a physician has attended more than 100 patients in their final days.

Washington is only the second state to allow doctors to prescribe lethal doses of medication for terminally ill patients.

The state's law is modeled on a 10-year-old measure in Oregon, where about 400 people have ended their lives.

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. Though the drugs are prescribed by a physician, the sick person must self-administer them.

The patient must make two oral requests for the drugs, 15 days apart, and also must present a written request witnessed by two people.

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.

About a third of Washington hospitals have barred their caregivers and pharmacies from helping patients die. But most individual doctors are free to decide whether to participate.

Lake, a Lutheran, was reluctant at first to serve as a witness for Fleming.

"I wondered, would God forgive us for that?" asked the former dairy farmer. "I told her: This is really going to upset your family."

But after conferring with her minister and listening to Fleming's arguments, she agreed.

"There's a lot of people who are suffering and wasting all the money for the families," Lake said. "They know they're not going to live, so why prolong it?"

As Fleming's health deteriorated, her daughter adopted Seri, the dog — but brought the animal back for a final visit. Fleming also gave away most of her possessions, including her car.

"That was Linda," Lake said. "Always helping the other person."

Sandi Doughton: 206-464-2491 or sdoughton@seattletimes.com

Material from The New York Times is included in this report.