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 [The] position paper - in response to the lawsuit - has since been rescinded by the Board and scrubbed from its website.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 4^th Avenue, 44^th Floor, Seattle, WA 98154

Please donate online by clicking here or here.

Thank you for your support.

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.³ 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."

6 RCW 11.88.160(2).[http://www.margaretdore.com/pdf/D-RCW-11.12.160_001.pdf]

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.

Video: Margaret Dore vs. Wanda Morris Video, Part 1

To see Part 2 go here

CFI Okanagan Presentation
Should assisted suicide be legal in Canada?

Wanda Morris, Executive Director of Dying With Dignity vs.
Margaret Dore, President of Choice is an Illusion

Margaret Dore is President of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia with a focus on the US and Canada. She is also a lawyer in Washington State where assisted suicide is legal. Her practice has included appeals, elder law, probate and guardianships. She is a former Law Clerk to the Washington State Supreme Court and has been licensed to practice since 1986. For more information, see www.choiceillusion.org andwww.margaretdore.com

Wanda Morris is the Executive Director of Dying with Dignity Canada, established in 1982 to educate the public about end of life options and the importance of advance care planning; to provide information and resources to the public and lawmakers about the choice in dying movement and the reasons why appropriately regulated medically assisted dying should be legalized in Canada; and to provide support for individuals at the end of their lives, including support at the bedside for those who wish to determine the nature and timing of their dying.

Video: Margaret Dore v. Wanda Morris Video, Part 2

To view Part 1, go here

Montana Judge Hears Assisted Suicide Arguments

http://www.kxlf.com/news/montana-judge-hears-assisted-suicide-arguments/

Posted: Dec 11, 2013 4:38 PM by Sanjay Talwani - MTN News

HELENA - The issue of physician assisted suicide was in court Tuesday [December 10, 2013]

Judge Michael Menehan

Montanans Against Assisted Suicide is arguing that a policy position by the Montana Board of Medical Examiners implies that physician assisted suicide may be legal. 

A lawyer for the Board says that the position - since rescinded, says no such thing. Michael Fanning says the group bringing the lawsuit has no real case is trying to force the issue to the Montana Supreme Court.

The position paper, written in response to doctor inquiries, said that the board would handle complaints related to assisted suicide on a case-by-case basis as it would other cases.

Margaret Dore
Attorney for Montanans
Against Assisted Suicide (MAAS)

Margaret Dore, an attorney for MAAS, said the paper overstepped the Board's authority and implied to many that assisted suicide was legal in Montana.

"They are a board that is comprised of 11 doctors and two members of the public," she said. "It has no expertise to be making a pronouncement, that aid in dying is legal in Montana. That's the role of the legislature or a court and they are neither."

She said that such an understanding had huge implications in devaluing the lives of the sick and elderly.

That position paper - in response to the lawsuit - has since been rescinded by the Board and scrubbed from its website. But 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.

But Menehan said it wasn't the role of a district judge to rule on a Montana Supreme Court order.

Craig Charlton

Attorney for MAAS

Michael Fanning, an attorney for the Board, said MAAS had no standing to bring the lawsuit, has suffered no damages from the Board's rescinded position and was simply jockeying to get the case before the Montana Supreme Court in hopes of overturning the Baxter ruling.

"This most certainly is a political question, a philosophical question or an academic debate, but it is not a lawsuit," he said. "In fact, this is a feigned case. It was contrived simply to bring this matter before you."

Menahan did not immediately rule on the case.

[Montanans Against Assisted Suicide is also represented by attorney Craig Charlton].

Oregon's New Statistics

By Margaret Dore, Esq.

Oregon's assisted suicide statistics are out for 2012.[1]

This annual report is similar to prior years.  The preamble implies that the deaths were voluntary (self-administered), but the information reported does not address that subject.[2]

Oregon's assisted suicide law allows the lethal dose to be administered without oversight.[3]  This creates the opportunity 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, for example, when the patient is asleep.  Who would know?

The new Oregon report provides the following demographics:  

"Of the 77 DWDA deaths during 2012, most (67.5%) were aged 65 years or older; the median age was 69 years.  As in previous years, most were white (97.4%), [and] well-educated (42.9% had at least a baccalaureate degree) . . . ."[4]  Most (51.4%) had private health insurance.[5]

Typically persons with these attributes are seniors with money, which would be the middle class and above, a group disproportionately victims of financial abuse and exploitation.[6]

As set forth above, Oregon's law is written so as to allow the lethal dose to be administered to patients without their consent and without anyone knowing how they died.  The law thus provides the opportunity for the perfect crime.  Per the new report, the persons dying (or killed) under that law are  disproportionately seniors with money, a group disproportionately victimized by financial abuse and exploitation.

Oregon's new report is consistent with elder abuse.

Footnotes:

[1]  The new report can be viewed here: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year15.pdf and http://choiceisanillusion.files.wordpress.com/2013/01/year-15-2012.pdf
[2]  Id.
[3]  Oregon's law can be viewed here:  http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx
[4]  Report cited at note 1.
[5]  Id.
[6]  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.

"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.