OLYMPIA, Wash. – Terminally ill patients with less than six months to live will soon be able to ask their doctors to prescribe them lethal medication.

But those who might seek the life-ending prescriptions once Washington’s “Death with Dignity” law takes effect Thursday could find their doctors conflicted or not willing to write them.

Dr. Tom Preston, a retired cardiologist and board member of Compassion & Choices, which campaigned for and supports the law, said that many doctors are hesitant to talk publicly about where they stand on the issue.

“There are a lot of doctors, who in principle, would approve or don’t mind this, but for a lot of social or professional reasons, they don’t want to be involved,” he said.

But Preston said discussions about end-of-life issues between doctor and patient will increase because of the new law and he thinks that as time goes on, more and more doctors who don’t have a religious or philosophical opposition will be open to participating.

“It will be a cultural shift,” he said.

Initiative 1000 was passed by nearly 60 percent of Washington state voters in November. Washington became the second state, behind Oregon, to have a voter-approved measure allowing assisted suicide. In December, a Montana district judge ruled that doctor-assisted suicides are legal. That decision, which was based on an individual lawsuit, not a state law or voter initiative, is before the Montana Supreme Court.

While doctors in Montana are allowed to write prescriptions pending the appeal, it’s unknown whether any actually have, because there’s no reporting process in place.

As in Oregon, under the Washington state measure, physicians and pharmacists are not required to write or fill lethal prescriptions if they are opposed to the law. Some hospitals are opting out of the law, which precludes their doctors from participating on hospital property.

Dr. Stu Farber, director of the palliative care consult service at the University of Washington Medical Center, and an associate professor in family medicine, voted against the measure and doesn’t plan on prescribing lethal medication for any of his patients.

But he doesn’t rule it out completely.

“I am not here to tell people how they should either live their life or the end of their life,” Farber said. “There’s possibly a story out there, in the future, that’s so compelling, that maybe I would write a prescription.”

But for now, Farber said that after talking to his patients about how they came to their decision, he would refer them to Compassion & Choices of Washington, the state’s largest aid-in-dying advocacy group.

Robb Miller, the organization’s executive director, said they are compiling a directory of physicians who aren’t opting out of the law, as well as pharmacies willing to fill the prescriptions.

“Physicians don’t understand yet exactly how the law works,” Miller said. “Whenever there’s lack of understanding, there tends to be some reluctance.”

Dr. Robert Thompson, an internist and cardiologist at Swedish Medical Center in Seattle who voted for the measure, said that in his 32 years of practice, he has treated patients who were suffering and would have benefited from this law.

“I believe for the sake of compassion and for a person’s own individual rights, that this should be an option for them,” he said.

The new law is based on Oregon’s measure, which took effect in late 1997. Since then, more than 340 people – mostly ailing with cancer – have used it to end their lives.

Under the new Washington law, any patient requesting fatal medication must be at least 18, declared competent and a resident of Washington state.

The patient would have to make two oral requests, 15 days apart, and submit a written request witnessed by two people. One of the witnesses must not be a relative, heir, attending doctor, or connected with a health facility where the requester lives.

Two doctors also would have to certify that the patient has a terminal condition and six months or less to live.

But some doctors opposed to the measure argue that a six-month terminal diagnosis is never a sure thing.

“There is no question in my mind, that if this is too easy of a task, people will die prematurely,” said Dr. Linda Wrede-Seaman, a family physician and palliative care specialist in Yakima.

Providence Health & Services, a Catholic-health care system that operates eight hospitals across the state, as well as hospice programs, nursing homes and assisted living facilities, has opted out. Virginia Mason Medical Center in Seattle has also opted out, but said its doctors can participate at outpatient clinics.

Swedish, where Thompson, works, has not yet made a decision, but a spokesman there said they would before the law takes effect.

The University of Washington health system and Group Health Cooperative chose not to opt out.

Dr. Larry Robinson, vice dean for clinical affairs at the UW School of Medicine, said their decision was made easier by the law’s clear option that physicians could opt out if they wanted to.

“We’re not forcing anyone to do anything,” he said.

Under the measure, any health care provider writing a prescription or dispensing medication must file a copy of the record with the state Department of Health, which is required to create an annual statistical report on how the law is used.

Dr. Robert Thompson poses for a photo Tuesday, Feb. 24, 2009 in his office in Seattle. Thompson, an internist and cardiologist at Swedish Medical Center in Seattle, voted for Washington’s “Death with Dignity” law. Photo by AP

Ted S. Warren