Monday, April 15, 2019

Maine: Tell the Legislature to Reject Bill LD 1313; Say "No" to Assisted Suicide & Euthanasia

By Margaret Dore, Esq., MBA

Click here for pdf version.

I.  INTRODUCTION

I am an attorney in Washington State where assisted suicide is legal.[1] Our law is based on a similar law in Oregon. In the fine print, both laws allow euthanasia. Both laws are similar to the proposed bill, LD 1313.[2]

The proposed bill seeks to legalize physician-assisted suicide and euthanasia as those terms are traditionally defined. If enacted, the bill will apply to people with years or decades to live. Individuals with money, meaning the middle class and above, will be especially at risk. I urge you to reject LD 1313.

II.  DEFINITIONS

A.  Physician-Assisted Suicide, Assisted Suicide and                         Euthanasia

The American Medical Association (AMA) defines physician-assisted suicide as occurring when “a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act.”[3] For example:
[T]he physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide.[4]
Assisted suicide is a general term in which an assisting person is not necessarily a physician.  Euthanasia is the administration of a lethal agent “by another person.”[5]

B.  Withholding or Withdrawing Treatment 

Withholding or withdrawing treatment (“pulling the plug”) is not euthanasia if the purpose is to remove burdensome treatment, as opposed to an intent to kill the patient. More importantly, the individual will not necessarily die. Consider this quote from Washington State regarding a man removed from a ventilator:
[I]nstead of dying as expected, [he] slowly began to get better.[6]
III.  ASSISTING PERSONS CAN HAVE AN AGENDA

Persons assisting a suicide or euthanasia can have an agenda. Consider Tammy Sawyer, trustee for Thomas Middleton in Oregon. Two days after his death by legal assisted suicide, she sold his home and deposited the proceeds into bank accounts for her own benefit.[7] Consider also Graham Morant, recently convicted of counseling his wife to kill herself in Australia, to get the life insurance. The Court found:
[Y]ou counseled and aided your wife to kill herself because you wanted . . . the 1.4 million.[8]
Medical professionals too can have an agenda. Michael Swango, MD, now incarcerated, got a thrill from killing his patients.[9] Consider also Harold Shipman, a doctor in the UK, who not only killed his patients, but stole from them and in one case made himself a beneficiary of the patient’s will.[10]

IV. PUSHBACK AGAINST ASSISTED SUICIDE AND                            EUTHANASIA

In 2016, the New Mexico Supreme Court overturned a lower court decision recognizing a right to “physician aid in dying,” meaning physician-assisted suicide.[11] Physician-assisted suicide is no longer legal in New Mexico. In the last eight years, seven other states have strengthened their laws against assisted suicide and/or euthanasia. They are: Alabama, Arizona, Louisiana, Georgia, Idaho, Ohio, and Utah.[12]

V.  HOW THE BILL WORKS

The bill has an application process to obtain the lethal dose, including a lethal dose request form.[13]  Once the lethal dose is issued by the pharmacy, there is no oversight.[14] No witness, not even a doctor, is required to be present at the death.[15]

VI. THE BILL WILL APPLY TO PEOPLE WITH YEARS OR                     DECADES TO LIVE

The proposed bill applies to people with a “terminal disease,” meaning those predicted to have less than six months to live.[16] Such persons may, in fact, have years or decades to live. This is true for three reasons.

A.  If Maine Follows Oregon Practice, the Bill Will Apply to             Young Adults With Chronic Conditions Such as Diabetes

The bill states:
"Terminal disease" means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within 6 months.[17]
Oregon’s law has a nearly identical definition:
“Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.[18]
In Oregon, this nearly identical definition is interpreted to include chronic conditions such as insulin dependent diabetes.[19] Oregon doctor, William Toffler, explains:
5.  In Oregon, people with chronic conditions are “terminal,” if without their medications, they have less than six months to live. This is significant when you consider that a typical insulin-dependent 20 year-old will live less than a month without insulin.

6.  Such persons, with insulin, are likely to have decades to live. In fact, most diabetics have a normal life span given appropriate control of their blood sugar. They can live happy, healthy and productive lives.[20] 
B.  Predictions of Life Expectancy Can Be Wrong

Eligible persons may also have years or decades to live because predictions of life expectancy can be wrong.  This is true due to actual mistakes (the test results got switched), and because predicting life expectancy is not an exact science.[21]

Consider John Norton, who was diagnosed with ALS (Lou Gehrig’s disease) at age 18.[22] He was told that he would get progressively worse (be paralyzed) and die in three to five years.[23] Instead, the disease progression stopped on its own.[24] In a 2012 affidavit, at age 74, he states:
If assisted suicide or euthanasia had been available to me in the 1950's, I would have missed the bulk of my life and my life yet to come.[25]
C.  Treatment Can Lead to Recovery

Consider also Jeanette Hall, who was diagnosed with cancer in 2000 and made a settled decision to use Oregon’s law.[26] Her doctor convinced her to be treated instead.[27] In a 2018 declaration, she states:
It has now been 18 years since my diagnosis.  If [my doctor] had believed in assisted suicide, I would be dead.[28]
VII.  THE BILL WILL CREATE A PERFECT CRIME

A.  The Definition of “Self-Administer” Does Not Require the           Qualified Patient to Know or Understand That He or She Is       Taking a Lethal Dose  

The bill states:
"Self-administer" means, for a qualified patient, to voluntarily ingest medication to end the qualified patient's life in a humane and dignified manner.[29]
With this definition, the qualified individual is not required to know or understand that the medication being taken is a lethal dose.

B.  The Cause of Death Will Be a Terminal Illness

The bill states:
A patient's death certificate, pursuant to section 2842 [Registration of deaths], must list the underlying terminal disease as the cause of death.  (Emphasis added).[30]
The significance of requiring a terminal disease to be listed as the cause of death on the death certificate is that it will create a legal inability to prosecute. Even if the qualified patient thought that he or she was taking a cold medication instead of the lethal dose, the official legal cause of death will be a terminal disease (not murder) as a matter of law.

VIII.  DR. SHIPMAN AND THE CALL FOR DEATH CERTIFICATE              REFORM

Per a 2005 article in the UK’s Guardian newspaper, there was a public inquiry regarding Dr. Shipman’s conduct, which determined that he had “killed at least 250 of his patients over 23 years.”  The inquiry also found:
that by issuing death certificates stating natural causes, the serial killer [Shipman] was able to evade investigation by coroners.[32]
Per a subsequent article in 2015, proposed reforms included having a medical examiner review death certificates, so as to improve patient safety.[33] Instead, the instant bill moves in the opposite direction to require a legal coverup in which doctors and other perpetrators will be able to kill patients with impunity.

IX. “EVEN IF THE PATIENT STRUGGLED, WHO WOULD KNOW?”

The bill has no required oversight over administration of the lethal dose.[34] In addition, the drugs used are water and alcohol soluble, such that they can be injected into a sleeping or restrained person without consent. Alex Schadenberg, Executive Director for the Euthanasia Prevention Coalition, puts it this way:
With assisted suicide laws in Washington and  Oregon [and with the proposed bill], perpetrators can . . . take a “legal” route, by getting an elder to sign a lethal dose request.  Once the prescription is filled, there is no supervision over administration.  Even if a patient struggled, “who would know?”  (Emphasis added).[36]
X.  EUTHANASIA WILL BE ALLOWED OR NONETHELESS OCCUR

The bill refers to the lethal dose as “medication,” which may be self-administered.  The bill does not say that the lethal dose “must” be self-administered.[37] Generally accepted medical practice allows a doctor, or a person acting under the direction of a doctor, to administer medication to a patient.[38]

With the medication a lethal dose, the bill allows euthanasia as traditionally defined.

The bill, however, also says that state reports must refer to acts committed under the bill as “self-administering life-ending medication.”[39]

If for the purpose of argument, another person administering the lethal dose is not allowed, it will nonetheless occur due to the bill’s complete lack of oversight at the death and motives such as life insurance and inheritance money. Consider also the quote below from an article in the New England Journal of Medicine, regarding a study of assisted suicide versus euthanasia. Problems were experienced more frequently with assisted suicide, which led to euthanasia:
The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5).[40]
XI. PARTICIPANTS WILL BE TRAUMATIZED 

A. The Swiss Study:  Physician-Assisted Suicide Can Be                  Traumatic for Family Members and Friends

In 2010, a European research study addressed trauma suffered by persons who witnessed legal physician-assisted suicide in Switzerland.[41] The study found that one out of five family members or friends present was traumatized, with the most severe mental health problems occurring 14 to 24 months post loss.[42] An article describing the study states that these people,
experienced full or sub-threshold PTSD (Post Traumatic Stress Disorder) related to the loss of a close person through assisted suicide.[43]
B. My Clients Suffered Trauma in Oregon and Washington              State

In Oregon and Washington State, I have had two cases where my clients and their family member patients suffered severe emotional trauma due to legal assisted suicide. In the first case, one side of the family wanted the father/patient to take the lethal dose, while the other side did not. The father spent the last months of his life caught in the middle and torn over whether or not he should kill himself. My client, his adult daughter, was severely traumatized. The father did not take the lethal dose and died a natural death.

In the other case, it’s not clear that administration of the lethal dose was voluntary. A man who was present told my client that his (my client's) father had refused to take the lethal dose when it was delivered, stating: "You're not killing me.  I'm going to bed." The man also said that my client’s father took the lethal dose the next night when he (the father) was already intoxicated on alcohol. The man who told this to my client subsequently changed his story.

My client, although he was not present, was severely  traumatized over the incident, and also by the sudden loss of his father.  He also followed the pattern of the Swiss cases described above, becoming especially traumatized about a year and a half after the death. 

XII. OREGON

A.  Oregon’s Data Collection Protocol for its Annual Reports           Does Not Record Patient Identities in Any Manner; Source         Documentation Is Destroyed

Oregon’s website describes the data collection protocol for its annual reports, as follows:
The identity of participating physicians is coded, but the identity of individual patients is not recorded in any manner. Approximately one year from the publication of the Annual Report, all source documentation is destroyed. (Emphasis added).[44]
Alicia Parkman, Mortality Research Analyst for the Oregon Health Authority [similar to Maine’s Department of Health and Human Services], makes a similar representation as follows:
To ensure confidentiality, our office does not maintain source information on participants. (Emphasis added).[45]
The significance is that Oregon’s annual reports are unverifiable. With this being the case, should Maine now enact a similar law based on the Oregon experience as presented by its unverifiable reports? Given that the instant bill involves life and death, the answer would seem to be an obvious “No.”

B. If Maine Follows Oregon’s Interpretation of “Not a Public          Record,” the Department of Health & Human Services 
      Will Be Insulated from Review

The bill charges the Department of Health and Human Services with issuing its own annual report.[46] The bill also states:
Except as otherwise provided by law, the information collected is confidential, is not a public record and may not be made available for inspection by the public ... (Emphasis added).[47]
Oregon’s law has a similar provision, as follows:
Except as otherwise required by law, the information collected shall not be a public record and may not be made available for inspection by the public. (Emphasis added).[48]
In Oregon, this similar provision is interpreted to bar release of information about individual cases, to everyone, including the media, researchers, students, advocates and law enforcement. Oregon’s website states:
[T]he Act specifically states that information collected is not a public record and is not available for inspection by the public (ORS 127.865 (2)).  The protection of confidentiality conferred by the Death with Dignity Act precludes the Oregon Health Authority [which oversees Oregon’s Department of Health] from releasing information that identifies patients or participants, to the public, media, researchers, students, advocates, or other interested parties.... (Emphasis added).[49]
Consider also this e-mail from Alicia Parkman, Mortality Research Analyst for the Oregon Health Authority, which states:
We have been contacted by law enforcement . . . in the past, but have not provided identifying information of any type. (Emphasis added).[50]
If Maine enacts the proposed bill and follows Oregon’s interpretation of “not a public record,” there will be a similar lack of transparency in which even law enforcement will have no access to information about individual cases.  How can the bill be considered safe?

C. If Maine Enacts the Proposed Bill and Follows Oregon               Practice, Assisted Suicide/Euthanasia Advocate,                         Compassion & Choices, Will Effectively Displace the                   Department of Health and Human Services as the Entity             Overseeing the Bill

In 2010, I had client who wanted to know if his father had died under Oregon’s law. I referred him to Oregon attorney Isaac Jackson, who asked the police to investigate. Jackson’s subsequent declaration states:
3.  In 2010, I was retained by a client whose father had apparently died under Oregon’s law. The client wanted to know whether that was true. I therefore made inquiry on his behalf. However and unlike other deaths I have investigated, it was difficult to get information. . . .
6.  I . . . received a copy of the decedent’s death certificate, which is the official death record in Oregon. A true and correct, but redacted copy, is attached hereto . . . .  The “immediate cause of death” is listed as “cancer.” The “manner of death” is listed as “Natural.”
7.  Per my request, a police officer was assigned to the case. Per the officer’s confidential report, he did not interview my client, but he did interview people who had witnessed the decedent’s death.
8.  The officer’s report describes how he determined that the [father’s] death was under Oregon’s assisted suicide law due to records other than from the State of Oregon. The officer’s report also describes that he was unable to get this information from the Oregon Health Authority, which was not willing to confirm or deny whether the deceased had used the act . . . . (Emphasis added).[51]
I also read the officer’s report.  According to the report,  Compassion & Choices provided the records necessary for the officer to determine that the decedent had, in fact, died under Oregon’s law.  In Oregon, Compassion & Choices, a non-governmental entity, has effectively displaced the Oregon Health Authority as the agency overseeing Oregon’s law.

XIII.  CONCLUSION

If enacted, the bill will apply to people with years or decades to live. This will be especially true if Maine follows Oregon practice to determine life expectancies without treatment. Young adults with chronic conditions, such as insulin dependent diabetes, will be considered terminal and therefore subject to assisted suicide/euthanasia.

Assisting persons, including doctors and family members, can have an agenda, with the more obvious reasons being inheritance and life insurance, but also, as in the case of Dr. Swango, the thrill of seeing someone die. The lack of required oversight at the death, coupled with the mandatory falsification of the death certificate will provide cover for murder. Families and individuals will be traumatized.

Don’t make Oregon and Washington’s mistake. I urge you to reject the proposed bill (H.P. 948, LD 1313).

Respectfully submitted this 8th day of April 2019


Margaret Dore, Esq., MBA
Law Offices of Margaret K. Dore, P.S.
Choice is an Illusion, a nonprofit corporation
www.margaretdore.com
www.choiceillusion.org
1001 4th Avenue, Suite 4400
Seattle, WA 98154
206 697 1217

Footnotes:

[1]  Click here to view my CV.
[2]  The proposed bill  (H.B. 948/LD 1313).
[3]  The AMA Code of Medical Ethics, Opinion 5.7, Physician-Assisted Suicide
[4]  Id.
[5]  The AMA Code of Medical Ethics, Opinion 5.8, Euthanasia
[6]  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?Seattle Weekly, 01/13/09.
[7]  "Sawyer Arraigned on State Fraud Charges," KTVZ.COM, 08/16/16
[8]  R v Morant [2018] QSC 251, Order and Opinion excerpt, page 11, ¶ 78, 11/02/18; full opinion available here
[9]  Charlie Leduff, “Prosecutors Say Doctor Killed to Feel a Thrill,” The New York Times, 09/07/00 (“Basically, Dr. Swango liked to kill people. By his own admission in his diary, he killed because it thrilled him.”). See also: CBSNEWS.COM STAFF, “Life in Jail for Poison Doctor,” 07/12/00.
[10]  David Batty, “Q & A: Harold Shipman,” The Guardian, 08/25/05. See also Fiona Guy, “Healthcare Serial Killers: Doctors and Nurses Who Kill,” Crime Traveller, (2015, Sept 09).
[11]  Morris v, Brandenburg, 376 P.3d 836 (2016).
[12]  For backup documentation, go to this link, pages 3 & 4, footnote 12.
[13]  See the bill in its entirety, link supra at footnote 2.
[14]  Id.
[15]  Id.
[16]  The bill, Sec. 2140.2.M
[17]  Id.
[18]  Or. Rev. Stat. 127.800 s.1.01(12), available at this link
[19]  Click this link for memo and appendix, Oregon Government Report for 2017, listing "diabetes" as a qualifying underlying illness, available at page 57 (A-37).
[20]  Click this link for memo and appendix, pages 58-62 (A-38 to A-42), to view the Declaration of William Toffler, MD, 04/20/17.
[21]  Cf. Jessica Firger, "12 Million Americans Misdiagnosed Each Year," CBS NEWS, April 17, 2014; and Nina Shapiro, "Terminal Uncertainty, " supra at note 6.
[22]  Affidavit of John Norton, available in the appendix at A-44 to A-46, at this link.
[23]  Id., paragraph 1.
[24]  Id., paragraph 4.
[25]  Id., paragraph 5.
[26]  Affidavit of Kenneth Stevens, MD, attached in the appendix at A-47 to A-49; Jeanette Hall discussed at A-47 to A-48; Hall declaration attached at A-50, available at this link.
[27]  Id.
[28]  Id., Declaration of Jeanette Hall, para. 4, at A-50, available at this link.
[29]  The bill, Section 2140.2.L, at page A-6, available at this link.
[30]  Id., the bill, Section 2140.20, available at this link.
[31]  David Batty, supra at note 10.
[32]  Id.
[33]  Press Association, "Death certificate reform delays 'incomprensible,'" The Guardian, January 21, 2015.
[34]  See the proposed bill in its entirety, in the appendix at pages A-5 to A-15, and A-34 to A-36, at this link
[35]  The drugs used include Secobarbital, and Pentobarbital (Nembutal) , which are water and alcohol soluble. 
[36]  Alex Schadenberg, Letter to the Editor, “Elder abuse a growing problem,” The Advocate, Official Publication of the Idaho State Bar, October 2010[37]  The bill, Section 2140.2K, states:
"Qualified patient" means a competent adult who is a resident of this State and who has satisfied the requirements of this Act in order to obtain a prescription for medication that the qualified patient may self-administer to end the qualified patient's life .... 
[38]  Oregon doctor, Kenneth Stevens, MD, testifies:
Generally accepted medical practice allows a doctor, or a person acting under the direction of a doctor, to administer prescription drugs to a patient. Common examples of persons acting under the direction of a doctor, include ... adult children who act under the direction of a doctor to administer drugs to their parents in a home setting. (Spacing changed, in the Appendix at page A-49, at this link).
[39]  The bill, Section 2140.20.
[40]  Johanna H. Groenewoud, MD, "Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands," The New England Journal of Medicine, 02/24/00, at https://www.nejm.org/doi/full/10.1056/NEJM200002243420805
[41]  “Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide,” B. Wagner, J. Muller, A. Maercker; European Psychiatry 27 (2010) 542-546, available at http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf
[42]  Id.
[43]  Id.
[44]  Frequently Asked Questions:  Death With Dignity Act, State of Oregon, printed April 7, 2019, attached in the Appendix at page A-59 (click this link for memo and appendix)
[45]  E-mail from Alicia Parkman to Margaret Dore, 01/04/12, in the appendix at A-57 to A-58.
[46]  The bill, Section 2140.17 states:
The department shall: ...
D. Generate and make available to the public an annual statistical report of information collected under paragraph C and submit a copy of the report to the joint standing committee of the Legislature having jurisdiction over health matters annually by March 1st. (Emphasis added).
[47]  The bill, Section 2140.17.C (last sentence).
[48]  ORS 127.685 s.3.11(2), in the Appendix at A-55 (click this link for memo and appendix).
[49]  "Release of Information Regarding the Death with Dignity Act," Oregon Health Authority website, printed April 7, 2019, copy attached in the Appendix at page A-56 click this link for memo and appendix).
[50]  E-mail from Alicia Parkman to me, 01/04/12, copy attached in the Appendix at page A-57 click this link for memo and appendix).
[51]  Isaac Jackson, Declaration of Testimony, 09/18/12, attached in the Appendix at page A-60 to A-65, click this link for memo and appendix).