Sunday, November 20, 2016

Quick Facts: District of Columbia B21-38

By Margaret Dore, Esq., MBA

Margaret Dore Esq., MBA, Councilmember
Yvette Alexander
For more information, see Memo Opposing B21-38 and attachments. See also Suicide Contagion Memo and attachments.

1.  Overview

B21-38 legalizes physician-assisted suicide and euthanasia as those terms are traditionally defined. Legally authorized participants include health care providers and family members.

2.  Definitions

Assisted suicide means that someone provides the means and/or information for another person to commit suicide. When a physician is involved,

the practice is physician-assisted suicide. Euthanasia, by contrast, is the direct administration of a lethal dose to cause another person's death. Euthanasia is also known as mercy killing and death by lethal injection.

3.  Suicide Contagion

B21-38 is based on a similar law in Oregon, enacted in late 1997. By 2000, Oregon's conventional suicide rate was "increasing significantly" and has continued to rise over time. This is consistent with a suicide contagion in which the legalization of physician-assisted suicide has encouraged other suicides.

In 2007, Oregon's conventional suicide rate was 35% higher than the national average; by 2010, Oregon's conventional suicide rate was 41% higher than the national average; by 2012, Oregon's conventional suicide rate was 42% higher than the national average. 

4.  The Cost of Suicide

A recent Oregon government report states: "The cost of suicide is enormous. In 201[2] alone, self-inflicted injury hospitalization charges in Oregon exceeded $54 million; and the estimate of total lifetime cost of suicide in Oregon was over $677 million."

5.  "Eligible" Persons May Have Years to Live

B21-38 applies to persons with a "terminal disease" with a prognosis of less than six months to live. In Oregon, this criteria is determined without treatment. Consider, for example, Jeanette Hall who was given a terminal diagnosis of six months to a year to live. This was based on her not being treated for cancer. She decided to use Oregon's law, but her doctor  stalled her and eventually convinced her to be treated. In a 2016 declaration she states: "This July, it will be 16 years since my diagnosis If [my doctor] had believed in assisted suicide, I would be dead."

In Oregon, annual statistical reports list chronic conditions such as diabetes mellitus (diabetes) as  underlying conditions sufficient to justify assisted suicide. 

6.  B21-38 Is a Recipe for Elder Abuse

Elder abuse is a significant problem in the District of Columbia and throughout the United States. Victims may even be murdered. The D.C. Department of Human Services states: "Typically, the abuser is a relative, frequently an adult child of the victim."

B21-38 allows a patient's adult child, who will financially benefit from the patient's death, to actively participate in the lethal dose request process. In the context of a executing a will, similar conduct is used to prove coercion and undue influence. 

Once the lethal dose is issued by the pharmacy, there is no oversight. No witness, not even a doctor is required to be present at the death. Even if the patient struggled, who would know?

7.  In Oregon, Law Enforcement Cannot Access Information Collected by the State

B21-38 contains language similar to Oregon's law, which in Oregon is interpreted to bar law enforcement from accessing information about deaths under Oregon's law. Oregon lawyer Isaac Jackson states: "Even law enforcement is denied access to information collected by the State."

8.  Contradictory Language

B21-38 provides patient protections in the front part of the bill. These protections are taken away in the back part of the bill in which doctors and other participants are to act in "accordance" with the act and in "good faith," which allows participants to merely act in the spirit of the law without actual compliance; "legal technicalities" can be ignored.

B21-38 also provides a felony for coercion or exerting undue influence, although as noted above, the bill also allows conduct normally used to prove coercion and undue influence.  For this reason, the felony is unenforceable.

9.  Physician-Assisted Suicide Can Be Traumatic for Patients and Families

In 2012, a European research study addressed trauma suffered by persons who witnessed legal physician-assisted suicide in Switzerland. The study found that one out of five family members or friends present at an assisted suicide was traumatized. These people, "experienced full or sub-threshold PTSD (Post Traumatic Stress Disorder) related to the loss of a close person through assisted suicide." I have seen this in my cases, plus trauma for the patients as well.

10.  Pain Is Not the Issue

I am not aware of any case in which a person has used Oregon's law for uncontrolled physical pain; the Oregon statistics do not make this claim  (they talk about "concerns" of "inadequate pain control or concern about it") . (Emphasis added).