"Assisted suicide in Washington and Oregon is a recipe for elder abuse and cloaked in secrecy"

http://missoulian.com/news/opinion/mailbag/oregon-washington-assisted-suicide-laws-include-no-protections-for-patients/article_074c4378-507b-11e2-8348-001a4bcf887a.html

By, Margaret Dore, Esq.  Supporting documentation follows letter, below.

Re: Susan Hancock, “Death with Dignity is about giving people choices" (Dec. 20, guest column):

I disagree with Susan Hancock’s description of how the Washington and Oregon assisted suicide laws work. I disagree that assisted suicide cannot be forced upon an unwilling person.

The Oregon and Washington assisted suicide acts have a formal application process. The acts allow an heir, who will benefit from the patient’s death, to actively participate in this process.

Once the lethal dose is issued by the pharmacy, there is no oversight. For example, there is no witness required at the death. Without disinterested witnesses, the opportunity is created for an heir, or for another person who will benefit from the patient’s death, to administer the lethal dose to the patient without his consent. One method would be by injection when the patient is sleeping. The drugs used in Oregon and Washington are water soluble and therefore injectable. If the patient woke up and struggled, who would know?

The Washington and Oregon acts require the state health departments to collect statistical information for the purpose of annual reports. According to these reports, users of assisted-suicide are overwhelmingly white and generally well-educated. Many have private insurance. Most are age 65 and older. Typically persons with these attributes are seniors with money, which would be the middle class and above, a group disproportionately at risk of financial abuse and exploitation.

The forms used to collect the statistical information do not ask about abuse. Moreover, not even law enforcement is allowed to access information about a particular case. Alicia Parkman a mortality research analyst at the Center for Health Statistics, Oregon Health Authority, wrote me: “We have been contacted by law enforcement and legal representatives in the past, but have not provided identifying information of any type.“

Assisted suicide in Washington and Oregon is a recipe for elder abuse and cloaked in secrecy. Don’t make our mistake.

Supporting documentation below.

Margaret Dore,

Seattle, Wash.

Assisted Suicide Users are Older People with Money

By Margaret Dore, Esq., Updated October 29, 2012

Users of assisted suicide in Oregon and Washington are overwhelmingly white and generally well-educated.[1]  Many have private insurance.[2]  Most are age 65 and older.[3]  Typically persons with these attributes are seniors with money, which would be the middle class and above, a group disproportionately at risk of financial abuse and exploitation.[4] 

In the United States, elder financial abuse costs elders an estimated $2.9 billion per year.[5] Perpetrators include strangers, family members and friends.[6]. The goals of financial abuse perpetrators are achieved "through deceit, threats, and emotional manipulation of the elder."[7]

The Oregon and Washington assisted suicide acts, and the similar Massachusetts proposal, do not protect users from this abuse. Indeed, the terms of these acts encourage abuse. These acts allow heirs and other persons who will benefit from an elder's death to actively participate in his or her lethal dose request.[8] There is also no oversight when the lethal dose is administered, not even a witness is required.[9] This creates the opportunity for an heir, or someone else who will benefit from the person's death, to administer the lethal dose to that person without his consent.[10]  Even if he struggled, who would know?

This is not to say that all persons who use the Oregon and Washington acts are subject to abuse or that their actions are not voluntary.  Rather, the Oregon and Washington acts do not protect such persons from abuse.  Neither will the Massachusetts proposal.

For more information about problems with the Massachusetts' proposal, click here and here. For a "fact check" on the proposal, click here.

[1] See the most current official report from Washington State, "Washington State Department of Health 2011 Death with Dignity Act Report, Executive Summary ("Of the 94 participants in 2011 who died, . . . 94% were white, non-Hispanic . . .75 percent had at least some college education"), available at http://www.doh.wa.gov/portals/1/Documents/5300/DWDA2011.pdf  See also the most current official report from Oregon, also for 2011 ("most [users] were white (95.6%) [and] well-educated (48.5% had at least a baccalaureate degree) . . .", available at http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year14.pdf
[2] See Washington's report in note 1, page 5, table 2 (46% had private insurance only, or a combination of private and Medicaid/Medicare).  See Oregon's report in note 1("patients who had private insurance (50.8%) was lower in 2011 than in previous years (68.0%). . ."
[3] See Washington's report in note 1, page 5, Table 2 (74% were aged 65 or older).  See Oregon's report in note 1, page 2 ("Of the 71 DWDA deaths during 2011, most (69.0%) were aged 65 years or older; the median age was 70 years").
[4]  Educated persons are generally financially better off than non-educated persons; persons with private insurance have funding to pay for it; seniors generally are well off.  See "Broken Trust:  Elders, Family, and Finances, a Study on Elder Financial Abuse Prevention, by the MetLife Mature Market Institute, the National Committee for the Prevention of Elder Abuse, and the Center for Gerontology at Virginia Polytechnic Institute, March 2009, Executive Summary, page 4 ("Elders’ vulnerabilities and larger net worth make them a prime target for financial abuse").
[5]  The Met Life Study of Elder Financial Abuse, " Crimes of Occasion, Desperation, and Predation Against America's Elders," June 2011, page 2, key findings ("The annual financial loss by victims of elder financial abuse is estimated to be at least $2.9 billion dollars, a 12% increase from the $2.6 billion estimated in 2008"). 
[6] Id.
[7] Id., page 3.
[8] See e.g. Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009; and Margaret K. Dore, Memo to Joint Judiciary Committee (regarding Bill H.3884, now Ballot Question No. 2), Section III
[9] Id.  See also entire proposed Massachusetts Act at http://choiceisanillusion.files.wordpress.com/2011/10/ma-initiative.pdf
[10]  The drugs used, Secobarbital and Pentobarbital, are water and alcohol soluable, such that they can be injected without consent, for example, to a sleeping individual.  See "Secobarbital Sodium Capsules, Drugs.Com, at  http://www.drugs.com/pro/seconal-sodium.html  If the person wakes up and trys to fight, who would know? 

Legalization And Violent Deaths

By Margaret Dore

Assisted suicide proponents claim that legal assisted suicide will prevent violent deaths such as those by murder-suicide and suicide involving a handgun.[1] In Oregon where assisted-suicide has been legal since 1997, murder-suicide has not been eliminated.[2]  Indeed, murder-suicides follow "the national pattern."[3]  As discussed below, suicides involving a handgun have also not been eliminated.  Oregon's suicide rate has instead increased with legalization of assisted suicide.

Oregon’s overall suicide rate, which excludes suicides under Oregon’s assisted suicide act, is 35% above the national average.[4] This rate has been "increasing significantly since 2000."[5]  Just three years prior, in 1997, Oregon legalized physician-assisted suicide.[6] Other suicides thus increased, not decreased, with legalization of assisted suicide.  Moreover, many of these deaths are violent.  For 2007, which is the most recent year reported, "[f]irearms were the dominant mechanism of suicide among men."[7] The claim that legalization will prevent violent deaths is without factual support.

* * *

[1]  See e.g. Lindsey Anderson, Associated Press, "Mass. Voters Consider Physician-Assisted Suicide," October 20, 2012, at http://www.wbur.org/2012/10/20/physician-assisted-suicide ("Dr. Marcia Angell ... believes [her father] would've lived longer and not turned to a pistol had assisted suicide been available").
[2]  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); Baldr Odinson, "Fourth Murder-Suicide for the Eugene Area," New Trajectory:  A blog for Ceasefire Oregon, March 2, 2011, ("Harry Hanus, age 74, shot and killed his wife, Barbara, before taking his own life")

Persons Living With HIV/AIDS: Is This What You Want? To be Just Like Us?

By Margaret Dore, Esq.

Some HIV/AIDS groups have endorsed Ballot Question 2, which seeks to legalize assisted suicide in Massachusetts via a proposed act.  This post suggests that these groups and/or persons living with HIV/AIDS should give the issue a second look. 

1.  "Terminal" Does Not Mean "Dying" 

The proposed act applies to persons with a "terminal disease," defined in terms of less than six months to live.[1]  In Oregon, where there is a similar act, the six months to live is determined without requiring treatment.[2] 

In other words, a person living with HIV/AIDS, who is doing well, but who is dependent on treatment to live, is "terminal" for the purpose of assisted suicide eligibility. 

2.  The Significance of a Terminal Label

Once someone is labeled "terminal," an easy justification can be made that his or her treatment should be denied in favor of someone more deserving.  In Oregon, "terminal" patients are not only denied treatment, they are offered assisted suicide instead.  In a recent affidavit, Oregon doctor Ken Stevens states:

"9.  Under the Oregon Health Plan, there is . . .  a financial incentive towards suicide because the Plan will not necessarily pay for a patient’s treatment.  For example, patients with cancer are denied treatment if they have a "less than 24 months median survival with treatment" and fit other criteria. . . . 

12. All such persons . . .  will . . . be denied treatment. Their suicides under Oregon’s assisted suicide act will be covered."[3]

Dr. Stevens concludes:

"14. The Oregon Health Plan is a government health plan administered by the State of Oregon. If assisted suicide is legalized in [your jurisdiction], your government health plan could follow a similar pattern. If so, the plan will pay for a patient to die, but not to live."[4]

3.  Barbara Wagner and Randy Stroup

In Oregon, the most well known persons denied treatment and offered suicide are Barbara Wagner and Randy Stroup.[5]  Neither saw this event as a celebration of their "choice."  Wagner said: "I'm not ready to die."[6]  Stroup said: "This is my life they’re playing with."[7] 

4.  Proposals for Expansion

I live in Washington State, where assisted suicide is legal under an act passed in 2008.[8]  Four years later, there have already been proposals to expand our act to non-terminal people.[9]  Moreover, this year, there was a Seattle Times column suggesting euthanasia as a solution for people unable to afford care, which would be involuntary euthanasia for those persons who want to live.[10]

Prior to our law's being passed, I never heard anyone talk like this.

Is this what you want?

To be just like us?

Legal assisted suicide puts anyone with a significant health condition at risk of being steered to suicide.  For other reasons to vote against assisted suicide, please click here for talking points.  I hope that AIDS groups and people living with AIDS reconsider any support of Ballot Question No. 2.  Thank you.

* * *

Margaret Dore is a lawyer in Washington State where assisted suicide is legal. She is also President of Choice is an Illusion, a non-profit corporation opposed to assisted suicide and euthanasia.  Ms. Dore has been licensed to practice law since 1986. She is a former Law Clerk to the Washington State Supreme Court. She has several published court cases and many published scholarly articles. Her viewpoint is that people should be in control of their own fates, but that assisted suicide laws do not deliver. This year, she had an editorial published in the NY Times: "Assisted Suicide: A Recipe for Elder Abuse." For more information see www.margaretdore.com and www.choiceillusion.org

Massachusetts: Ballot Question 2, Whose Choice?

"[This] would be on an involuntary basis for those persons who want to live."

By Margaret Dore

I am an attorney in Washington State, where assisted suicide is legal.  Our law was passed by a ballot initiative in November 2008 and went into effect in March 2009.  Our law is similar to Ballot Question 2. 

In Washington State, my former clients own two adult family homes (small elder care facilities).  Four days after the election, the adult child of one of their residents asked about getting pills for the purpose of causing his father's death.  It wasn't the older gentleman asking for his "right to die."[1]

At that time, our law had not yet gone into effect; the man died before it did.  But if our law had been in effect, whose choice would it have been?  The choice of his son, or the choice of the older gentleman?

In Washington state, we have already had suggestions to expand our law to direct euthanasia for non-terminal people.[2].  More disturbing, there was this discussion in the Seattle Times suggesting euthanasia for people unable to afford care, which would be on an involuntary basis for those persons who want to live.  Columnist Jerry Large stated:

"After Monday's column, some readers were unsympathetic [to people unable to afford care], a few 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."[3]

I never saw anything like this prior to our law's being passed in 2008.  Be careful what you vote for.

Montana State Senator Corrects New England Journal of Medicine

Assisted Suicide is Not Legal in Montana
Dear Editor:

I am a Montana State Senator.  I disagree with your article, "Redefining Physicians' Role in Assisted Dying," claiming that assisted suicide is legal in Montana.  At the very least, Montana law is unclear.

Last year, Senate Bill 167, which would have legalized assisted suicide in Montana, failed.  This leaves assisted suicide governed by a Montana Supreme Court case, Baxter v. Montana.  An analysis by attorneys Greg Jackson and Matt Bowman describes Baxter as follows:

"The Montana Supreme Court s assisted-suicide decision . . . didn't even 'legalize' assisted-suicide. . . . After Baxter, assisted-suicide continues to carry both criminal and civil liability risks for any doctor, institution, or lay person involved."[1]

Since then, competing articles have appeared in the official Montana State Bar publication disputing whether Baxter legalized assisted suicide.[2]  The editor's headline states: "Court ruling still leaves the issue open to argument." [3]

Correct reporting would be that assisted suicide is not legal in Montana and/or hotly disputed.  Thank you for your attention to this matter.

Senator Greg Hinkle
Thompson Falls, MT 

* * *

[1] Greg Jackson, Esq., and Matt Bowman, Esq., "Analysis of Implications of the Baxter Case on Potential Criminal Liability," Montanans Against Assisted Suicide & For Living with Dignity, April 2010, available at http://montanansagainstassistedsuicide.org/wp-content/uploads/2011/05/Analysis-of-Baxter.pdf                                                
[2] Senator Anders Blewett (pro article), Senator Jim Shockley and Margaret Dore (con article), "The aid-in-dying debate: Can a physician legally help a patient die in Montana?  Court ruling still leaves the issue open to argument," The Montana Lawyer, November 2011, available at http://maasdocuments.files.wordpress.com/2012/07/montana-lawyer-pro-con-articles-nov-2011.pdf[3]  Id.

New England Journal of Medicine Article Misleading

Dear Editor:

I am a lawyer in Washington State, one of two states where assisted-suicide is legal.  The other state is Oregon, which has a similar law.  Lisa Lehmann's article, "Redefining Physicians' Role in Assisted Dying," is misleading regarding how these laws work.

First, the Oregon and Washington laws are not limited to people in their "final months" of life.[1,2]  Consider for example, Jeanette Hall, who in 2000 was persuaded by her doctor to be treated rather than use Oregon's law.  She is alive today, twelve years later.[3]

Second, these laws are not "safe" for patients.[4][5]  For example, neither law requires a witness at the death.  Without disinterested witnesses, the opportunity is created for the patient's heir, or someone else who will benefit from the patient's death, to administer the lethal dose to the patient without his consent.  Even if he struggled, who would know?  

Third, the fact that persons using Oregon's law are "more financially secure" than the general population is consistent with elder financial abuse, not patient safety.  Do not be deceived. 

* * *

[1]  Margaret K. Dore, "Aid in Dying: Not Legal in Idaho; Not About Choice," The Advocate, official publication of the Idaho State Bar, Vol. 52, No. 9, pages 18-20, September 2010, available at http://www.margaretdore.com/pdf/Not_Legal_in_Idaho.pdf.
[2]  Kenneth Stevens, MD, Letter to the Editor, "Oregon mistake costs lives," The Advocate, official publication of the Idaho State Bar, Vol. 52, No. 9, pages 16-17, September 2010, available athttp://www.margaretdore.com/info/September_Letters.pdf 
[3]  Ms. Hall corresponded with me on July 13, 2012.
[4]  See article at note 1.  See also Margaret Dore, "Death with Dignity": A Recipe for Elder Abuse and Homicide (Albeit Not by Name)," at 11 Marquette Elder's Advisor 387 (Spring 2010), original and updated version available at http://www.choiceillusion.org/p/the-oregon-washington-assisted-suicide.html 
[5]  Blum, B. and Eth, S.  "Forensic Issues: Geriatric Psychiatry." InKaplan and Sadock's Comprehensive Textbook of Psychiatry, Seventh Edition, B. Sadock and V. Sadock editors.  Baltimore, MD: Lippincott, Williams and Wilkins, pp. 3150-3158, 2000. 

Users of Assisted Suicide are Seniors with Money

By Margaret Dore, Esq.

Users of assisteds suicide are "overwhelmingly white, well educated and financially comfortable."[1]  They are also age 65 and older.[2]  In other words, users are older people with money, which would be the middle class and above, a group disproportionately at risk of financial abuse and exploitation.[3]  

In the United States, elder financial abuse costs elders an estimated $2.9 billion per year.[4]  Perpetrators include strangers, family members and friends.[5].  The goals of financial abuse perpetrators are achieved "through deceit, threats, and emotional manipulation of the elder."[6]

The Oregon and Washington assisted suicide acts, and the similar Massachusetts proposal, do not protect users from this abuse. Indeed, the terms of these acts encourage abuse.  These acts allow heirs and other persons who will benefit from an elder's death to actively participate in his or her lethal dose request.[7]  There is also no oversight when the lethal dose is administered, not even a witness is required.[8]  This creates the opportunity for an heir, or someone else who will benefit from the person's death, to administer the lethal dose to that person without his consent.  Even if he struggled, who would know?

For more information about problems with the Massachusetts' proposal, click here and here.  For a "fact check" on the proposal, click here.

* * * [1]  Katie Hafner, "In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide," New York Times, August 11, 2012.
[2]  See e.g., the most current official report from Oregon, "Oregon Death with Dignity Act--2011" ("Of the 71 DWDA deaths during 2011, most (69.0%) were aged 65 years or older; the median age was 70 years"), available at http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year14.pdf
[3]  The MetLife Study of Elder Financial Abuse, "Crimes of Occasion, Desperation, and Predation Against America's Elders," June 2011 (a follow up to MetLife's 2009 "Broken Trust: Elders, Family, and Finances"), available at http://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf
[4]  Id., page 2, key findings  
[5]  Id.
[6]  Id., page 3.
[7]  See Memo to Joint Judiciary Committee (regarding Bill H.3884, now ballot measure No. 2), Section III.A.2. ("Someone else is allowed to speak for the patient"), available at http://www.massagainstassistedsuicide.org/p/memo-to-joint-judiciary-committee.html
[8]  See above memo at Section III.A.1("No witnesses at the death").  See also entire proposed Massachusetts Act at http://choiceisanillusion.files.wordpress.com/2011/10/ma-initiative.pdf

Washington Assisted Suicide Report: No Information About Consent

By Margaret Dore

Washington assisted suicide act was enacted via a ballot initiative in 2008 and went into effect in 2009.[1]  During the election, proponents claimed that its passage would ensure individuals control over their deaths.  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.


Today, the Washington State Department of Health issued its annual report about Washington's act.[3]  That report, similarly, does not demonstrate that individuals are in control. The report provides no information as to whether the people who died under the act consented and/or acted voluntarily at the time of death.  The report instead talks about "ingestion" of the lethal dose.  A drug can be "ingested" while a person is asleep, sedated and/or not aware of his or her surroundings.


For more information about Washington's act, See Margaret Dore, "'Death with Dignity': What Do We Advise Our Clients?," Bar Bulletin, May 2009.[4]  

* * *

[1]  Washington's act was passed by in November 2008 as Initiative 1000 and has now been codified as RCW chapter 70.245.
[2]   I-1000 color pamphlet, "Paid for by Yes! on 1000."
[3]  See News Release here and report here.
[4]  Further information can be viewed here.

Dore v. Morris: Assisted suicide debate deals with abuse, compassion

http://www.kamloopsnews.ca/article/20120419/KAMLOOPS0101/120419759/-1/kamloops01/assisted-suicide-debate-deals-with-abuse-compassion

Lawyer cautions against legislating through courts

By Mike Youds, Daily News Staff Reporter
 

Margaret Dore (L) and Wanda Morris (R)

A right to medically assisted suicide may sound compassionate and just, but beware the details when it comes to the act itself, a U.S. lawyer warned Wednesday in a debate at TRU.

Margaret Dore shared some of her experiences with assisted suicide in Washington State, where the practice became legal through a ballot measure four years ago.

 "A lot of people think this is a great idea until they start thinking and reading about how you do it," she told an audience of about 30 people in the Irving K. Barber Centre.

In effect, laws in Washington and Oregon empower people who may choose to abuse the responsibility, Dore said.

"Your heir can be there to help you sign up. Once the legal dose leaves the pharmacy, there is no oversight whatsoever."

Wanda Morris, head of the Canadian charity Dying With Dignity, advocated for the right to choose to end life humanely.

"These are individuals who want to live, but they are individuals facing a horrific death," she said. "The fundamental difference is choice. Choice is important in Canada. Why is it, at the time of life when we're facing our toughest decision we could ever make, that choice is taken away?"

The issue has long been debated in Canada, where two years ago Parliament easily defeated a bill that would have permitted assisted suicide and euthanasia. Recently the subject has made headlines again with two court high-profile court cases in B.C. and Quebec.

"Autonomy is such a critical value, it is a cornerstone of modern medicine," Morris continued. "Nothing can be done without consent. And yet here, at the end of life, I'm not given that choice."

Dore said she agrees that people should have the right to choose how they die, but the U.S. laws don't give that. Four days after the Washington State law passed, the adult son of a care facility resident showed up asking how "to get them pills," she said.

"Who's choice?," she asked rhetorically. An adult child can administer the lethal dose with no one else to tell whether it was a matter of consent. "There is no oversight over administration."

Morris insisted that the law her organization has long pushed for would only apply to individuals with six months or less to live. Dore countered that such a restriction does not apply in the U.S. and pointed to a case where an Oregon woman, who was talked out of suicide by her doctor, remains thankful she has survived another 12 years.

There was a $5.4-million lobby for assisted suicide in Washington, a machine that was up against a volunteer group, she said.

"In Canada and the U.S., there is a very significant funder in this debate and it is the Catholic church," Morris said.

Opponents of assisted suicide argue from dogmatic positions and cannot be satisfied, she said.

"Excuse me, but I never said anything about Catholic dogma," Dore replied.

She warned that Canada, having rejected the idea in Parliament, is facing the possibility of legislating it through the courts with the Carter and Leblanc court cases.

"We have a blank slate and we can write in whatever controls we want to protect the weak and the vulnerable," Morris said.

NY Times: Assisted Suicide: A Recipe for Elder Abuse

April 10, 2012
http://www.nytimes.com/roomfordebate/2012/04/10/why-do-americans-balk-at-euthanasia-laws/assisted-suicide-laws-are-a-recipe-for-elder-abuse

Margaret Dore, a lawyer in Washington State where assisted suicide is legal, is the president of Choice is an Illusion, a nonprofit organization opposed to assisted suicide.

Assisted suicide means that one person provides the means or information for another person to commit suicide. In Oregon and Washington, assisted-suicide laws were passed by ballot measures. No such law has made it through the scrutiny of a legislature despite more than 100 attempts.

The Oregon and Washington acts apply to "terminal" patients, defined as patients predicted to have no more than six months to live. Doctor prognoses, however, can be wrong. Moreover, treatment can lead to recovery. My friend Jeanette Hall was adamant that she would "do" Oregon's act. She had been diagnosed with cancer and was given six months to a year to live. Her doctor convinced her to be treated. That was nearly 12 years ago.

Proponents tout assisted suicide as providing "choice" over the timing of one's death. But choice under the Oregon and Washington acts cannot be assured. For example, neither act requires witnesses at the death. Without disinterested witnesses, the opportunity is created for an heir, or someone else who will benefit from the patient's death, to administer the lethal dose to the patient without his consent. Even if he struggled, who would know?

Assisted suicide is a concept contrary to public safety and a recipe for elder abuse.  Americans are right to be skeptical of these laws.

Press Release: Mass Against Assisted Suicide

FOR IMMEDIATE RELEASE 

Massachusetts Assisted Suicide Initiative a Recipe for Elder Abuse

Choice is an Illusion, a nonprofit corporation opposed to assisted suicide, has launched a new website agianst the Massachusetts "death with dignity" initiative.  The website's name is "Mass Against Assisted Suicide." 

Margaret Dore, President of Choice is an Illusion and an elder law attorney, states: "The initiative's introduction declares that the process will be 'entirely voluntary' for the patient.  The act, as written, does not deliver on this promise.  The act is instead a recipe for elder abuse."

The proposed act has an application process to obtain a lethal dose for the purpose of causing the patient's death.  The act allows the patient's heir, who will benefit financially from the death, to actively help the patient sign up for the lethal dose.  Dore states:  "The act allows an heir to participate as one of two witnesses on the lethal dose request form.  The act also allows someone else to speak for the patient." 

"This does not meet the stink test," said Dore. "Signing away your life under the proposed act has less protection than signing a will."

Dore explained that when signing a will, similar conduct can create a presumption of fraud and undue influence.

Dore also pointed out that there is no oversight once the lethal dose of has been filled under the proposed act.

"The death is not required to be witnessed by disinterested persons," Dore said.  "Indeed, no one is required to be present." 

"Without disinterested witnesses, the opportunity is created for an heir, or someone else who will benefit from the death, to administer the lethal dose to the patient without his consent.  Who would know?"

This year in New Hampshire, a similar "death with dignity" act was defeated in the House of Representatives by a vote of 234 to 99. 

Former New Hampshire State Representative Nancy Elliott said: "Assisted suicide laws empower heirs and others to pressure and abuse older people to cut short their lives.  This is especially an issue when the older person has money.  There is no assisted suicide bill that you can write to correct this huge problem."

* * *

To view the new website, go here:  http://www.massagainstassistedsuicide.org  To learn more about "Choice" is an Illusion, visit:  www.choiceillusion.org  To learn about the New Hampshire bill that failed, go here:  http://www.choiceillusionnewhampshire.org/2011/05/new-hampshire-defeats-assisted-suicide.html

* * *

Margaret Dore is President of Choice is an Illusion and an elder law attorney. Contact her at 206-389-1754 or margaretdore@margaretdore.com.  See also http://www.margaretdore.org/  Contact Former New Hampshire State RepresentativeNancy Elliott at mmknhrep@gmail.com  

Washington: A Better Response Would be to Repeal the Act as a Fraud on the Voters

By Margaret Dore

On November 16, 2011, an article appeared in a Washington State newspaper arguing for expansion of Washington's physician-assisted suicide act to direct euthanasia and to persons without a terminal disease.[1]  The author, Brian Faller, candidly admitted:  "To improve the chances of passage, the Death with Dignity Act was written to apply only to the choices of the terminally ill who are competent at the time of their death."[2]  Now, he shows the other side's true colors.

In any case, this is my response:

Dear Editor:

I am an attorney who has written multiple articles about our physician-assisted suicide act. I am also President of Choice is an Illusion, a non-profit corporation opposed to assisted-suicide. I disagree with Brian Faller that our physician-assisted act should be expanded to include direct euthanasia. A better course would be to repeal that act as a fraud on the voters.

Our assisted-suicide act was enacted as Initiative 1000 in 2008 and went into effect in 2009. During the election, proponents claimed that its passage would assure individuals control over their deaths. The act is instead a recipe for elder abuse. Key provisions include that a patient’s heir, who will benefit financially from his death, is allowed to actively assist him to sign up for the lethal dose. Specifically, an heir is allowed to be one of two witnesses on the lethal dose request form. In the context of a will, the same situation would create a presumption "duress, menace, fraud, or undue influence." (RCW 11.12.160(2)).

There are also no witnesses required at the death. Without disinterested witnesses, the opportunity is created for someone else, including an heir, to administer the lethal dose to the patient without his consent. Even if he struggled, who would know?

The idea that our act promotes patient control or individual liberty is untrue. Our act instead puts older people and others in the cross-hairs of abuse. For more information, please see www.choiceillusion.org and click on the page for Washington State.

* * *

[1]  Brian Faller, "Perhaps it's time to expand Washington's Death with Dignity Act, The Olympian, November 16, 2011, available at http://www.theolympian.com/2011/11/16/1878667/perhaps-its-time-to-expand-washingtons.html

[2]  Id.

Montana Bar Article by Senator Jim Shockley and Margaret Dore

"No, physician-assisted suicide is not legal in Montana:

 It's a recipe for elder abuse and more" [1]

By State Senator Jim Shockley and Margaret Dore

Published in The Montana Lawyer, the official
publication of the State Bar of Montana.

There are two states where physician-assisted suicide is legal: Oregon and Washington.  These states have statutes that  give doctors and others who participate in a qualified patient’s suicide immunity from criminal and civil liability.  (ORS 127.800-995 and RCW 70.245). 

In Montana, by contrast, the law on assisted suicide is governed by the Montana Supreme Court decision, Baxter v. State, 354 Mont. 234 (2009).  Baxter gives doctors who assist a patient’s suicide a potential defense to criminal prosecution.  Baxter does not legalize assisted suicide by giving doctors or anyone else immunity from criminal and civil liability.  Under Baxter, a doctor cannot be assured that a suicide will qualify for the defense.  Some assisted suicide proponents nonetheless claim that Baxter has legalized assisted suicide in Montana.

Legalizing assisted suicide in Montana would be a recipe for elder abuse.  The practice has multiple other problems.

Massachusetts: "Don't be fooled by assisted-suicide bill"

http://www.lowellsun.com/editorials/ci_19137188
The Lowell Sun
Updated: 10/18/2011 09:27:53 AM EDT

This letter responds to Marie Donovan's article about the proposed Massachusetts death-with-dignity act, which seeks to legalize assisted suicide in your state (" 'Death with Dignity Act' renews end-of-life debate"). I am an attorney in Washington state, one of just two states where physician-assisted suicide is legal. The other state is Oregon. I am also president of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide as an issue of public safety (www.choiceillusion.org).

In both Washington and Oregon, assisted-suicide laws were passed via highly financed sound-bite, ballot-initiative campaigns. No such law has made it through the scrutiny of a legislature -- despite more than 100 attempts. This year, a bill was defeated in the New Hampshire House, 234 to 99.

The proposed Massachusetts act is a recipe for elder abuse. Key provisions include that an heir, who will benefit financially from a patient's death, is allowed to actively help sign the patient up for the lethal dose. See e.g., Section 21 allowing one of two witnesses on the lethal-dose request form to be an heir (http://www.mass.gov/Cago/docs/Government/2011-Petitions/11-12.pdf  ).

Once the lethal dose is issued by the pharmacy, there is no oversight over administration. The proposed act does not require that a doctor or anyone else be present at the time of death. This creates the opportunity for an heir, or another person who will benefit from the death, to administer the lethal dose to the patient without the patient's consent. Even if he struggled, who would know?

Donovan's article prominently features a discussion of religion. In Washington state, proponents used similar discussions and even religious slurs to distract voters from the pitfalls of legalization. What the proposed law said and did was all but forgotten.

Do not be deceived.

MARGARET DORE
Choice is an Illusion
Seattle, Wash.

Massachusetts: Assisted Suicide is a Recipe for Elder Abuse; Do not be Deceived

By Margaret Dore

A ballot initiative to legalize physician-assisted suicide via a "death with dignity" act is now in the signature-gathering stage in Massachusetts.[1]

Physician-assisted suicide is legal in just two states: Oregon and Washington.[2]  In both states, acts to legalize the practice were enacted via sound-bite ballot initiative campaigns.[3]  No such law has made it through the scrutiny of a legislature.  Just this year, bills to legalize assisted suicide were defeated in Montana, New Hampshire and Hawaii.[4] Just this year, Idaho enacted a statute to strengthen its law against assisted suicide.[5]

The proposed Massachusetts act is a recipe for elder abuse.  Key provisions include that an heir, who will benefit financially from a patient's death, is allowed to participate as a witness to help sign the patient up for the lethal dose.  See Section 21 of the act, allowing one of two witnesses on the lethal dose request form to be an heir, available here.  This situation invites undue influence and coercion.

Once the lethal dose is issued by the pharmacy, there is no oversight.  See entire proposed act, available here.  The act does not require witnesses when the lethal dose is administered.  See act here.  Without disinterested witnesses, an opportunity is created for an heir, or another person who will benefit from the patient's death, to administer the lethal dose to him without his consent.  Even if he struggled who would know?

In Massachusetts, proponents are framing the issue as religious.  In Washington state, proponents used a similar tactic and even religious slurs to distract voters from the pitfalls of legalization.  What the proposed law said and did was all but forgotten.

        

        Do not be deceived.

* * *

Margaret Dore is an attorney in Washington State where assisted suicide is legal.  She is also President of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide.  Her publications include Margaret K. Dore, "Physician-Assisted Suicide: A Recipe for Elder Abuse and the Illusion of Personal Choice," The Vermont Bar Journal, Winter 2011.

* * *

[1]  To view the proposed Massachusetts initiative, click here:  http://www.mass.gov/Cago/docs/Government/2011-Petitions/11-12.pdf
[2]  In Montana, there is a court decision that gives doctors who cause or aid a suicide, a potential defense to criminal prosecution for homicide.  The decision does not legalize assisted suicide by giving doctors or anyone else immunity from criminal prosecution and civil liability.  To learn more, go here:  http://www.montanansagainstassistedsuicide.org/p/baxter-case-analysis.html  The assisted suicide promotion group, Compassion & Choices, has a new campaign claiming that assisted suicide is "already legal" in Hawaii.  This is an odd claim given that bills to legalize assisted suicide in Hawaii have repeatedly failed, most recently this year.  See here for the most recent bill: http://capitol.hawaii.gov/Archives/measure_indiv_Archives.aspx?billtype=SB&billnumber=803&year=2011
[3]  Oregon's physician-assisted suicide act was enacted via Ballot Measure 16.  Washington's act was enacted via Initiative 1000.
[4]  In Montana, SB 167 was tabled in Committee and subsequently died on April 28, 2011.  In New Hampshire, HB 513 was defeated on March 16, 2011.  In Hawaii, SB 803 was defeated on February 7, 2011 .
[5]  On July 1 2011, Idaho's new statute strengthening Idaho law against assisted suicide went into effect:   http://www.choiceillusionidaho.org/2011/07/idaho-strengthens-law.html

Vermont: Bennington Banner: Suicide choice is an illusion

http://www.benningtonbanner.com/opinion/ci_19084377

Posted: 10/10/2011 10:26:03 PM EDT
Monday October 10, 2011

This letter responds to Dr. Guerrero's letter referring to an upcoming assisted suicide bill, which he discusses in terms of providing patient choice. Last March, I did a legal analysis of two assisted-suicide bills that were pending in your legislature. I previously analyzed two similar bills introduced in 2009.

None of these bills assured patient choice or control over their deaths. For example, there was no required supervision over administration of the lethal dose. The death was not even required to be witnessed. This created the opportunity for an heir, or someone else who would benefit from the patient's death, to administer the lethal dose to the patient without his consent. Even if he struggled, who would know?

To view my most recent analysis, go here:  http://www.choiceillusionvermont.org/p/2011-bills.html To view my prior analysis, see Physician-Assisted Suicide: "A Recipe for Elder Abuse and the Illusion of Personal Choice," Vermont Bar Journal, winter 2011, available at www.vtbar.org/Images/Journal/journalarticles/winter2011/PhysicianAssistedSuicide.pdf .

Choice is an Illusion, a nonprofit corporation www.margaretdore.com  [should be www.choiceillusion.org ]

MARGARET K. DORE

Seattle, Wash.

Hawaii: Assisted Suicide is Still Not Legal

By Margaret Dore

Barbara Coombs Lee has a new article on Huffington Post, claiming that physician-assisted suicide ("aid in dying") is legal in Hawaii.  This is an odd claim given that bills to legalize assisted suicide in Hawaii have repeatedly failed, most recently this year.[1] 

Coombs Lee's article begins with a discussion of melting snow, moves on to a panel of experts, focuses on Montana and then finally discusses the law of Hawaii.[2]  With regard to Hawaii, her arguments are similar to those presented in a brief drafted by Kathryn Tucker, which was apparently removed from the internet after I published a critique of the arguments presented.[3]

To view my critique, click here.

The bottom line:  Assisted suicide is still not legal in Hawaii. 

* * *

1.  On February 7, 2011, SB 803 was defeated in Committee 4 to 0.  See Hawaii Legislative website at http://www.capitol.hawaii.gov/session2011/lists/measure_indiv.aspx?billtype=SB&billnumber=803
2.  Barbara Coombs Lee, "Hawaii:  The Latest State Where Doctors Can Provide Aid in Dying," Huffington Post, October 6, 2011, available here.
3.  See:  Margaret Dore, "Hawaii: Assisted Suicide is not 'Already Legal,'" September 21, 2011, available at http://www.choiceillusion.org/2011/09/hawaii-assisted-suicide-is-not-already.html#more  and Kathryn Tucker, "End-of-life Law and Policy in Hawaii Aid in Dying," as of September 20, 2011, available at http://choiceisanillusion.files.wordpress.com/2011/10/tucker-brief_0011.pdf

Hawaii: Assisted Suicide is Not "Already Legal"

By Margaret Dore

Kathryn Tucker, Director of Legal Affairs for Compassion & Choices, claims that physician-assisted suicide, which she terms "aid in dying," is already legal in Hawaii.[1]  Her claim, based in part on a 1909 statute, fails for the reasons set forth below.

A.  Hawaii's Manslaughter Statute Applies

Tucker argues that Hawaii's manslaughter statute, providing that an individual commits manslaughter if "[t]he person intentionally causes another person to commit suicide," does not apply to "aid in dying" because aid in dying is not "suicide."[2]  Just last year, in Blick v. Connecticut, Tucker made a similar argument that was summarily rejected by the trial court.[3]  The trial judge stated:

"[T]he legislature intended the [manslaughter] statute to apply to physicians who assist a suicide . . ." [4]

Assisted Suicide Report Lacks Information about Consent

(published in the King County Bar Association, Bar Bulletin, July 2011; for a print version, click here).

By Margaret Dore

On March 10, the Washington State Department of Health issued a formal report about our physician-assisted suicide act.¹ However, the report does not address whether the people who died under the act did so on a voluntary basis.

Washington's Act

Washington's assisted-suicide act was enacted via a ballot initiative in 2008 and went into effect in 2009.² During the election, proponents claimed that the act's passage would assure individuals control over their deaths.

The act, however, does not assure such control. For example, the act allows a person's heir, who will benefit financially from the death, to assist in signing the person up for the lethal dose.³ There are also no witnesses required at the death.⁴ Without disinterested witnesses, the opportunity is created for someone else to administer the lethal dose to the person without his consent.

The Assisted-Suicide Report

Statistical Information

The Department of Health report focuses on statistical information. This information states that lethal doses were dispensed to 87 people during 2010. Of these 87 people, 51 are reported to have died after ingesting a lethal dose.⁵

Physician Reports

The report also includes information about the circumstances of the deaths. For example, the report provides statistics regarding how long it took people to die after ingesting the lethal dose.⁶

According to the report, the data for these statistics were obtained from an "After Death Reporting Form" completed by the prescribing physician after each death.⁷ According to the report, however, the prescribing physician is rarely present at the death.⁸ If that is the case, he or she is necessarily relying on other persons for the data reported.

Patient "Concerns"

The report seeks to document the "concerns" of the people who died, which led to their requesting the lethal dose.⁹ The data for these concerns come from the "After Death Reporting Form," which lists seven questions to be checked off by the prescribing doctor.¹⁰ These choices do not include the possibility of abuse by an heir.¹¹

The report also provides no information as to whether the people who died consented when the lethal dose was administered. In other words, there is no information regarding whether the deaths were truly voluntary.¹²

Margaret K. Dore is an elder law/appellate attorney in Washington. She is a former law clerk to the Washington Supreme Court and a former chair of the Elder Law Committee of the American Bar Association Family Law Section. Her publications include "'Death with Dignity': A Recipe for Elder Abuse and Homicide (Albeit not by Name)," Marquette Elder's Advisor, Vol. 11, No. 2, Spring 2010, available at http://www.margaretdore.com/pdf/Recipe_for_Elder_Abuse.pdf. For more information, see www.margaretdore.com.

 * * *

1 Washington State Department of Health 2010 Death with Dignity Act Report ("Report"), issued March 10, 2011, available at http://www.doh.wa.gov/dwda/forms/DWDA2010.pdf.

2 Washington's assisted-suicide law was passed as Initiative 1000 on November 4, 2008, and went into effect on March 5, 2009. See RCW 70.245.903.

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 witness may be an heir or other person who will benefit from the death.

4 See Washington's act in its entirety at RCW 70.245.010 et. seq.

5 Report, Executive Summary, at 1.

6 Report at 9, Table 5 ("Circumstances and complications relating to ingestion of medication prescribed under the Death with Dignity Act of the participants who have died").

7 Id. ("Data are collected from the After Death Reporting form"). A blank "After Death Reporting Form" can be viewed at http://www.doh.wa.gov/dwda/forms/AfterDeathReportingForm.pdf (last viewed March 10, 2011).

8 According to the Report, the prescribing physician was present when the lethal dose was ingested in just 4% of the deaths occurring in 2010; the prescribing physician was present at 8% of such deaths in 2009. See Report at 9, Table 5.

9 Report at 7, Table 3.

10 See After Death Reporting Form, supra note 7, Question 7.

11 Id.

12 The act provides for self-administration of the lethal dose. "Self-administer" is, however, a specially defined term that allows someone else to administer the lethal dose to the person at issue. For more information, see Margaret K. Dore, "Death with Dignity: What Do We Tell Our Clients?", Washington State Bar Association, Bar News, July 2009, available at http://wsba.org/media/publications/barnews/jul-09+deathwithdignity.htm.