California: Contact the Governor now to stop assisted suicide/euthanasia.

Outright Lies to Trusting Legislators Gets California Bill to Governor's Desk.  Tell Jerry Brown to Veto ABX2-15 Now! 

• Call 916-445-2841!
• Fax 916-558-3160 
• Use this form to send an e-mail to Governor Brown:  https://govnews.ca.gov/gov39mail/mail.php  (US Mail will be too slow)

On Friday, September 11th, ABX2-15 passed the Senate just weeks after its initial introduction during a special session called for another purpose. During its short and expedited life, proponents ran roughshod on the facts to induce busy legislators to vote yes. This was evident during the final floor debate in the Senate where proponents repeatedly stated or implied the following, which are not true:

1.  That the bill is limited to people who are actively dying and in pain. The bill doesn't say this anywhere. The bill, instead, applies to people with a "terminal disease" defined as having a prediction of less than six months to live. (Memo, pp.9 -12). Such persons can, in fact, have years, even decades, to live.  (Id.) In Oregon, which has a nearly identical definition, "eligible" persons include young adults with chronic conditions such as insulin dependent diabetes. (Id).

2.  That the bill is "one of the strongest bills regarding patient protections." The bill, however, doesn't even require a witness when the lethal dose is administered.[1] If the patient protested or struggled, who would know?[2] In addition, the bill's various legal "requirements" are not actually "required." This is because participants are merely held to a "good faith" standard.[3] This standard is not defined in the bill, but common meanings include that participants need not comply with legal technicalities when they have honest intent.  See, for example, this legal dictionary definition:

[Good faith means] honest intent to act without taking an unfair advantage over another person or to fufill a promise to act, even when some legal technicality is not fulfilled.  (Emphasis added).[4] 

For these and other reasons, tell Jerry Brown to veto ABX2-15. For more information, see: Dore letter discussing why the Baker amendments did not fix the bill's problems; Dore memo why the financial cost of ABX2-15 could be "enormous"; and a formal memo regarding the bill generally, including "key points," an index, aformal memo and an appendix.

* * *
[1]  See ABX2-15 in its entirety.
[2]  Id.
[3]  ABX2-15, Sections 443.19(d), 443.14(b), 443.14(d)(1) and 443.15(c).
[4]  "Hill" citation at http://legal-dictionary.thefreedictionary.com/good+faith

Memo to the California State Assembly: "No" on SB 128

The original pdf version of this memo has an executive summary and index, which can be viewed here. The attachments can be viewed here.

I. INTRODUCTION.

I am an attorney in Washington State where assisted suicide is legal.[1] Our law is based on a similar law in Oregon. Both laws are similar to the proposed California bill, SB 128.[2] 

Enactment of SB 128 will create new paths of elder abuse. “Eligible” patients will include people with years, even decades, to live.  

I urge you to reject this measure. Do not make Washington’s and Oregon’s mistake.

Utah: Problems with H.B. 391

By Margaret Dore, Esq., MBA

H.B. 391 seeks to legalize physician-assisted suicide in Utah.  I am a lawyer in Washington State where we have a similar law.  Our law is based on a law in Oregon.

Problems include:

1.  HB 391, if enacted, will encourage people with years to live to throw away their lives.

HB 391 seeks to legalize assisted suicide for persons with a "terminal disease," which is defined as having less than six months to live.  In Oregon's law, which uses the same definition, young adults with chronic conditions, such as diabetes, are "eligible" for assisted suicide.  Such persons can have years, even decades, to live.  See https://choiceisanillusion.files.wordpress.com/2014/12/a-2270-3r-memo-12-02-14.pdf   "Eligible" patients can also have years to live because doctors can be wrong.  See https://choiceisanillusion.files.wordpress.com/2013/10/terminal-uncertainty.pdf and https://choiceisanillusion.files.wordpress.com/2014/08/signed-john-norton-affidavit_001.pdf

Preventing Abuse and Exploitation: A Personal Shift in Focus. An Article About Guardianship, Elder Abuse and Assisted Suicide

By Margaret K. Dore, Esq., MBA

The Voice of Experience, American Bar Association

Volume 25, No. 4, Winter 2014

To view the original version, click here and here

I graduated from law school in 1986. I first worked for the courts and then for the United States Department of Justice. After that, I worked for other lawyers, and then, in 1994, I officially started my own practice in Washington State. Like many lawyers with a new practice, I signed up for court-appointed work in the guardianship/probate context. This was mostly guardian ad litem work. Once in awhile, I was appointed as an attorney for a proposed ward, termed an “alleged incapacitated person.” In other states, a guardianship might be called a “conservatorship” or an “interdiction.” A guardian ad litem might be called a “court visitor.”

My Guardianship Cases

Most of my guardianship cases were straightforward. There would typically be a elderly person who could no longer handle his or her affairs. I would be the guardian ad litem. My job would be to determine whether the person needed a guardian, and if that were the case, to recommend a person or agency to fill that role.

My work also included private pay cases with moderate estates. With these cases, I would sometimes see financial abuse and exploitation. For example, there was an elderly woman whose nephew took her to the bank each week to obtain a large cash withdrawal. She had dementia, but she could pass as “competent” to get the money. In another case, “an old friend from 30 years ago” took “Jim,” a 90 year old man, to lunch. The friend invited Jim to live with him in exchange for making the friend sole beneficiary of his will. Jim agreed. The will was executed and he went to live with the friend in a nearby town. A guardianship was started and I was appointed guardian ad litem. I drove to the friend’s house, which was dilapidated. Jim did not seem to have his own room. I asked him if he would like to go home. He said “yes” and got in my car. He was not incompetent, but he had allowed someone else to take advantage of him. In another case, there was a disabled man whose caregiver had used his credit card to remodel her home. He too was competent, but he had been unable to protect himself.

In those first few years, I loved my guardianship cases. I had been close to my grandmother and enjoyed working with older people. I met guardians and other people who genuinely wanted to help others.

But then I got a case involving a competent man who had been railroaded into guardianship. The guardian, a company, refused to let him out. The guardian also appeared to be churning the case, i.e., causing conflict and then billing for work to respond to the conflict and/or to cause more conflict. I have an accounting background and also saw markers of embezzlement. I tried to tell the court, but the supervising commissioner didn’t know much about accounting. She allowed the guardian to hire its own CPA to investigate the situation, which predictably exonerated the guardian. The guardian had many cases and if what I said had been proved true, there would have been political fallout. There were also conflicts of interest among the lawyers.

At this point, the scales began to fall from my eyes. My focus started to shift from working within the system to seeing how the system itself sometimes facilitates abuse. This led me to write articles addressing some of the system’s flaws.  See e.g., Margaret K. Dore, Ten Reasons People Get Railroaded into Guardianship, 21 AM. J. FAM. L. 148 (2008); Margaret K. Dore, The Time is Now: Guardians Should be Licensed and Regulated Under the Executive Branch, Not the Courts, WASH. ST. B. ASS’N B. NEWS, Mar. 2007 at 27-9, available at http://maasdocuments.files.wordpress.com/2013/08/dore-the-time-is-now-ashx.pdf

The MetLife Studies 

In 2009, the MetLife Mature Market Institute released its landmark study on elder financial abuse. see https://www.giaging.org/documents/mmi-study-broken-trust-elders-family-finances.pdf The estimated financial loss by victims in the United States was $2.6 billion per year.

The study also explained that perpetrators are often family members, some of whom feel themselves “entitled” to the elder’s assets. The study states that perpetrators start out with small crimes, such as stealing jewelry and blank checks, before moving on to larger items or coercing elders to sign over the deeds to their homes, change their wills or liquidate their assets.

In 2011, Met Life released another study available at https://www.giaging.org/documents/mmi-elder-financial-abuse.pdf, which described how financial abuse can be catalyst for other types of abuse and which was illustrated by the following example. “A woman barely came away with her life after her caretaker of four years stole money from her and pushed her wheelchair in front of a train. After the incident the woman said, “We were so good of friends . . . I’m so hurt that I can’t stop crying.”

Failure to Report

A big reason that elder abuse and exploitation are prevalent is that victims do not report. This failure to report can be for many reasons. A mother being abused by her son might not want him to go to jail. She might also be humiliated, ashamed or embarrassed about what’s happening. She might be legitimately afraid that if she reveals the abuse, she will be put under guardianship.

The statistics that I’ve seen on unreported cases vary, from only 2 in 4 cases being reported, to one in 20 cases. Elder abuse and exploitation are, regardless, a largely uncontrolled problem. 

A New Development: Legalized Assisted Suicide

Another development relevant to abuse and exploitation is the ongoing push to legalize assisted suicide and euthanasia in the United States. “Assisted suicide” means that someone provides the means and/or information for another person to commit suicide. If the assisting person is a physician who prescribes a lethal dose, a more precise term is “physician-assisted suicide.” “Euthanasia,” by contrast, is the direct administration of a lethal agent with the intent to cause another person’s death.

In the United States, physician-assisted suicide is legal in three states:  Oregon, Washington and Vermont. Eligible patients are required to be “terminal,” which means having less than six months to live. Such patients, however, are not necessarily dying.  One reason is because expectations of life expectancy can be wrong. Treatment can also lead to recovery. I have a friend who was talked out of using Oregon’s law in 2000. Her doctor, who did not believe in assisted suicide, convinced her to be treated instead.  She is alive today, 13 years later.

Oregon’s law was enacted by a ballot measure in 1997. Washington’s law was passed by another measure in 2008 and went into effect in 2009. Vermont’s law was enacted on May 20, 2013.  All three laws are a recipe for abuse. One reason is that they allow someone else to talk for the patient during the lethal dose request process. Moreover, once the lethal dose is issued by the pharmacy, there is no oversight over administration. Even if the patient struggled, who would know? [See e.g., http://www.choiceillusion.org/2013/11/quick-facts-about-assisted-suicide_11.html 

Here in Washington State, we have already had informal proposals to expand our law to non-terminal people. The first time I saw this was in a newspaper article in 2011. More recently, there was a newspaper column suggesting euthanasia “if you couldn’t save enough money to see yourself through your old age,” which would be involuntary [or non-voluntary] euthanasia. Prior to our law being passed, I never heard anyone talk like this.

I have written multiple articles discussing problems with legalization, including Margaret K. Dore, "Death with Dignity”: What Do We Advise Our Clients?," King Co. B. ASS’N, B. BuLL., May 2009, available atwww.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm; Margaret K. Dore, Aid in Dying: Not Legal in Idaho; Not About Choice, 52 THE ADVOCATE [the official publication of the Idaho State Bar] 9, 18-20 (Sept. 2013) 

My Cases Involving the Oregon and Washington Assisted Suicide Laws

I have had two clients whose parents signed up for the lethal dose. In the first case, one side of the family wanted the father to take the lethal dose, while the other did not.  He  spent the last months of his life caught in the middle and traumatized over whether or not he should kill himself. My client, his adult daughter, was also traumatized.  The father did not take the lethal dose and died a natural death.

In the other case, it's not clear that administration of the lethal dose was voluntary. A man who was present told my client that the father refused to take the lethal dose when it was  delivered (“You’re not killing me.  I’m going to bed”), but then took it the next night when he was high on alcohol. The man who told this to my client later recanted. My client did not want to pursue the matter further.

Conclusion

In my guardianship cases, people were financially abused and sometimes treated terribly, but nobody died and sometimes we were able to make their lives much better. With legal assisted suicide, the abuse is final.  Don’t make Washington's mistake.

Margaret K. Dore (margaretdore@margaretdore.com) JD, MBA, is an attorney in private practice in Washington State where assisted suicide is legal. She is a former Law Clerk to the Washington State Supreme Court and the Washington State Court of Appeals. She worked for a year with the U.S. Department of Justice and is president of Choice is an Illusion, www.choiceillusion.org, a nonprofit corporation opposed to assisted suicide and euthanasia.

Autistic Self Advocacy Network (ASAN) Condemns Exclusion of Disabled People at NJ Hearing on Assisted Suicide Bill

http://www.notdeadyet.org/2014/12/autistic-self-advocacy-network-asan-condemns-exclusion-of-disabled-people-at-nj-hearing-on-assisted-suicide-bill.html

The Autistic Self Advocacy Network  (ASAN) has issued a statement condemning the exclusion of disabled people from testifying at yesterday’s (Dec.7) hearing on a proposed assisted suicide bill in front of the New Jersey Senate Health, Human Services and Senior Citizens Committee:
(Excerpt)

The Autistic Self Advocacy Network is deeply concerned about the omission of disabled people and representatives from disability rights organizations at yesterday’s hearing. Given that more than half of the groups in the New Jersey coalition opposing the bill are disability rights organizations and centers for independent living, it is unconscionable that the committee deliberately excluded witnesses from the disability community. Even after our community submitted a formal request for inclusion among the witnesses, the committee declined to invite a disability community representative.

Read the entire statement here.

* * *

Margaret Dore, President of Choice is an Illusion, was also excluded despite multiple requests to participate.  So the proponents' deceptively named advocacy group,  Compassion & Choices, was allowed to present unopposed by its opposition counter-part, Choice is an Illusion.  To view a legal/policy memo opposing the proposed bill to legalize assisted suicide and euthanasia in New Jersey, please go here:  https://choiceisanillusion.files.wordpress.com/2014/12/a-2270-3r-memo-12-02-14.pdf

Whose Choice Will It Be? Telling the truth about assisted suicide. Excerpts from an NRO Interview

http://www.nationalreview.com/article/392444/whose-choice-will-it-be-interview  . . . .

Margaret Dore is a lawyer in Washington State, where assisted suicide is also legal. Dore is a former law clerk to the Washington state supreme court and president of Choice Is an Illusion, a 501(c)(4) nonprofit corporation opposed to assisted suicide and euthanasia. She talks with National Review Online about assisted suicide as it exists now and how we might make a change. — Kathryn Jean Lopez 

. . . .
Lopez: What is the absolute first thing that you would like anyone who was moved by Brittany Maynard’s life and death to know?

Dore: I would want them to know that “eligibility” for legal assisted suicide is not limited to people who are near death. This is true for the following reasons:

Under the Oregon and Washington assisted-suicide laws, assisted suicide is legal for “terminal” patients, meaning those predicted to have less than six months to live. But such predictions can be wrong. Moreover, treatment can lead to recovery. Consider Jeanette Hall, who was diagnosed with cancer in Oregon in 2000 and was adamant that she would “do” Oregon’s law. Her doctor, who didn’t believe in assisted suicide, stalled her and convinced her to be treated instead. Today, 14 years later, she is thrilled to be alive. You can see her doctor’s affidavit here.

Once assisted suicide is legal, there is pressure to expand. For example, here in Washington State, we have already had “trial balloon” proposals to expand our law to euthanasia for non-terminal people. For me, the most disturbing proposal was a discussion in our largest paper suggesting euthanasia for people who didn’t have enough money for their old age. So, if you worked hard all your life, paid taxes, and then your pension plan went broke, this is how society will pay you back? With non-voluntary or involuntary euthanasia? (The newspaper column can be read here.)

In other words, with legal assisted suicide, people with years to live are encouraged to throw away their lives. Moreover, and contrary to the media hype, legal assisted suicide (or euthanasia) may not be voluntary. . . .

Lopez: Why is the “death with dignity” language misleading?

Dore: Because it’s a euphemism, which doesn’t readily disclose that we are talking about assisted suicide and euthanasia for people who may or may not be dying anytime soon, and that such death may not be voluntary.

Lopez: Who is Compassion & Choices? Is its name misleading?

Dore: Compassion & Choices is a successor organization to the Hemlock Society, originally formed by Derek Humphry. In March 2011, Humphry was in the news as a promoter of mail-order suicide kits from a company now shut down by the FBI. This was after a 29-year-old man had used one of the kits to commit suicide. Seven months later, on October 22, 2011, Humphry was the keynote speaker at Compassion & Choices’ annual meeting here in Washington State.

Compassion & Choices’ name is misleading because it does not disclose its true nature as a suicide/euthanasia advocacy group. The name is also misleading because Compassion & Choices’ true mission is to reduce choice in health care and to change public policy so as to reduce patient cures.

Lopez: Speaking of names: How did your group arrive at Choice Is an Illusion?   

Dore: The name, Choice Is an Illusion, is a commentary on Compassion & Choices because the laws it promotes do not assure patient choice. . . .

Lopez: What might you want to leave readers with in closing?

Dore: Problems with legal assisted suicide include:

• The encouragement of people with years to live to throw away their lives.
• New paths of elder abuse, for example, in the context of inheritance.
• A push to expand euthanasia to non-terminal individuals.

Don’t make Washington State’s mistake.

To read the entire article, please go here:  http://www.nationalreview.com/article/392444/whose-choice-will-it-be-interview

"This is how society will pay you back? With non-voluntary or involuntary euthanasia?"

http://missoulian.com/news/opinion/mailbag/assisted-suicide-discussion-veering-into-talk-of-terminating-lives-of/article_87332fc0-4fe8-11e4-94f5-632029a45aed.html

I am a lawyer in Washington State, where assisted suicide is legal. Our law was passed by a deceptive ballot measure spearheaded by Compassion & Choices. Voters were promised that only the patient would be allowed to administer the lethal dose, which is false. Our law does say that the patient may self-administer the lethal dose, but there is no language saying that administration must be by self-administration. For more information, please go here:  https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm

Once assisted suicide is legal, there is pressure to expand. For example, here in Washington State, we have had “trial balloon” proposals to expand our law to non-terminal people. For me, the most disturbing one was a casual discussion in our largest paper suggesting euthanasia for people who didn’t save enough money for their old age. So, if you worked hard all your life, paid your taxes, and your pension plan went broke, this is how society will pay you back? With non-voluntary or involuntary euthanasia?

To view a copy of the newspaper column, please go here: https://choiceisanillusion.files.wordpress.com/2014/10/jerry-large_001.pdf.

Protect yourselves and your families. Don’t let assisted suicide become legal in Montana.

Margaret Dore, president,
Choice is an Illusion,
Seattle, Washington

Margaret Dore published in the Baltimore Sun

The letter below, published in the Baltimore Sun, describes the positive statistical correlation between legalizing physician-assisted suicide and the significant increase in other "regular" suicides in Oregon.  This is at great financial cost to that state.

For more detail and links to supporting documentation, please see: Letter from Margaret Dore to Members of the New Hampshire House of Representatives, March 4, 2014, titled:  "The High Financial Cost of (Regular) Suicide."

* * *

The published letter:  Margaret Dore," Legalizing assisted suicide is a bad idea."

Alexa Fraser's recent commentary promotes the idea of legalizing physician-assisted suicide. . . .

The term "physician-assisted suicide" means that a physician provides the means or information to enable a patient to perform a life-ending act, such as through a lethal prescription.

The premise of Ms. Fraser's commentary is that legalization of physician-assisted suicide will eliminate other types of suicides, such as those resulting from self-inflicted gunshot wounds.

This premise is not, however, supported by statistics from Oregon, which is the only state in which physician-assisted suicide has been legal long enough to have valid statistics over time.

The Oregon statistics support the conclusion that, if anything, "ordinary" suicides will actually increase if physician-assisted suicide were legalized in Maryland.

A suggestion that Bishop Tutu confuses assisted suicide with “switching off life support.” If so, perhaps we are to blame.

By Margaret Dore, Esq., MBA*

www.margaretdore.com

www.choiceillusion.org

An assisted suicide bill is coming up for a vote in the UK House of Lords.  The bill, HL Bill 6, is based on similar laws in Oregon and Washington State, USA.

Assisted Suicide and HL Bill 6

HL Bill 6, like the Oregon and Washington laws on which it is based, applies to patients who have been given 6 months or less to live.  Such patients may, in fact, have years to live.  One reason is that doctors’ predictions of life expectancy can be wrong.  See Margaret Dore, “Falconer Assisted Suicide Bill: ‘Eligible’ Patients May Have Years, Even Decades, to Live,” Choice is an Illusion, July 12, 2014.

Bishop Tutu’s Remarks

I don't know Bishop Tutu, but I have seen him speak and I admire him very much.  He has now, however, voiced his support for “assisted dying”, with reference to the death of Nelson Mandela.

According to a New Zealand blog post, Bishop Tutu may be confusing the withdrawal of life support with assisted suicide.  The post says in part:

Interesting that Bishop Tutu now admits publicly that Mandela was indeed on life support and that “prolonging his life was an affront to his dignity”, according to an article on BBC.com.

Switching off life support is, regardless, different from euthanasia and assisted suicide.  When life support is switched off the patient doesn't necessarily die. Consider, for example, this case from Washington State reported in the Seattle Weekly:

[I]nstead of dying as expected, the man slowly began to get better. [Dr. J. Randall Curtis] doesn't know exactly why, but guesses that for that patient, "being off the ventilator was probably better than being on it.  He was more comfortable, less stressed." Curtis says the man lived for at least a year afterwards. 

With assisted suicide and euthanasia, the patient deliberately kills himself or is killed by another person.  See e.g., AMA Code of Medical Ethics, Opinion 2.21 (defining euthanasia).  Moreover, that patient could have had years to live.

The Blame is on us

Perhaps the blame for the confusion should be placed on us and the language of the debate in which both sides have been referring to assisted suicide and euthanasia as “assisted dying.”  Perhaps it’s time for those of us who oppose legalization to call a spade a spade and eliminate the misleading term, “assisted dying” from our vocabulary. Our very lives may depend on it.

*  Margaret Dore is an attorney in Washington State USA where assisted suicide is legal.  She is also President of Choice is an Illusion, a human rights organization opposed to assisted suicide and euthanasia. Her publications include Margaret K. Dore, "''Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009 (regarding Washington's law).  See also Margaret Dore, Quick Facts About Assisted Suicide, at http://www.choiceillusion.org/2013/11/quick-facts-about-assisted-suicide_11.html

Washington’s ‘Death with Dignity’ law imperils the poor

http://realchangenews.org/index.php/site/archives/9122

Last week’s article by an assisted suicide/euthanasia advocate struck me as a bizarre article for Real Change, which advocates for the dignity and self-determination of the poor. (“Terminally ill patients face shortage of right-to-die drug amid controversy over capital punishment,” Real Change, June 18)

Washington’s assisted suicide law was passed in 2008 and went into effect in 2009. This was after a deceptive initiative campaign promised us that “only” the patient would be allowed to take the lethal dose. Our law does not say that anywhere. See Margaret K. Dore, “’Death with Dignity,” What Do We Advise Our Clients?,” King County Bar Association, Bar Bulletin, May 2009, available at https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm.

In Oregon, which has a similar law, there are documented cases of that state’s Medicaid program using the law to steer patients to suicide. In other words, indigent patients are offered suicide in lieu of desired treatments to cure or to extend life. The most well-known cases are Barbara Wagner and Randy Stroup.  See: Susan Donaldson James, “Death Drugs Cause Uproar in Oregon,” ABC News, August 6, 2008, at http://abcnews.go.com/Health/story?id=5517492&page=1; and “Letter noting assisted suicide raises questions,” KATU TV, July 30, 2008, at http://www.katu.com/news/specialreports/26119539.html  See also the Affidavit of Kenneth Stevens, MD, filed by the Canadian government in Leblanc v. Canada, available at http://maasdocuments.files.wordpress.com/2012/09/signed-stevens-aff-9-18-12.pdf.

Finally, consider this quote from a March 8, 2012 Jerry Large column in the Seattle Times. He says that at least a couple of his readers suggested euthanasia “if you couldn’t save enough money to see you through your old age.” http://seattletimes.com/text/2017693023.html  For the poor, this would be non-voluntary or involuntary euthanasia. 

So much for the dignity and self-determination of the poor.

Margaret Dore, Esq., MBA *

Seattle

* www.margaretdore.com & www.choiceillusion.org 

Legal/Policy Analysis Against New Jersey Bill, A2270 (Assisted Suicide & Euthanasia)

By Margaret Dore, Esq., MBA

A legal/policy analysis against New Jersey's proposed assisted suicide/euthanasia bill, A2270, can be viewed by clicking here.

If the analysis is "too big" for your computer, you can view it in pieces, by clicking the following links to: the cover sheet and index; the memo; and the appendices.

There are three main points:

1.  A2270 is titled "Aid in Dying for the Terminally Ill Act."  "Aid in Dying" is a euphemism for assisted suicide and euthanasia.  The title is, regardless, deceptive because it implies that A2270 is limited to people who are dying, which is untrue.  A2270 applies to people who may have years, even decades, to live.  See memo, pp. 5-8.

2. The bill is a recipe for elder abuse with the most obvious reason being a complete lack of oversight when the lethal dose is administered to the patient.  Even if he struggled, who would know? See memo, pp. 8-17.

3. The bill lacks transparency and accountability.  Id., pp. 17-19.

The last part of the memo is a discussion of the "Oregon and Washington Experience," with supporting documentation attached.

Please contact me with any questions or concerns at contact@choiceillusion.org or margaretdore@margaretdore.com.

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

Margaret Dore writes the New Hampshire Judiciary Committee: Vote "No" on HB 1325

Madame Chair and Members of the Committee,

During the recent hearing on assisted suicide, I mentioned that there had been a significant increase in other suicides in Oregon after assisted suicide legalization.  This is consistent with a suicide contagion (legalizing and thereby normalizing one type of suicide encouraged other suicides). 

Of course, a correlation does not prove causation. 

However, as set forth below, there is a significant statistical correlation between the two events.  Moreover, the financial cost to Oregon from the other suicides is enormous.  Please see the data below:

Oregon's assisted suicide act went into effect in 1997. See top line at this link: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx

By 2000, Oregon's regular suicide rate was "increasing significantly"  See http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf ("After decreasing in the 1990s, suicide rates have been increasing significantly since 2000")

In 2010, Oregon's other suicide rate was 35% above the national average.  http://maasdocuments.files.wordpress.com/2013/02/oregon-suicide-info_001.pdf

In 2012, the most recent report, Oregon's other suicide rate was 41% above the national average.  http://choiceisanillusion.files.wordpress.com/2014/02/oregon-suicide-report-2012-through-2010-pdf.pdf  Moreover, this report, page 3, states:

"Suicide is the second leading cause of death among Oregonians ages 15-34, and the 8th leading cause of death among all ages in Oregon.  The cost of suicide is enormous.  In 2010 alone, self-inflicted injury hospitalization changes exceeded 41 million dollars; and the estimate of total lifetime cost of suicide in Oregon was over 680 million dollars.  The loss to families and communities broadens the impact of each death."

The report, itself, does not address the possible influence of assisted suicide legalization.  But, again, the significant statistical correlation is there.  The cost to the state is enormous.

Please feel free to contact me for any further information.

Thank you.

Margaret Dore
Law Offices of Margaret K. Dore, P.S.
www.margaretdore.com
www.choiceillusion.org
1001 4th Avenue, 44th Floor
Seattle, WA  98154
206 389 1754 main line

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

By Margaret Dore, Esq.
Updated February 19, 2014

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

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

Per the report, most of the people who died from a lethal dose were white, aged 65 or older, and well-educated. See note [7].  People with these attributes are typically well off, i.e., the middle class and above.  The report's introduction implies that their deaths were voluntary, stating that Oregon's act "allows" residents to obtain a lethal dose for self-administration.  There is, however, nothing in the report stating that the specific deaths described in the report were self-administered and/or voluntary.[8] Older well-off people are, regardless, in a vulnerable demographic for abuse and exploitation.  This includes murder.  A 2009 MetLife Mature Market Institute Study states:

"Elders’ vulnerabilities and larger net worth make them a prime target for financial abuse . . . Victims may even be murdered by perpetrators who just want their funds and see them as an easy mark."[9]

Oregon's act was passed in 1997.[10]  Just three later, Oregon's suicide rate for other suicides was "increasing significantly."[11]  Last year, an article in Oregon's largest paper reported:

"New figures show a sharp rise in suicides among middle-aged Americans, and an even bigger increase in Oregon. A Centers for Disease Control and Prevention report shows suicides among men and women aged 35-64 increased 49 percent in Oregon from 1999-2010, compared to 28 percent nationally."[12] 

This "significant increase" is consistent with a suicide contagion in which legalizing one type of suicide encouraged other suicides.[13]

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

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

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

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

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

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

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

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

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

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

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

***

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

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.