When doctors told Barbara McKay she would probably not live much longer, she began to think about how she would end her life.

“I was very determined I was not going to allow myself to get to the point where I couldn’t care for myself because I didn’t want to put my family in that position,” the Kirkland resident recalled of when she was diagnosed with late-stage ovarian cancer seven years ago.

McKay, 60, spoke with her family about her end-of-life choices, but knew when the time came she could not allow them to be with her because she didn’t want them to get in trouble for assisting her in any way.

So when Washington’s Death with Dignity Act took effect March 5, McKay was relieved.

The voter-approved initiative (I-1000), which models an Oregon act, allows doctors to prescribe lethal medication for a mentally competent adult with a terminal condition that is expected to be fatal within six months. The patient must self-administer the drugs.

More than 400 people have ended their life under the Oregon initiative since it took effect in 1997.

On Thursday, McKay publicly signed a letter to her physician indicating her wish to take life-ending medication if necessary and when she chooses, to help her achieve a “peaceful” and “gentle” death. Compassion & Choices of Washington, a nonprofit organization that advocates for better end-of-life care and choices, created the form to help patients start the conversation with physicians.

“With terminal illness, it’s difficult to be in a position where you don’t have control over your body,” said McKay.

Since her cancer diagnosis, she has undergone three extensive chemotherapy treatments, two surgeries and has endured back pain, fatigue, indigestion and embarrassment from having a bald head.

She has also watched a number of women pass away who she’s gone through chemo with “and I’ve watched the different ways they die and seen the effects it has on families and that’s no place to put someone,” she said. “With the new act, it’s nice to know that you have that option if you choose it and it gives me that feeling of control.”

She said she understands Death with Dignity is not for everybody and “everyone has opinions on what’s important to them.”

A retired Seattle cardiologist and Compassion & Choices medical director, Dr. Tom Preston has worked on the initiative since 1991, when a broader attempt to legalize physician assistance in dying was rejected by Washington voters.

He believes the new measure is a “more honest way of doing things,” as physicians have assisted patients in dying “back-alley for decades” by administering high dosages of morphine and other medications.

The purpose of modern medicine, Preston said, is to prolong life and “that’s fine for some, but the new law gives the choice of how to die to patients and families, not to doctors and machines.”

The measure also means communication between patients and physicians is in place, he said.

Much of the deep opposition has been ideological, Preston said, noting the “problem comes when their stance might prevent other people from living out there own values.”

Some opponents, who refer to the law as “physician-assisted suicide,” say that people facing death need caring and compassion, not lethal medication.

Others, such as Bellevue probate lawyer Theresa Schrempp, say there is no safeguard in the measure to protect patients from financial or elderly abuse. She is also concerned that there is no requirement of a witness at the time of death.

Schrempp protested the law with a group called True Compassion Advocates outside the University of Washington School of Medicine on March 5. The health facility is one of five in the state that has chosen to participate in the law so far.

The act allows facilities and individual healthcare providers not to participate.

“It’s really disturbing to me that they have chosen to become a hospital that voluntarily administers a lethal dosage,” Schrempp added.

Evergreen Healthcare will not allow people to take life-ending medication while they are in-patients, but it will adopt a formal policy later this month on how it will comply with the measure, said Dr. Hope Wechkin, medical director at Evergreen Hospice.

King County Public Hospital District No. 2 – which includes Kirkland, Bothell, Kenmore, Redmond, and part of Sammamish – operates Evergreen Healthcare, and more than 60 percent of the voters in the district supported the Death with Dignity initiative in the November 2008 election.

In addition, Kirkland residents contributed approximately $30,000 to support the I-1000 campaign, according to PDC records.

McKay’s husband and children have been supportive of her choice to die with dignity, which she fears could be soon.

After a two-year break from chemotherapy, McKay recently found out her tumors have tripled and spread to her lungs.

“I hope to live for many more years,” she said, “But when my time comes, I want to be able to choose my time and my way.”