Today, the New England Journal of Medicine published a study by the

Today, the New England Journal of Medicine published a study by the Seattle Cancer Care Alliance that looked at the medical group’s implementation of the state’s Death with Dignity Act.

The conclusion might seem boring– “overall, our Death with Dignity program has been well accepted by patients and clinics,” the study reads– except for the fact that what used to be called “assisted suicide”was an incredibly controversial issue when the state law passed by initiative in 2008.

The study underscores one of the most notable features of Washington’s experience with Death with Dignity: Nobody talks about it all that much, at least outside of the circles of dying patients and those who care for them. There have been few media stories on people who have utilized the law. Little attention is paid to the statistical reports related to Death with Dignity that are posted each year by the Department of Health.

This sharply contrasts with the experience of Oregon, which in 1997 became the first state to pass a Death with Dignity law, giving rise to countless articles, a documentary (

How to Die in Oregon

) and a U.S. Supreme Court case (ultimately upholding the law).

“It’s a different cultural moment,” explains Anthony Back, a doctor at Fred Hutchinson Cancer Research Center and one of the authors of the paper published today. “Oregon did a huge paving of the way.” And what he says happened in that state is that the fears of Death with Dignity opponents didn’t materialize. The act didn’t become a “slippery slope,” encouraging suicide among people that were really at death’s door. Nor, he says, was it targeted at “a vulnerable population with no medical insurance.”

Instead, Back observes, very small numbers of Oregonians took advantage of the law, and those that did tended to be educated, upper middle class and “very, very determined people who really want control.”

The same has happened here. Seattle Cancer Care Alliance—a center uniting doctors from Fred Hutchinson, UW Medicine and Seattle Children’s—analyzed information about its 40 patients who took their own lives between March 2009 and December 2011. “Typically white, male and well-educated,” according to the study, they nearly universally said a prime motivation for them was not wanting to lose their autonomy.

The study also went into a variety of ways that the alliance has attempted to make doctors and staffers comfortable with the organization’s implementation of the law. The alliance doesn’t compel anyone’s participation or post information about Death with Dignity in public spaces. It also requires patients to sign an agreement that they will not take their own lives in a public way.

Back says this approach has worked, illustrating that “there are ways that an institution can handle” this type of law, even when a number of staffers, as at the alliance, question “in their heart of hearts” whether it’s the right thing to do.

One of the reasons for the study, according to a press release put out by the alliance, is that several other states are now considering Death with Dignity laws. And while Death with Dignity has become something of a non-issue here, that is not necessarily the case elsewhere. In Montana today, the state Senate moved to have a floor vote on a bill that would imprison doctors for up to 10 years if they help a patient die.