Tuesday, January 28, 2014

Oregon's new assisted suicide report: chronic conditions; people with money and more

By Margaret Dore, Esq.
Updated February 19, 2014

Oregon's assisted suicide report for 2013 has been released to the public.[1]  Per the report, the number of deaths from ingesting a lethal dose is low when compared to overall deaths, just 71 out of 32,475 total.[2] The report is nonetheless significant for the following reasons.

Per the report, some people who died from a lethal dose under Oregon's assisted suicide act had chronic conditions such as diabetes.[3] People with these conditions, and other conditions such as cancer, can have years to live.[4]  Jeanette Hall, the woman in the photo, had cancer and was talked out of assisted suicide 13 years ago.[5]  Her doctor convinced her to be treated instead.[6] Legalization, regardless, encourages people with years to live to throw away their lives.

Per the report, most of the people who died from a lethal dose were white, aged 65 or older, and well-educated. See note [7].  People with these attributes are typically well off, i.e., the middle class and above.  The report's introduction implies that their deaths were voluntary, stating that Oregon's act "allows" residents to obtain a lethal dose for self-administration.  There is, however, nothing in the report stating that the specific deaths described in the report were self-administered and/or voluntary.[8] Older well-off people are, regardless, in a vulnerable demographic for abuse and exploitation.  This includes murder.  A 2009 MetLife Mature Market Institute Study states:
"Elders’ vulnerabilities and larger net worth make them a prime target for financial abuse . . . Victims may even be murdered by perpetrators who just want their funds and see them as an easy mark."[9]
Oregon's act was passed in 1997.[10]  Just three later, Oregon's suicide rate for other suicides was "increasing significantly."[11]  Last year, an article in Oregon's largest paper reported:
"New figures show a sharp rise in suicides among middle-aged Americans, and an even bigger increase in Oregon. A Centers for Disease Control and Prevention report shows suicides among men and women aged 35-64 increased 49 percent in Oregon from 1999-2010, compared to 28 percent nationally."[12] 
This "significant increase" is consistent with a suicide contagion in which legalizing one type of suicide encouraged other suicides.[13]

The new Oregon report also lists "concerns" as to why the people who died requested the lethal dose.[14]  The data for these concerns is originally generated by the prescribing doctor who uses a check-the-box form developed by suicide proponents.[15] One listed concern is "inadequate pain control or concern about it."[16]  There is, however, no claim that anyone who ingested the lethal dose was actually in pain.[17]

A copy of Oregon's new report can be viewed at this link: http://choiceisanillusion.files.wordpress.com/2014/01/year16-2013.pdf  For more information, please see the footnotes below.

Margaret Dore is an attorney in Washington State where assisted suicide is legal.  She is President of Choice is an Illusion, a human rights organization opposed to assisted suicide and euthanasia.  She is one of the attorneys of record in the Montana assisted suicide case, Montanans Against Assisted Suicide (MAAS) v. Montana Board of Medical Examiners.  The case has already resulted in the removal of an official policy statement implying that assisted suicide is legal in Montana.  For more information, please click here.  Funds are needed for an upcoming appeal to the Montana Supreme Court.  Please consider a generous donation to MAAS and/or Choice is an Illusion, by clicking here and/or here. Thank you.

[1]  Oregon's Death with Dignity Act-2013, available at http://choiceisanillusion.files.wordpress.com/2014/01/year16-2013.pdf
[2]  Id., Report, page 2, first paragraph and footnote 1.
[3]  Id., Report, page 6 (underlying illness, listing chronic conditions such as "chronic lower respiratory disease" and "other illnesses"). See also page 7, footnote 6 (listing "diabetes mellitus").
[4]  See e.g., Opinion letter of and Dr. Richard Wonderly and Attorney Theresa Schrempp (regarding a young adult with diabetes and other chronic conditions such as HIV/AIDS, "each of these patients could live for decades"), available at http://choiceisanillusion.files.wordpress.com/2012/07/schrempp_wonderly_opn_ltr1.pdf
[5]  See Affidavit of Ken Stevens MD, available at: http://choiceisanillusion.files.wordpress.com/2013/07/signed-stevens-aff-9-18-12-as-filed.pdf  See also, Affidavit of Jeanette Hall, available at:  http://choiceisanillusion.files.wordpress.com/2013/05/jeanette-hall-affidavit.pdf
[6]  Id.
[7]  Report at note 1, page 2, last full paragraph.
[8]  Id..As a further explanation, the report page 1 says that Oregon's Act (DWDA) "allows" terminally ill Oregonians to self-administer the lethal dose.  Nothing says that administration "must" be by self-administration.  Self-administration can also be non-voluntary, for example, if the patient was under a threat of harm to a pet, or incapacitated, say due to alcohol. The rest of the report, pages 2-7 talks about the patient's "ingestion" of the lethal dose, which could also be voluntary, non-voluntary or involuntary. For more information about the term "ingestion," see Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009, at https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm. See also Margaret Dore, "'Death with Dignity': A Recipe for Elder Abuse and Homicide (Albeit not by Name)," Marquette Elder's Advisor, Vol. 11, No. 2, Spring 2010, pp. 391-2, available at http://choiceisanillusion.files.wordpress.com/2014/01/dore-marquette-law-review-article.pdf
[9]  MetLife, "Broken Trust: Elders, Family and Finances," 2009, at https://www.metlife.com/mmi/research/broken-trust-elder-abuse.html#findings
[10]  Oregon's Death with Dignity Act Report at note 1, supra, page 2, paragraph 2.
[11]  News Release, "Rising suicide rate in Oregon reaches higher than national average," Christine Stone, Oregon Public Health Information Officer, Oregon Health Authority, September 9, 2010.
http://choiceisanillusion.files.wordpress.com/2014/01/rising-suicide-rate-in-oregon.pdf
[12]  David Stabler, "Why Oregon's suicide rate is among highest in the country, " The Oregonian, May 15, 2013, at http://blog.oregonlive.com/living_impact/print.html?entry=/2013/05/why_oregons_suicide_rate_is_am.html
[13]  http://en.wikipedia.org/wiki/Suicide_contagion
[14]  Report at note 1, page 6 (middle of page)
[15]  The check-the-box form is Question 15 of the Oregon Death with Dignity Act Attending Physician Follow-up Form, page 5, available at http://choiceisanillusion.files.wordpress.com/2014/01/attending-physician-follow-up-form.pdf
[16]  Report at note 1, page 6 (middle of page).
[17]  Id, entire report.

Monday, January 27, 2014

A Legislator's Question

By Margaret Dore, Esq.
Updated February 5, 2014

A legislator considering an assisted suicide law asked me this question:  "Is there a way to allow a person to end his life without making someone else a criminal?"

This was my (slightly edited) response:

People take their lives all the time.  One of my cousins shot himself and another threw himself in front of a train.  There was no criminality involved.  Also, if people are in pain, palliative care laws allow medical personnel to give patients copious amounts of drugs, including up to sedation, which can hasten the patient's death. This is the principal of double effect.  This is legal.  For more information, read the Affidavit of Kenneth Stevens, MD, page 3, paragraph 13.

There is also palliative care abuse in which no one seems to be held accountable, except for maybe one case in California where doctors relied on a wealthy patient's daughters, who said that their father was really bad off and didn't want treatment, which was not the case.  At least, that's what's claimed by the man's son. See William Dotinga, "Grim Complaint Against Kaiser Hospital," Court House News Service, February 6, 2012.

I've had like 15-20 contacts in the past year by people upset about their family member being suddenly off'd by medical personnel and/or having DNR's put on family members/friends without the patient's consent.  My caregiver friends also talk about guarding their patients in the hospital.  Here are some letters from Montana.  http://www.montanansagainstassistedsuicide.org/2013/04/dont-give-doctors-more-power-to-abuse.html

Here's a letter from Washington State where assisted suicide is legal. The letter talks about doctors being quick with the morphine and also regarding the conduct of an adult son shortly after our assisted suicide law was passed ("an adult child of one of our clients asked about getting the pills [to kill the father].  It wasn't the father saying that he wanted to die").  http://www.montanansagainstassistedsuicide.org/2012/07/dear-montana-board-of-medical-examiners.html  Here's a letter from a wife about how she was afraid to leave her husband alone after a doctor pitched assisted suicide to her husband. http://www.montanansagainstassistedsuicide.org/2013/01/i-was-afraid-to-leave-my-husband-alone.html

There is also the issue that people who say they want to die don't mean it, as with any suicide.  See http://www.montanansagainstassistedsuicide.org/p/what-people-mean-when-they-say-they.html

I've had two clients whose fathers signed up for the Oregon/Washington assisted suicide acts.  With the first case, one side of the family wanted the father to use the act and the other side didn't.  He spent the last months of his life torn over whether of not he should kill himself.  His daughter was also traumatized.  He died a natural death.  There is a Swiss study that you might be interested in, that 1 out of 5 family members were traumatized by witnessing the legal assisted suicide of a family member.  See http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf

In my other case, the father had two suicide parties and it's not clear that it was voluntary.  My client, his son, was told that his dad had said "You're not killing me, I'm going to bed").  Regarding the next day, my client was told that his dad was already high on alcohol when he drank the lethal dose.  But then the person telling him this changed his story.  In Montana, Senator Jeff Essman, made a relevant observation regarding this point:
"[All] the protections [in Oregon's law] end after the prescription is written.  [The proponents] admitted that the provisions in the Oregon law would permit one person to be alone in that room with the patient. And in that situation, there is no guarantee that that medication is self-administered.
So frankly, any of the studies that come out of the state of Oregon's experience are invalid because no one who administers that drug . . . to that patient is going to be turning themselves in for the commission of a homicide."
Senate Judiciary Hearing on SB 167 on February 10, 2011

I, however, doubt that a person in Oregon could be prosecuted.  If you read the act carefully, there is no requirement of patient consent to administration of the lethal dose, and to the extent that's ambiguous, there's the rule of lenity.  In Washington State, prosecutors are required to report assisted suicide deaths as "Natural" - no matter what - at least, that's what the regulation says:  http://www.doh.wa.gov/portals/1/Documents/5300/DWDAMedCoroner.pdf   How can you prosecute someone for homicide if the death is required to be reported as "Natural?"

Here in Washington, we have already had some informal proposals to expand the scope of our assisted suicide act.  One in particular disturbed me.  A Seattle Times column suggested euthanasia as a solution for people unable to support themselves, which would be involuntary euthanasia.  See Jerry Large, "Planning for old age at a premium," March 8, 2012, which states:
"After Monday's column,  . . . a few [readers] suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out. At least a couple mentioned euthanasia as a solution."  (Emphasis added)
So, if you worked hard and paid taxes all your life and then your company pension plan goes belly up, this is how you want society to pay you back?

As a Democrat, I see us as looking out for the little guy, not passing laws to protect perpetrators, healthcare systems, etc. from legitimate claims.  I hope that you will vote against any effort to legalize assisted suicide/euthanasia.

Thank you for writing me back.

Margaret Dore

Sunday, January 26, 2014

A response to the press: The wife would still be a victim. In Oregon, murder-suicide follows "the national pattern."

I am an attorney in Washington State where physician-assisted suicide is legal.  I was disturbed by your article suggesting that legal assisted suicide would somehow prevent murder-suicides.

According to Donna Cohen, a professor of psychiatry and behavioral sciences, the typical murder-suicide case involves a depressed controlling husband who shoots his ill wife.  "The wife does not want to die and is often shot in her sleep.  If she was awake at the time, there are usually signs that she tried to defend herself." 
 
The typical wife in these cases does not "choose" her death.  She is a victim of spousal abuse.  Legal assisted suicide, regardless, fails to guarantee "choice."  These laws instead empower doctors, family members and new "best friends" to legally pressure people to take their lives.  See Margaret K. Dore, "'Death with Dignity,' What Do we Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009.

 In Oregon where assisted-suicide has been legal since 1997, murder-suicide has not been eliminated.[1]  Indeed, murder-suicide follows "the national pattern."[2]  The suggestion that legal assisted suicide prevents murder-suicide is without factual support. 

 For information about problems with legalization, please see this link: http://www.choiceillusion.org/2013/11/quick-facts-about-assisted-suicide_11.html        

Thank you for your consideration.  (the cited footnotes are below my signature block)

Margaret Dore, Esq. and President
Law Offices of Margaret K. Dore, P.S.
Choice is an Illusion
www.margaretdore.com
www.choiceillusion.org
1001 4th Avenue, 44th Floor
Seattle, WA  98154

***

[1]  See Don Colburn, "Recent murder-suicides follow the national pattern," The Oregonian, November 17, 2009 ("In the span of one week this month in the Portland area, three murder-suicides resulted in the deaths of six adults and two children"), available at  http://www.oregonlive.com/health/index.ssf/2009/11/recent_murder-suicides_follow.html ; "Murder-suicide suspected in deaths of Grants Pass [Oregon] couple," Mail Tribune News, July 2, 2000 (regarding husband, age 77, and wife, age 76) at http://archive.mailtribune.com/archive/2000/july/070200n6.htm; and Colleen Stewart, "Hillsboro [Oregon] police investigating couple's homicide and suicide," The Oregonian, July 23, 2010 ("Wayne Eugene Coghill, 67, shot and killed his wife, Nyla Jean Coghill, 65, before taking his own life in their apartment"), at http://www.oregonlive.com/hillsboro/index.ssf/2010/07/hillsboro_police_investigating_homicide_and_suicide.html.
[2]  See Don Colburn above.

Saturday, January 25, 2014

Montana board forced to remove position statement. Help us make it permanent & overturn Baxter

For the last three years, Montanans Against Assisted Suicide (MAAS) has been an integral player in keeping assisted suicide from becoming legal in Montana.  Most recently, MAAS has been prosecuting a lawsuit against the Montana Board of Medical Examiners.  The suit has already caused the Board to remove a position statement implying that assisted suicide "may" be legal in Montana.

The lawsuit, however, has also been dismissed due to the Board's removal of the position statement.  See court order here.  If MAAS does not appeal by February 11, 2014 , there will be nothing to stop the Board from re-issuing its statement, or a worse statement, the very next day.  Appeal will also allow MAAS to challenge the Baxter decision, which proponents claim legalized assisted suicide in Montana.  A MTN News article describes the situation, as follows:
 [The] position paper - in response to the lawsuit - has since been rescinded by the Board and scrubbed from its website. But [MAAS's attorney, Margaret] Dore said court action was still needed to prevent the Board from reinstating such a position.
She repeatedly asked District Judge Mike Menahan to weigh in on a Montana Supreme Court ruling known as Baxter, that envisions potential defenses to doctors charged with homicide for assisting with suicide.
Sanjay Talwani, "Montana judge hears assisted suicide arguments," MTN News, December 11, 2013.

Problems with legal assisted suicide include that it encourages people with years to live, to throw away their lives.  Legalization also creates new opportunities for elder abuse, for example, when there is an inheritance involved.  In Oregon, legalization has enabled Oregon's Medicaid program to offer the "treatment" of suicide in lieu of desired treatments (to improve the quality of life, to extend life or to cure). 

For more information, please click here.

MAAS's attorney, Margaret Dore, who is also President of Choice is an Illusion, is donating her time. Choice is an Illusion has also provided financial support for the MAAS lawsuit.  Ongoing funds are, however, needed to pay for the rest of MAAS's legal team including the Charlton Law Firm and for out of pocket expenses such as transcripts, computer research and court fees.   We are asking for your support as your finances allow.  Any amount is appreciated.
                                                                                
Choice is an Illusion is proud to have been part of MAAS' victory to force this action by the Board.  Please donate directly to MAAS, or to Choice is an Illusion as set forth below:

Please make checks payable to: MAAS, 610 North 1st St. Suite 5-285, Hamilton, MT  59840, or to Choice is an Illusion, 1001 4th Avenue, 44th Floor, Seattle, WA 98154

Please donate online by clicking here or here.

Thank you for your support.

Sunday, January 5, 2014

New Board Member Kate Kelly!

Welcome to our newest Board member, Kate Kelly!


Kate Kelly, B.Ed., B.A.
Kate Kelly grew up in Halifax Nova Scotia, Canada.  She is the daughter of self-educated working-class parents, who instilled in her a love of books, music, nature, old movies, and compassion for "the average Joe" and all vulnerable creatures. Kate dropped out of high-school, becoming well-acquainted with minimum-wage jobs. She eventually attended university as a mature student, graduating with a B.Ed. in English and a B.A. in Drama.  

Kate has been a travel  agent, salesclerk, child care worker, actress, cab driver, art model, gas jockey, reporter, cleaning woman, teacher, jazz singer and office clerk. She has lived and worked in 6 Canadian provinces and 1 territory, and travels extensively. Kate is passionate about seniors' rights, rescuing dogs, and singing. She hopes to live to at least 100, and die without being "pushed along."  

Kate's publications include "Mild Stroke Led to Mother's Forced Starvation."

Board Member William Reichel, M.D.

Below is an updated biography for Choice is an Illusion Board Member, William Reichel MD.

As noted below, he was recently named as one of five Pioneers in Geriatric Medicine.  Thank you for your work Dr. Reichel!


image of Dr. ReichelWilliam Reichel, M.D.

William Reichel, M.D. is Vice President and a Board member of Choice is an Illusion.  He is also an Affiliated Scholar with the Center for Clinical Bioethics, Georgetown University School of Medicine. Dr. Reichel received his M.D. from Columbia University College of Physicians and Surgeons in 1961. His residency in Internal Medicine was at Stanford Medical Center. He provided leadership in Geriatrics, serving 13 years on the Board of Directors of the American Geriatrics Society, including serving as its President. He was recently named as one of five Pioneers in Geriatric Medicine.  The 6th Edition of a Cambridge University Press text, "Reichel's Care of the Elderly: Clinical Aspects of Aging," was released in February 2009, and the 7th Edition is in preparation.

In his practice, Dr. Reichel saw the many ethical dilemmas that occur in patient care. He thus pursued a study of ethics, at first at Georgetown in 1984, and then as a Visiting Scholar in Medical Ethics at Harvard Divinity School, 1988-1990. At Harvard Divinity School, he concentrated on euthanasia, both in Germany before and during World War II, and in the Netherlands, publishing on assisted suicide and euthanasia. In 1998, Dr. Reichel was appointed to the Center for Clinical Bioethics at Georgetown where he continued his scholarly work that included the study of assisted suicide and euthanasia. Now retired from practice, Dr. Reichel continues as an Affiliated Scholar at the Center for Clinical Bioethics and he continues to participate in the public debate against legalization of assisted suicide and euthanasia. His commentaries in letters to the editor have been published throughout the United States, in Canada, the UK and New Zealand. For example, click here.

William Reichel MD: Dutch law allows euthanasia

Originally published in The Advocate, the Official Publication of the Idaho State Bar, October 2010.
http://www.margaretdore.com/info/October_Letters.pdf
        
I am a physician who has studied assisted-suicide and euthanasia since 1988, especially in the Netherlands.  I respond to Margaret Dore's article, which quotes me for the proposition that those who believe that legal euthanasia and/or assisted suicide will assure their "choice," are naive.  ("Aid in Dying: Not Legal in Idaho; Not About Choice").  The quote is accurate....

In the Netherlands, Dutch law calls for performing euthanasia and assisted suicide with the patient's consent.  This is not, however, always done.  Indeed, over time, assisted-suicide on a strictly voluntary basis evolved into allowing euthanasia on an involuntary basis.  Euthanasia is also performed on infants and children, who are not capable of giving consent.

2005 is the most recent year for which we have an official report from the Dutch government.  The report is "spun" to defend its law, but nonetheless concedes that 550 patients (an average of 1.5 per day) were actively killed by Dutch doctors "without an explicit request."  The report also concedes that an additional 20% of deaths were not reported to the authorities as required by Dutch law.
        
 [Proponents of assisted suicide and euthanasia] hold . . . out the carrot of  "choice" to induce the public into believing that [these practices] are somehow benign.  Do not be misled.

William Reichel, M.D.
Affiliated Scholar
Center for Clinical Bioethics
Georgetown University School of Medicine
Washington DC

Mild stroke led to mother's forced starvation

By Kate Kelly

I watched an old woman die of hunger and thirst.  She had Alzheimer's, this old woman, and was child-like, trusting, vulnerable, with a child's delight at treats of chocolate and ice cream, and a child's fear and frustration when tired or ill.
Kate Kelly with a
photo of her mother.

I watched her die for six days and nights.

I watched her suffer, and I listened to the medical practitioners, to a son who legally decided her fate, and to an eldest daughter who advised him and told me that the old woman, my mother, was "comfortable," except when she was "in distress," at which times the nurses medicated her to make her "comfortable" again.

I watched the old woman develop ulcerations inside her mouth as she became more and more dehydrated; the caregivers assured me these were not painful.

I listened to her breathing become more and more laboured, as her lungs became congested from the morphine administered every three to four hours, and later every hour.

That is what morphine does, you see.  It relieves pain, but its cumulative effect is that eventually it shuts down the respiratory system.

No one explained why the old woman was given morphine in the first place, since she was conscious and trying to speak.  It is normal that a mild stroke causes temporary inability to swallow, slurred speech, and a severe headache, but all of these are often reversed when the stroke victim is treated and the treatment includes nourishment and water.

The explanation for not giving nourishment and water - a feeding tube and IV (intravenous) - is that these were "extraordinary measures" for keeping someone alive.

I watched the old woman day and night for six days.  The first night, after the first shot of morphine, her mouth hung open and her tongue started to roll and flutter.  At the same time, her jaw trembled continuously.

This went on all night and into the early hours of the morning.  Her mouth never closed again, except to clamp tightly on wet cloths placed on her lips.  Her eyes were partially closed, but they moved back and forth, back and forth, becoming small slits after seven or eight hours, not closing fully until that long first night was over.

She opened her eyes only once after that, when the nurse was late with the morphine, on the third, or maybe the fourth, day.

The old woman started to moan.

Not moaning, said the nurses and the old woman's eldest daughter.  Just air escaping from the lungs.  Not moaning at all.

The old woman's eyes started to open, and the air escaping from the lungs sounded exactly like a moan of agony, as the old woman's face twisted in horrible contortions.  I screamed, "Her eyes are opening! Oh, God. Oh, God!"

Even as the morphine, quickly injected by a disconcerted nurse, caused the old woman's eyes to close and her face to relax, I doubted its efficacy.  I thought back to the night before, when I, in tears at the old woman's slow dying, had been confronted by a delegation of four of the nursing staff, each of them in turn trying to convince me that the old woman was not suffering in any way at all.  The morphine, they said, takes away all pain.

But, I answered them, she can feel: she's squeezing my hand, and if I try to take my hand out of hers, she squeezes tighter, and when I hold a little piece of gauze to her lips, she tries to suck the water out of it.  She's thirsty!  This is a horror; this is cruelty!

No, they said.  She's not thirsty.  It's just reflex.  But, I tell them, I watched her clamp her lips on the gauze so tightly that I had to pull to get it out of her mouth.

She reacts when you touch her feet, her legs, and her hair. If she can feel that she can feel thirst, I plead with them.

It's not the same, they tell me.  She's not in pain.

I look at her.  But what if you're wrong? I say.  What if you're wrong?

They stand there, saying nothing.  Then one looks at the old woman and says, we'd better turn her now.  She and another care worker go about the business of repositioning the old woman, to keep her “comfortable" and the other two leave.

The days and nights went in and out of focus.  I sat in a chair at the side of the old woman's bed, one hand grasped tightly by her hand.  I slept an hour or two, here and there, waking always with a start.

"I'm here," I murmured, so the old woman would know I was keeping the promise I made to her on the first night, after her son and eldest daughter left to get some food, drink, and rest.  I promised her then, "I will not leave here until you do.

The old woman was fading by the fourth day.  Her eldest daughter had been visiting for an hour or so each day, usually mid-morning.  This daughter, a former hospital worker, lightly stroked her mother's face and hair and timed the length of her mother's "breath apnea," the length of time her mother
stopped breathing.

She announced the number of seconds, and then counted the number of breaths between each stopped breath.  Seven breaths, she said, 11 breaths.

Sometimes she described the progress of her mother's death, She's probably down to about 60 pounds now, she pronounced.

Sometimes - I'm not sure when I noticed it first - the nurses asked us to leave while they attended to the old woman.  Other times they didn't.  Once, perhaps on the fourth day, I told them I didn't have to leave: I had watched them turn her, I had seen her tiny naked body as they gently washed her.  I didn't even flinch anymore when they injected the syringe of morphine.

We have to give her a suppository, they said.

A suppository?  Why?

For anxiety, they said.

Anxiety.  So that she would appear to die with dignity.  The morphine was no longer enough.  This courageous old woman, who could face, who had faced, unimaginable hardships with nothing but her faith and her dignity, she could teach you about dignity, I thought to myself.

On the fifth day the eldest daughter visited twice.  On her second visit, several staff members entered the room with her.   They were all talking loudly, about nothing in particular, except for one care worker, fond of the old woman, who walked over to the bed and called the old woman's name loudly enough to interrupt the others' light conversation.  She examined the old woman's hands, lifted the sheet covering her and looked at her legs and feet.  She called the old woman's name again, and the care worker's face showed alarm.

How long has it been? she asked.  She's not even mottling! (Mottling is the term given to describe the blackening of the feet and hands as the body, dehydrating, tries to preserve the vital organs by stopping the flow of blood to the limbs).

You know, continued the care worker, I don't think it's her time.  It's been, what, five days?  If she had been ready to go, she'd have gone in 24 hours.

The room went quiet.  The care worker and I looked at each other.  You're right, I said.  The eldest daughter and one of the nurses began to tell her she was wrong, and a nurse hustled her out of the room.

By the sixth night I was not sure I could go on.  I slept for an hour or so every four or five hours. I still sat in the chair by her bed, but now I slept with my head on bed, near her stomach.

The old woman's breathing was laboured, her will to live defying the system and the foolish young doctor who, on that first night, gave her 24 hours to live, as though he were God Himself.

My heart was breaking for her.  I could do nothing to save her, could do nothing but suffer with her.  I cried much of the time, but softly, so she would not know.  I didn't want to add to her agony.

I had been there six days.  She could no longer hold my hand, so I slipped my hand gently under hers.  I felt an anguish so profound that I began to wonder if I could survive it.

The old woman's breathing was suddenly no longer laboured.  Her breath eased from her, and her face - oh, her face had become the colour of pearls.

In a split second, the frown that had creased the line between her brows was smoothed away.  Her head rested gently to one side.  Two care workers entered the room.  I saw them in my peripheral vision, but I kept my gaze on the old woman.

We're just going to turn her, one of the workers said.

No, I said, my mother is dying.

One of them left to get a nurse, and then the old woman - my dear mother, my little, child-like, beautiful mother - died.

I put my arms round her, kissed her poor, closed eyes and her now relaxed mouth, and held her limp, tiny body, no more struggling for breath.

I watched an old woman die of hunger and thirst.  I watched her die for six days and nights.  I watched her suffer, and struggle, and hold onto life.

She had not often found life easy, but she had always found it worthwhile.  She was 94 years old.  She had been born and had lived all her life in Canada.  She had worked hard all her life, married, raised three children, voted, paid taxes, saved enough money to buy her own home, obeyed the laws, donated to charity, done volunteer work, paid her bills, and given much love and brought much joy to many, many people in her 94 years.

In return, in the spring of 2009, her son and her eldest daughter, with the permission and assistance of the law, because this old woman had had a mild stroke, refused her food and water.  She could not swallow, so she would have needed the food and water administered artificially.

And the youngest daughter could do nothing except watch her mother die slowly, and write this, in the hope that my mother's death, like her life, will have made a difference.

* * *

Kate Kelly is a member of the Board of Choice is an Illusion.  She is also a teacher, a jazz singer and a former newspaper reporter.  To read more about Kate, click here.

"He made the mistake of asking for information about assisted suicide"

http://missoulian.com/news/opinion/mailbag/legalizing-assisted-suicide-allows-physicians-to-pressure-patients/article_5726f258-84fb-11e2-9707-001a4bcf887a.html

Last year, my brother, Wes Olfert, died in Washington state, where assisted suicide is legal.

When he was first admitted to the hospital, he made the mistake of asking for information about assisted suicide. I say a mistake, because this set off a chain of events that interfered with his care and caused him unnecessary stress in what turned out to be the last months of his life.

By asking the question, he was given a “palliative care” consult by a doctor who heavily and continually pressured him to give up on treatment before he was ready to do so. It got so bad that Wes actually became fearful of this doctor and asked me and a friend to not leave him alone with her. Justified or not, Wes was afraid that the doctor would do something to him or have him sign something if she would find him alone.

In fact, even though he was on heavy doses of narcotic pain medications and not in a clear state of mind to sign documents without someone to advocate for him, this palliative care MD actually did try to get him to sign a DNR or “Do Not Resuscitate” form without his Durable POA or any family member present. Fortunately, his close friend/POA arrived at that moment to stop this from happening. Some of the other doctors and staff members seemed to also write Wes off once they learned that he had asked about assisted suicide.

I am writing to urge your readers to prevent assisted suicide in Montana. I do this on behalf of myself and my other brother, Ron Olfert, of Sanders County, who also died last year. He was strongly opposed to assisted suicide.

Please contact your legislators and ask them to vote “yes” on House Bill 505.

Marlene Deakins, RN
Tuscon, Arizona

Friday, January 3, 2014

Suicide prevention plans at odds with right to die

This Canadian article is consistent with the Oregon experience in which legalization of physician-assisted suicide was followed by a significant increase in other suicides.  See footnote 1.

http://www.calgaryherald.com/opinion/op-ed/Martinuk+Suicide+prevention+plans+odds+with+right/9343852/story.html

By Susan Martinuk, Calgary Herald January 3, 2014 

Retired politician Bob Rae used the occasion of a friend's apparent suicide to call on Canada to establish a national suicide prevention plan.
Susan Martinuk

Chris Peloso was Rae's friend and well known in Ontario's political circles as the husband to George Smitherman, a former high-profile cabinet minister and politician. Media reports haven't utilized the term suicide, but the phrase "lost his battle with depression" seems to indicate that was the case.

Calls for such a strategy are made every time there is a high-profile suicide in this country (such as Amanda Todd and Rehtaeh Parsons, two girls who suffered unbearable bullying in school and on the Internet). Parliament passed a suicide prevention strategy one year ago, but few seem to be aware of its existence or its implementation, and society continues to call for somebody to do something to prevent such tragedies from occurring.

Prevention is usually a good policy. But I have questions about whether any suicide prevention policy can be successful with Canada's health-care system and be consistent with other societal messages.

The first question is how can we effectively prevent suicides by those who are depressed when our health-care system offers limited (at best) access to psychiatric care and treatment?

A depressed person can call a suicide hotline or speak with a counsellor, and a crisis may be prevented. Or maybe not. But, at some point, the only way to prevent suicide is to access medical treatment.

The Fraser Institute's 2013 report, Waiting Your Turn: Wait Times for Health Care in Canada, reveals that the national average wait time from referral by a general practitioner to the time of beginning non-urgent psychiatric treatment was 20.3 weeks. If you live in New Brunswick, that wait is 73.5 weeks. That's about 1.5 years to access treatment and includes a 46-week wait from the time of GP referral to seeing a psychiatric specialist.

If you live in Saskatchewan, the wait for treatment is one year. Even if the case is urgent, patients still face a five-week wait to get an appointment with a psychiatrist. Anyone familiar with depression or other mental illnesses knows that a lot can change in five weeks, let alone one year.

Rae thinks it's important to have public conversations about mental illness. But awareness has absolutely nothing to do with treatment and, based on the above statistics, it's difficult to imagine that any province could maintain an effective suicide prevention strategy.

My second question raises an issue that Canadians may not be familiar with, but will undoubtedly face in the coming months as Quebec (and eventually the rest of Canada) debates the legalization of euthanasia.

That is, how can we credibly promote suicide prevention strategies at the same time as a large portion of society is publicly claiming they have a right to die? After all, euthanasia is supposedly about the right to self-determination when individuals are forced to live in circumstances that are unbearable.

At least that's how the conversation goes. The reality of legalization is very different, as we've seen in Belgium, the Netherlands, Switzerland and Oregon. Each of these has relaxed their laws to the point that depressed people can easily access euthanasia. As one bioethicist claims, euthanasia in these districts expands the options for the mentally ill and "empowers" them when they make the choice.

A 2005 study in the Journal of Clinical Oncology showed that almost one half (44 per cent) of requests for euthanasia were made by patients with depression. These authors started with the premise that terminally ill people who requested euthanasia were more accepting of death and that depression would therefore not be a factor. In contrast, they found that depressed patients were four times more likely to request death.

A report in Current Oncology in 2011 summarized euthanasia in the Netherlands by saying that in 30 years, it "has moved from euthanasia of people who are terminally ill, to euthanasia of those who are chronically ill; from euthanasia for physical illness, to euthanasia for mental illness; from euthanasia for mental illness, to euthanasia for psychological distress of mental suffering," and now to euthanasia of those over 70 who are simply "tired of living."

How do we talk about such facts while promoting a national suicide prevention policy? A society that knows the slippery slope of euthanasia and still accepts its legalization has no credibility in talking about suicide prevention for those with mental illness.

Susan Martinuk is a columnist based in Western Canada. Her column appears every Friday.

* * *
[1]   This quote is from  page 17 of Vote No on SB 220:
Oregon’s suicide rate, which excludes suicide under Oregon’s physician-assisted suicide act, is 35% higher than the national average.  This rate has been "increasing significantly since 2000." Just three years prior, Oregon legalized physician-assisted suicide.  This increased suicide rate is consistent with a suicide contagion (legalizing one type of suicide encourag[ing] other suicides).  There is, regardless, a statistical correlation between these two events.

Washington's Assisted Suicide Act

Originally published as "'Death with Dignity':  What Do We Advise Our Clients?," King County Bar Bulletin, May 2009.  See here.

Margaret Dore, Esq.

A client wants to know about the new Death with Dignity Act, which legalizes physician-assisted suicide in Washington.1 Do you take the politically correct path and agree that it's the best thing since sliced bread? Or do you do your job as a lawyer and tell him that the Act has problems and that he may want to take steps to protect himself?

Patient "Control" is an Illusion

The new act was passed by the voters as Initiative 1000 and has now been codified as Chapter 70.245 RCW.  During the election, proponents touted it as providing "choice" for end-of-life decisions. A glossy brochure declared, "Only the patient — and no one else — may administer the [lethal dose]."2 The Act, however, does not say this — anywhere. The Act also contains coercive provisions. For example, it allows an heir who will benefit from the patient's death to help the patient sign up for the lethal dose.

How the Act Works

The Act requires an application process to obtain the lethal dose, which includes a written request form with two required witnesses.The Act allows one of these witnesses to be the patient's heir.4 The Act also allows someone else to talk for the patient during the lethal-dose request process, for example, the patient's heir.5 This does not promote patient choice; it invites coercion.

Interested witness

By comparison, when a will is signed, having an heir as one of witnesses creates a presumption of undue influence. The probate statute provides that when one of the two required witnesses is a taker under the will, there is a rebuttable presumption that the taker/witness "procured the gift by duress, menace, fraud, or undue influence."6

Once the lethal dose is issued by the pharmacy, there is no oversight. The death is not required to be witnessed by disinterested persons. Indeed, no one is required to be present. The Act does not state that "only" the patient may administer the lethal dose; it provides that the patient "self-administer" the dose.

"Self-administer"

In an Orwellian twist, the term "self-administer" does not mean that administration will necessarily be by the patient. "Self-administer" is instead defined as the act of ingesting. The Act states, "'Self-administer' means a qualified patient's act of ingesting medication to end his or her life."7

In other words, someone else putting the lethal dose in the patient's mouth qualifies as "self-administration." Someone else putting the lethal dose in a feeding tube or IV nutrition bag also would qualify. "Self-administer" means that someone else can administer the lethal dose to the patient.

No witnesses at the death

If, for the purpose of argument, "self-administer" means that only the patient can administer the lethal dose himself, the patient still is vulnerable to the actions of other people, due to the lack of required witnesses at the death.

With no witnesses present, someone else can administer the lethal dose without the patient's consent. Indeed, someone could use an alternate method, such as suffocation. Even if the patient struggled, who would know? The lethal dose request would provide an alibi.

This situation is especially significant for patients with money. A California case states, "Financial reasons [are] an all too common motivation for killing someone."8 Without disinterested witnesses, the patient's control over the "time, place and manner" of his death, is not guaranteed.

If one of your clients is considering a "Death with Dignity" decision, it is prudent to be sure that they are aware of the Act's gaps.

What to Tell Clients

1. Signing the form will lead to a loss of control

By signing the form, the client is taking an official position that if he dies suddenly, no questions should be asked. The client will be unprotected against others in the event he changes his mind after the lethal prescription is filled and decides that he wants to live. This would seem especially important for clients with money. There is, regardless, a loss of control.

2. Reality check

The Act applies to adults determined by an "attending physician" and a "consulting physician" to have a disease expected to produce death within six months.9 But what if the doctors are wrong? This is the point of a recent article in The Seattle Weekly: Even patients with cancer can live years beyond expectations10. The article states:
Since the day [the patient] was given two to four months to live, [she] has gone with her children on a series of vacations . . . .
"We almost lost her because she was having too much fun, not from cancer," [her son chuckles].11 
Conclusion

As lawyers, we often advise our clients of worst-case scenarios. This is our obligation regardless of whether it is politically correct to do so. The Death with Dignity Act is not necessarily about dignity or choice. It also can enable people to pressure others to an early death or even cause it. The Act also may encourage patients with years to live to give up hope. We should advise our clients accordingly.

Margaret Dore is a Seattle attorney admitted to practice in 1986. She is the immediate past chair of the Elder Law Committee of the ABA Family Law Section. She is a former chair of what is now the King County Bar Association Guardianship and Elder Law Section. For more information, visit her website at www.margaretdore.com.

1 The Act was passed by the voters in November as Initiative 1000 and has now been codified as RCW chapter 70.245 [available at http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245 ]
2 I-1000 color pamphlet, "Paid for by Yes! on 1000."
3 RCW 70.245.030 and .220 state that one of two required witnesses to the lethal-dose request form cannot be the patient's heir or other person who will benefit from the patient's death; the other may be.  [See http://www.margaretdore.com/pdf/C-SECTION-3_001.pdf]
4 id.
5 RCW 70.245.010(3) allows someone else to talk for the patient during the lethal-dose request process; for example, there is no prohibition against this person being the patient's heir or other person who will benefit from the patient's death. The only requirement is that the person doing the talking be "familiar with the patient's manner of communicating."
7 RCW 70.245.010(12).
8 People v. Stuart, 67 Cal. Rptr. 3rd 129, 143 (2007).
9 RCW 70.245.010(11) & (13).
10 Nina Shapiro, "Terminal Uncertainty," Washington's new "Death with Dignity" law allows doctors to help people commit suicide - once they've determined that the patient has only six months to live. But what if they're wrong? The Seattle Weekly, January 14, 2009. http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty [or formatted versions here and here - the second version is more clear, but has an advertisement that may be objectionable to some viewers]
11 id.