Canada: Oregon Doctor Urges Rejection of Carter and Bill C-14

Dear Member of Canadian Parliament,

VOTE NO ON BILL C-14; INVOKE THE NOTWITHSTANDING CLAUSE TO OVERRIDE THE CARTER DECISION

"Don't follow Oregon's
 failed experiment"

For 49 years I have been a cancer doctor in Oregon where assisted suicide has been legal for a number of years. I have seen the tragedy and harm to patients, the medical profession and society from assisted suicide.

If enacted Bill C-14 will encourage people with years to live to have their lives terminated prematurely. My patient, Jeanette Hall, wanted assisted suicide from me in 2000. After helping her have hope in her cancer condition, she agreed to be treated and is now alive and very well 15 years later.  She says, "It's great to be alive!"

Quick Facts About Assisted Suicide

By Margaret Dore, Esq., MBA

For a pdf version, please click here

1.  Assisted Suicide

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

2. The Oregon and Washington Laws

In Oregon, physician-assisted suicide was legalized in 1997 via a ballot measure. In Washington State, a similar law was passed by another ballot measure in 2008 and went into effect in 2009.

3.  Problems With Legalization

The Oregon and Washington laws are a recipe for elder abuse and encourage people with years to live to throw away their lives. In Oregon, there are documented cases of the Oregon Heath Plan (Medicaid) steering patients to physician-assisted suicide via coverage incentives. Oregon’s conventional suicide rate has increased with legalization of assisted suicide, which is consistent with a suicide contagion. Patients and families are traumatized.

The Oregon and Washington laws require the death certificate to be falsified to reflect a natural death via a terminal disease, as opposed to the actual cause of death, a lethal dose. The significance is a lack of transparency and an inability to take legal action against overreaching parties.

The Cost of Physician-Assisted Suicide.

By Margaret Dore, Esq., MBA*
Updated November 25, 2015 

It is often assumed that legalizing physician-assisted suicide will save states money. Don’t be so sure. In Oregon, legalization is correlated with an increase in other suicides, the cost of which is "enormous."

More Suicide

Oregon's law legalizing physician-assisted suicide went into effect “in late 1997.”[1] Since then, Oregon has reported a small, but steadily rising number of deaths.[2]

Oregon's other suicides, which are tracked separately, have also increased. Indeed, by 2000, Oregon's suicide rate for other suicides was "increasing significantly."[2] By 2007, Oregon's suicide rate for other suicides was 35% above the national average.[3] By 2010, Oregon's suicide rate for other suicides was 41% above the national average.[4]

The Financial Cost

The financial cost of these other suicides (and suicide attempts) is huge for Oregon, a smaller population state. The Oregon Health Authority states:

The cost of suicide is enormous. In 2010 alone, self-inflicted injury hospitalization charges exceeded 41 million dollars; and the estimate of total lifetime cost of suicide in Oregon was over 680 million dollars. (Footnotes omitted).[5]

Dore Professional Commentary

http://jurist.org/hotline/2015/10/margaret-dore-physician-assisted-suicide.php

California's New Assisted Suicide Law: Whose Choice Will it Be?

JURIST Guest Columnist, Margaret Dore, Esq., MBA

Editor, Maria Coladonato; 

©  WikiMedia (Christopher Padalinski)

California has passed a bill to legalize physician-assisted suicide, which is scheduled to go into effect during 2016. "The End of Life Option Act" was sold as giving patients choice and control at the end of life. The bill, in fact, is about ending the lives of people who are not necessarily dying anytime soon and giving other people the "option" to hurry them along. The bill is a recipe for elder abuse and family trauma. 

Attorney slams California suicide bill

FOR IMMEDIATE RELEASE

Dore: “Even if you like the concept of assisted suicide, SB 128 is the wrong bill.”

Contact: Margaret Dore (206) 697-1217

Seattle, WA -- Attorney Margaret Dore, president of Choice is an Illusion, which has fought assisted suicide legalization efforts in many states and now California, made the following statement after the California Senate Appropriations Committee passed SB 128 on May 28, sending the assisted suicide bill to the Senate floor.

"SB 128 is sold as giving people an 'end of life option,’” Dore said. “The fact is this bill is about ending the lives of people who aren’t necessarily dying anytime soon, and giving other people the ‘option’ to hurry them along."

Dore, an attorney in Washington State where assisted suicide is legal, explained, “In my law practice, I started out working in guardianships, wills and probate, and saw abuse of all kinds, especially where there was money involved (where there's a will, there are heirs). Then, in 2008, I got dragged to a meeting about our assisted suicide law and saw the perfect crime: your heir could help sign you up, and once the lethal dose was in the house, there was no oversight. Not even a witness is required. If you struggled, who would know?"

Assisted Suicide: How One Woman Chose to Die, Then Survived

http://dailysignal.com/2015/05/18/assisted-suicide-how-one-woman-chose-to-die-then-survived/

Kelsey Harkness / May 18, 2015

In 1994, Jeanne Hall, a resident of King City, Ore., voted in favor of Ballot Measure 16, which for the first time in the United States, would allow terminally ill patients to end their own lives through physician-assisted suicide.

“I thought, hey, I wouldn’t want anyone to suffer,” Hall told The Daily Signal. “So I checked it. Then it became legal.”

That day at the ballot box, Hall never could have predicted that more than 15 years later, she would be diagnosed with inoperable colon cancer.

Doctors gave Hall, who was 55 at the time, two options: She could get radiation and chemotherapy and attempt to fight the cancer, or she could take a lethal dose of barbiturates to end her life.

“I was calling it over,” she said. “I wasn’t going to do chemo. When I heard what might take place in radiation "I wasn’t going to do it. I looked for the easy way out.”

Without treatment, Hall was given six months to a year to live, and therefore qualified for physician-assisted suicide through Oregon’s Death With Dignity law.

“She was terminal because she was refusing treatment,” Dr. Kenneth Stevens, one of Hall’s two cancer doctors, told The Daily Signal. “It’s like a person could be considered terminal if they’re not taking [their] insulin or [other] medications.”

Washington Post Puts the Spotlight on Hospice/Palliative Care Abuse

By Margaret Dore, Esq., MBA

Choice is an Illusion, President

Below and finally, a comprehensive article in a major paper describing what a lot of us know already, that non-consenting, non-dying people are being killed with morphine and other drugs under the guise of hospice/palliative care.  The article, excerpted below from the Washington Post, describes cases in the US. There are similar cases in Canada and the UK (e.g, the former "Liverpool Pathway").

There are a myriad of reasons why these cases occur, including mistakes and negligence, which is described in the Post article.  The wishes of heirs interested in a speedy inheritance and/or to get dad out of the way before he changes his will, can also be at play.  For a particularly egregious example, see William Dotinga, "Grim Complaint Against Kaiser Hospital," at http://www.courthousenews.com/2012/02/06/43641.htm

With hospice, eligibility is determined by a prediction of less than six months to live.  This is the same eligibility cutoff used for legal assisted suicide in Oregon and Washington State.  This is, however, just a prediction and there are many people deemed eligible who live longer than that and/or who are not dying.  See, e.g., the Washington Post article excerpted below and this article from the Seattle Weekly: "Terminal Uncertainty."  See also this affidavit from Oregon doctor Kenneth Stevens, MD and this affidavit from John Norton.

This hospice/palliative care abuse issue is important for itself, as well, as for its implications in the larger debate over assisted suicide/euthanasia legalization.  Consider, for example, the letter below from Washington State.  The author, the owner of a care facility, describes how since passage of Washington's assisted suicide law, doctors more readily resort to morphine, sometimes without consent.  He states:

Since [Washington's assisted suicide law] passed, we have . . .  noticed that some members of the medical profession are quick to bring out the morphine to begin comfort care without considering treatment. Sometimes they do this on their own without telling the client and/or the family member in charge of the client's care. http://www.choiceillusion.org/2013/12/it-wasnt-father-saying-that-he-wanted.html

He also describes a general devaluation of older people, as follows:

Since our [assisted suicide] law was passed, I have also observed that some medical professionals are quick to write off older people as having no quality of life whereas in years past, most of the professionals we dealt with found joy in caring for them. Our clients reciprocated that joy and respect.  (Id.).

He concludes by asking readers to not make Washington's mistake of legalizing assisted suicide. He states:

Someday, we too will be old. I, personally, want to be cared for and have my choices respected. I, for one, am quite uncomfortable with these developments. Don't make our mistake.  (Id.).

* * *
Below, the excerpt from the Washington Post article.

As More Hospices Enroll Patients who Aren't Dying, Questions About Lethal Doses Arise

http://www.washingtonpost.com/news/storyline/wp/2014/08/21/as-more-hospices-enroll-patients-who-arent-dying-questions-about-lethal-doses-arise/?

By Peter Whoriskey at peter.whoriskey@washpost.com

UK: Falconer Assisted Suicide Bill: "Eligible" Patients May Have Years, Even Decades, to Live

By Margaret Dore, Esq., MBA

www.margaretdore.com

www.choiceillusion.org

In the UK, HL Bill 6 is an assisted suicide law proposed by Lord Falconer, which is based on the Oregon and Washington assisted suicide laws.  Bill 6 would legalize assisted suicide for persons with a "terminal illness," defined in terms of a prediction of less than six months to live.[1]  The Oregon and Washington laws have a similar six months to live criteria.[2]

Under all three laws, "eligible" patients may have years, even decades, to live.  This is true for the following the following reasons: 

1.      Predictions of life expectancy can be wrong.  

Patients may have years or even decades to live because predicting life expectancy is not an exact science.  Consider John Norton who was diagnosed with ALS.  He was told that he would get progressively worse (be paralyzed) and die in three to five years.  Instead, the disease progression stopped on its own.  In a 2012 affidavit, at age 74, he states:

If assisted suicide or euthanasia had been available to me in the 1950's, I would have missed the bulk of my life and my life yet to come.  http://www.massagainstassistedsuicide.org/2012/09/john-norton-cautionary-tale.html [3]

2.      The six months to live is determined without treatment. 

Consider Oregon resident, Jeanette Hall, who was diagnosed with cancer and decided to "do" Oregon's law.  Her doctor, Kenneth Stevens, didn't believe in assisted suicide and encouraged her to be treated instead.  It is now 14 years later and she is "thrilled" to be alive.  This is Dr. Steven's affidavit filed by the Canadian government in Leblanc v. Canada, now dismissed, discussing Jeanette.  http://choiceisanillusion.files.wordpress.com/2013/07/signed-stevens-aff-9-18-12-as-filed.pdf   This is Jeanette's affidavit, also filed by the Canadian government:  http://choiceisanillusion.files.wordpress.com/2013/05/jeanette-hall-affidavit.pdf  

3.      In Oregon, the six months to live criteria is now being interpreted to include chronic conditions such as diabetes.  

Oregon doctor, William Toffler, explains: 

Our law applies to “terminal” patients who are predicted to have less than six months to live. In practice, this idea of terminal has recently become stretched to include people with chronic conditions such as chronic lower respiratory disease and diabetes. Persons with these conditions are considered terminal if they are dependent on their medications, such as insulin, to live. They are unlikely to die in less than six months unless they don’t receive their medications. Such persons, with treatment, could otherwise have years or even decades to live.[4]  

* * *
[1]  See HL Bill 6, Sections 2, at http://services.parliament.uk/bills/2014-15/assisteddying.html (defining "terminal illness" as an "inevitably progressive condition which cannot be reversed by treatment," and for which the patient "is reasonably expected to die in six months.").
[2]  See ORS 127.800 s.1.01(12) and RCW 70.245.010(13) at    http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx and http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245.010  (both stating:  "'Terminal disease' means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.").
[3]  See also:  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://choiceisanillusion.files.wordpress.com/2013/10/terminal-uncertainty.pdf and http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty
[4]  Letter from William Toffler, MD, to the New Haven Register, published February 26, 2014, 2^nd letter at http://www.nhregister.com/opinion/20140226/letters-to-the-editor-dying-deserve-right-to-choice  See also, Dore Memo at pp 6-7, at http://choiceisanillusion.files.wordpress.com/2014/06/nj-a2270-legal-analysis_001.pdf and Margaret Dore, “Oregon's new assisted suicide report: chronic conditions;  people with money and more,” February 19, 2014, at http://www.choiceillusion.org/2014/01/oregons-new-assisted-suicide-report.html 

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

Live Free or Die! New Hampshire Obliterates Oregon-Style Death with Dignity Act!

Today, the New Hampshire House of Representatives defeated HB 1325. The bill had sought to enact an Oregon-style assisted suicide law in New Hampshire. The bipartisan vote was an overwhelming 219 to 66.

To view a short testimony against the bill, click here.

"I hope that Connecticut does not repeat Oregon's mistake."

http://www.journalinquirer.com/opinion/letters_to_the_editor/march-letters/article_ccb4e384-a2bb-11e3-b9c8-001a4bcf887a.html (second letter)

I have been a professor of family medicine and a practicing physician in Oregon for more than 30 years. I write to provide some insight on the issue of assisted suicide, which is legal in Oregon, and which has been proposed for legalization in Connecticut (raised bill No. 5326).

Our law applies to “terminal” patients who are predicted to have less than six months to live.  In practice, this idea of “terminal” has recently become stretched to include people with chronic conditions, such as “chronic lower respiratory disease” and “diabetes”.  Persons with these conditions are considered terminal if they are dependent on their medications, such as insulin, to live.  They are unlikely die in less than six months unless they don’t receive their medications.  Such persons, with treatment, could otherwise have years or even decades to live.

This illustrates a great problem with our law — it encourages people with years to live, to throw away their lives.

I am also concerned that by starting to label people with chronic conditions “terminal,” there will be an excuse to deny such persons appropriate medical treatment to allow them to continue to live healthy and productive lives.

These factors are something for your legislators to consider. Do you want this to happen to you or your family? Furthermore, in my practice I have had many patients ask about assisted-suicide. In each case, I have offered care and treatment but declined to provide assisted suicide. In one case, the man’s response was “Thank you.”

To read a commentary on the most recent Oregon government assisted-suicide report, which lists chronic conditions as the “underlying illness” justifying assisted suicide, please go here:  http://www.noassistedsuicideconnecticut.org/2014/02/oregons-new-assisted-suicide-report.html

To read about some of my cases in Oregon, please go here:  http://www.choiceillusion.org/p/what-people-mean_25.html

I hope that Connecticut does not repeat Oregon’s mistake.

William L. Toffler
Portland, Ore.

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

Preventing Abuse and Exploitation: A Personal Shift in Focus. An article about guardianship, elder abuse and assisted suicide.

http://www.americanbar.org/publications/voice_of_experience/2014/winter/preventing_abuse_and_exploitationa_personal_shift_focus.html

http://choiceisanillusion.files.wordpress.com/2014/02/dore-preventing-abuse-and-exploitation-aba.pdf

By Margaret K. Dore, Esq., MBA

The Voice of Experience, American Bar Association

Volume 25, No. 4, Winter 2014

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), available at www.margaretdore.com/pdf/Dore_AJFL_Winter08.pdf; 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 www.metlife.com/assets/cao/mmi/publications/studies/2011/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 still 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.  Onw 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 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 at  www.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) available at www.margaretdore.com/pdf/Not_Legal_in_Idaho.pdf  

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 Washinton’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.

Suicide prevention plans at odds with right to die

This Canadian article is consistent with the Oregon experience in which legalization of physician-assisted suicide was followed by a significant increase in other suicides.  See footnote 1.

http://www.calgaryherald.com/opinion/op-ed/Martinuk+Suicide+prevention+plans+odds+with+right/9343852/story.html

By Susan Martinuk, Calgary Herald January 3, 2014 

Retired politician Bob Rae used the occasion of a friend's apparent suicide to call on Canada to establish a national suicide prevention plan.

Susan Martinuk

Chris Peloso was Rae's friend and well known in Ontario's political circles as the husband to George Smitherman, a former high-profile cabinet minister and politician. Media reports haven't utilized the term suicide, but the phrase "lost his battle with depression" seems to indicate that was the case.

Calls for such a strategy are made every time there is a high-profile suicide in this country (such as Amanda Todd and Rehtaeh Parsons, two girls who suffered unbearable bullying in school and on the Internet). Parliament passed a suicide prevention strategy one year ago, but few seem to be aware of its existence or its implementation, and society continues to call for somebody to do something to prevent such tragedies from occurring.

Prevention is usually a good policy. But I have questions about whether any suicide prevention policy can be successful with Canada's health-care system and be consistent with other societal messages.

The first question is how can we effectively prevent suicides by those who are depressed when our health-care system offers limited (at best) access to psychiatric care and treatment?

A depressed person can call a suicide hotline or speak with a counsellor, and a crisis may be prevented. Or maybe not. But, at some point, the only way to prevent suicide is to access medical treatment.

The Fraser Institute's 2013 report, Waiting Your Turn: Wait Times for Health Care in Canada, reveals that the national average wait time from referral by a general practitioner to the time of beginning non-urgent psychiatric treatment was 20.3 weeks. If you live in New Brunswick, that wait is 73.5 weeks. That's about 1.5 years to access treatment and includes a 46-week wait from the time of GP referral to seeing a psychiatric specialist.

If you live in Saskatchewan, the wait for treatment is one year. Even if the case is urgent, patients still face a five-week wait to get an appointment with a psychiatrist. Anyone familiar with depression or other mental illnesses knows that a lot can change in five weeks, let alone one year.

Rae thinks it's important to have public conversations about mental illness. But awareness has absolutely nothing to do with treatment and, based on the above statistics, it's difficult to imagine that any province could maintain an effective suicide prevention strategy.

My second question raises an issue that Canadians may not be familiar with, but will undoubtedly face in the coming months as Quebec (and eventually the rest of Canada) debates the legalization of euthanasia.

That is, how can we credibly promote suicide prevention strategies at the same time as a large portion of society is publicly claiming they have a right to die? After all, euthanasia is supposedly about the right to self-determination when individuals are forced to live in circumstances that are unbearable.

At least that's how the conversation goes. The reality of legalization is very different, as we've seen in Belgium, the Netherlands, Switzerland and Oregon. Each of these has relaxed their laws to the point that depressed people can easily access euthanasia. As one bioethicist claims, euthanasia in these districts expands the options for the mentally ill and "empowers" them when they make the choice.

A 2005 study in the Journal of Clinical Oncology showed that almost one half (44 per cent) of requests for euthanasia were made by patients with depression. These authors started with the premise that terminally ill people who requested euthanasia were more accepting of death and that depression would therefore not be a factor. In contrast, they found that depressed patients were four times more likely to request death.

A report in Current Oncology in 2011 summarized euthanasia in the Netherlands by saying that in 30 years, it "has moved from euthanasia of people who are terminally ill, to euthanasia of those who are chronically ill; from euthanasia for physical illness, to euthanasia for mental illness; from euthanasia for mental illness, to euthanasia for psychological distress of mental suffering," and now to euthanasia of those over 70 who are simply "tired of living."

How do we talk about such facts while promoting a national suicide prevention policy? A society that knows the slippery slope of euthanasia and still accepts its legalization has no credibility in talking about suicide prevention for those with mental illness.

Susan Martinuk is a columnist based in Western Canada. Her column appears every Friday.

* * *
[1]   This quote is from  page 17 of Vote No on SB 220:

Oregon’s suicide rate, which excludes suicide under Oregon’s physician-assisted suicide act, is 35% higher than the national average.  This rate has been "increasing significantly since 2000." Just three years prior, Oregon legalized physician-assisted suicide.  This increased suicide rate is consistent with a suicide contagion (legalizing one type of suicide encourag[ing] other suicides).  There is, regardless, a statistical correlation between these two events.

"I was afraid to leave my husband alone"

When my husband was seriously ill several years ago, I collapsed in a half-exhausted heap in a chair once I got him into the doctor's office, relieved that we were going to get badly needed help (or so I thought).

To my surprise and horror, during the exam I overheard the doctor giving my husband a sales pitch for assisted suicide. 'Think of what it will spare your wife, we need to think of her' he said, as a clincher.

Now, if the doctor had wanted to say 'I don't see any way I can help you, knowing what I know, and having the skills I have' that would have been one thing. If he'd wanted to opine that certain treatments weren't worth it as far as he could see, that would be one thing. But he was tempting my husband to commit suicide. And that is something different.

I was indignant that the doctor was not only trying to decide what was best for David, but also what was supposedly best for me (without even consulting me, no less).

We got a different doctor, and David lived another five years or so. But after that nightmare in the first doctor's office, and encounters with a 'death with dignity' inclined nurse, I was afraid to leave my husband alone again with doctors and nurses, for fear they'd morph from care providers to enemies, with no one around to stop them.

It's not a good thing, wondering who you can trust in a hospital or clinic. I hope you are spared this in Hawaii.

Kathryn Judson, Oregon 
Published in the Hawaii Free Press, February 15, 2011.
To view as published, click here and scroll down towards the bottom of the page.   

Not what Vermont needs

http://www.timesargus.com/apps/pbcs.dll/article?AID=/20130517/OPINION02/705179982?template=printart

May 17, 2013

By Rep. Anne Donahue
 
Wake up, Dorothy. You’re not in Oregon anymore.

The final week of the political path to death with dignity in Vermont was a reminder of how a cadre of politicians can want something so desperately that they push it through even if abandoning key promises.

For months — no, for years — Vermonters have been told that Oregon’s experience of physician-assisted suicide has demonstrated that extending this compassionate option to persons who want it comes at no risk to the vulnerable.

The mantra has been Oregon. Oregon protections. Oregon data. Everything has worked flawlessly in Oregon, so if we follow the exact model as Oregon, we can ignore the fears of the naysayers.

When the Senate was short one vote in February to pass the Oregon model, it sent a narrow bill to the House that focused instead on independent actions of a patient rather than on prescriptions for intentionally lethal medication. It was roundly criticized for lacking the protections of the Oregon bill.

The House restored the Oregon, active-prescription version. Proponents were emphatic on the House floor that it was because every one of the Oregon protections were locked into place that members could be assured there could be no coercion, no errors in diagnosis, and no one making the choice lacking full informed consent.

When it pingponged back, the Senate still couldn’t muster the votes to pass it. So a few backers patched and pasted an assorted set of new and old language together directed exclusively at gaining the one extra vote needed.

Gone were both the Oregon model and any model that left the doctor out of the role of prescribing lethal drugs. Enter the land of political Oz.

Sen. Claire Ayer, who had been the most vigorous in attacking what the Senate had passed via a floor amendment in February, now pressed for the new hybrid, though acknowledging that it was drafted “on the fly.”

Eradicated by the Senate were fully 29 separate protective provisions that the House had required in its Oregon version, some of them small, some of them huge. Among the huge ones:

— There is no longer any written informed consent required.

— A guardian or an agent for an advance directive is no longer barred from taking the place of a direct patient request.

— There is no longer any requirement that the patient actually be able to “self-administer.”

— There is no longer a second opinion required to assess whether a patient has the rational judgment capacity to make an informed decision.

— There are no requirements for follow-up by the Department of Health. The required review of patient files is gone. The requirement to collect statistical data and publish annual reports is gone.

This last is particularly ironic, because it has been the patient information and report data from Oregon that has been the basis for assuring Vermonters that all is well in Oregon.

The new Vermont bill sunsets even the “Oregon-lite” approach in 2016, then eliminates all remaining structural protections. But there isn’t any data being required to assess how the process works in those first three years.

Despite all this, House members who wanted to see a bill pass stuck by what they had so strongly criticized before: a bill that no longer maintained many of the long-promised protections. Only a few looked twice and voted against accepting what the Senate had done. The winning vote margin dropped from 17 to 10.

Our radical new social policy that endorses having doctors write prescriptions that will kill their patients, cobbled together by just a few individuals from bits and pieces of language drafted on the fly, was passed by two votes in the Senate and 10 votes in the House.

But no, Dorothy. We’re no longer in Oregon.

Rep. Anne Donahue, a Republican from Northfield, is a member of the House Human Services Committee, which passed the Oregon-style bill on a 7-4 vote in April. She was an opponent.

---

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.

Mass: Inclusion Key in anti suicide drive

http://www.washingtontimes.com/news/2012/nov/14/inclusion-key-in-anti-suicide-drive/#disqus_thread

By Valerie Richardson, The Washington Times, November 14, 2012

The anti-euthanasia movement found new life last week after voters in Massachusetts defied the conventional wisdom by rejecting a physician-assisted suicide initiative.

In a setback for the “aid in dying” movement, Question 2, known as the Death With Dignity initiative, lost by a margin of 51 percent to 49 percent after leading by 68-to-20 in a poll released in early September by the Boston Globe.

The turnaround came after the “No on 2” camp fractured the liberal coalition that approved similar measures in Oregon and Washington by building a diverse campaign of religious leaders, medical professionals and advocates for the disabled along with a few prominent Democrats and a member of the Kennedy clan.

Massachusetts: Support withered for assisted-suicide ballot question

http://www.lowellsun.com/todaysheadlines/ci_22157064/support-withered-assisted-suicide-ballot-question#ixzz2Egbgwy23

 

By Chris Camire, ccamire@lowellsun.comlowellsun.com

Updated:   12/09/2012 07:15:07 AM EST

In late September, polls showed a ballot initiative that would make physician-assisted suicide legal for terminally ill patients had support from 68 percent of Massachusetts voters. 

Over the next month, that support steadily eroded, and on Election Day the measure failed by a razor-thin 51-49 percent margin. 

How did a proposal that seemed sure to pass just five weeks before the election come up short? 

Joseph Baerlein, president of Rasky Baerlein Strategic Communications, who handled public relations for the Committee Against Physician Assisted Suicide, said the measure's opponents had to convince voters who supported the idea of assisted suicide that the bill before them was flawed. 

"We focused our campaign strategy on looking at those weaknesses," said Baerlein. "For us to have a chance to win, we would have to have some amount of voters who felt it was their right take another look, so they would see that this wasn't the right way to do it."

The Death with Dignity Act, or Question 2, mirrored legislation passed in Oregon and Washington state.