Killing with kindness: Why the Death With Dignity Act endangers people with disabilities

http://thephoenix.com/boston/news/146648-killing-with-kindness-why-the-death-with-dignity-/#ixzz2AvS5wlXH

 

By S.J. Rosenbaum

I think my opinions about doctor-assisted suicide crystallized the night Mike — my wheelchair-using, ventilator-breathing boyfriend — choked on pineapple juice, passed out, and died.

He was dead for several minutes, on a steel table in the ER. The doctor shocked the pulse back into his heart and dropped him into an induced coma, but it still wasn't clear whether he would make it. As I stood by his bedside, shaking, one of the nurses touched me on the shoulder.

"Maybe it's better this way," she murmured.

I'll never forget that moment. We'd been watching a movie together a few hours before. We had plans to go clubbing. Maybe it's better this way?

I'm not a violent person, but I wanted to punch that lady in the face.

When I started going out with Mike, I thought that prejudice against people with disabilities was something we'd left behind along with Jim Crow and sodomy laws. I was shocked, again and again, to find that I was wrong. So wrong. Everyone I met had ideas about what it must be like to date Mike — that we never went out, that we couldn't have sex, that I must have to take care of him all the time — that were so false as to be laughable. We did laugh at that stuff. We had to. But for every person who came up to us to congratulate Mike on his "bravery" in taking a trip to the mall, there was someone who actually thought he'd be better off dead.

Some of those people were doctors.

Not the young doctor who fought like a demon to restart his heart in the ER. But there were others: well-meaning doctors who saw Mike, and people like him, as pitiable — as "bad outcomes." In fact, that's the norm: study after study has shown that doctors, as a group, consistently underestimate the quality of life of their disabled patients. Those prejudices — unquestioned and unacknowledged — can have disastrous results.

I don't know anyone born with a serious disability whose doctors didn't tell their parents that they would never be able to live independently. A doctor at Mass General, who treats children with muscular dystrophy, told me about colleagues who had counseled their patients against using the ventilators that would prolong their lives by decades. Those doctors weren't trying to do harm. They simply saw their patients' lives as not worth living.

As disability activist Carol Gill writes: "Many of us have been harmed significantly by medical professionals who knew little about our lives, who thought incurable functional impairments were the worst things that could happen to a person, and who were confident they knew best."

All this, then, is why I'll be voting against referendum Question 2, the Death with Dignity Act, on November 6.


The language of the bill sounds reasonable: it would allow doctors to prescribe lethal doses of medication, upon request, to patients with terminal diseases. But it wouldn't actually have much benefit for the dying, who already have the same access to self-administered suicide as anyone else. Instead, it could present doctors with an option to offer the patients they think they can't help: the bill's definition of "terminal disease" is so vague as to encompass disabilities like Mike's, and it has no requirement that a person seeking the fatal dose see a counselor or be screened for depression.

So why would a person with a disability ask for a suicide pill? My ex never would. Disabled from birth, Mike has been fighting for his rights since he was in grade school. He's a badass with 60 tattoos, and he's not ready to die any time soon.

But for the late-disabled, it's different. People diagnosed with a progressive disease — MS, ALS, and other such dire acronyms — still carry the same prejudices they've held all their able-bodied lives. Often, they don't know anyone living a full, enjoyable life with disabilities, don't know such lives are possible. So if a doctor offers them an exit, they're all too likely to take it.

It's happened. One of the earliest right-to-die cases, in 1989, was that of David Rivlin, a spinal-cord-injury survivor. Isolated in a nursing home, cut off from meaningful work, unable to live independently on the meager assistance the state offered at the time, he demanded to die. "I don't want to live an empty life lying helplessly in a nursing home for another 30 years," he told a reporter.

No one offered him an alternative. "The nondisabled people around him assumed that when a person with such a disability said he would rather be dead, he was acting rationally," disability activist Paul K. Longmore wrote a few years after Rivlin's death. Neither Rivlin, nor other people with disabilities seeking "death with dignity," realized that they could have been fighting for the support to live, rather than the right to die. Longmore observed, "The only real aid the system offered any of them . . . was assistance in ending their lives."

It's not 1989 anymore. The disabled in Massachusetts have more access, and more agency, than those in almost any other state, and activists fought hard to make it that way. Disabled Bostonians are filmmakers, tattoo artists, psychologists, writers. They ride the T. They own houses and businesses. And like Mike and me, they fall in love.

But not everyone knows that those things are an option. And with Romney — a man who sees adequate health care as a privilege, not a right — on the same ballot as Question 2, all that progress is scarily close to rolling back. Now is the worst time to perpetuate the myth that death is better than disability.

Vote no on Question 2.

Read more: 

http://thephoenix.com/boston/news/146648-killing-with-kindness-why-the-death-with-dignity-/#ixzz2AvRHl7Jn

Assisted Suicide Users are Older People with Money

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

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

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

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

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

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

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

UK govt agrees to investigate "death pathway"

Article below regarding abuse of the Liverpool Pathway, from Michael Cook of Bio Edge.

A problem also in the US and Canada.  See, for example, Kate Kelly's article about her mother and "VSED" by clicking here

With some doctors abusing the power they already have with the Liverpool Pathway, etc., why would you give them more power to effect patient death, i.e., by legalizing assisted suicide and/or euthanasia?

The problem will only get worse.

* * *

http://www.bioedge.org/index.php/bioethics/bioethics_article/10293
by Michael Cook | Oct 27, 2012 |

Pressure from the British media has forced an investigation into the controversial Liverpool Care Pathway by National Health Service and the Association of Palliative Medicine.

The medical establishment appears very reluctant to question the LCP. Only a few days ago 22 organisations signed a consensus statement supporting it. It quoted the Parliamentary Under Secretary of State for Health, Earl Howe:

"The Liverpool Care Pathway has sometimes been accused of being a way of withholding treatment, including hydration and nutrition. That is not the case. It is used to prevent dying patients from having the distress of receiving treatment or tests that are not beneficial and that may in fact cause harm rather than good."

But the campaign by the Daily Mail and the Telegraph has been relentless. "When well over 100,000 are dying on the LCP each year, the suspicion inevitably arises that the pathway is being used to hasten death and free up beds," said the Daily Mail in an editorial.

Neurologist Patrick Pullicino contends that the LCP has made euthanasia a "standard way of dying on the NHS". He and his supporters were scathing about the consensus statement: 

"It is self-evident that stopping fluids whilst giving narcotics and sedatives hastens death... The median time to death on the Liverpool Care Pathway is now 29 hours. Statistics show that even patients with terminal cancer and a poor prognosis may survive months or more if not put on the LCP."

The investigation coordinated by the NHS will examine poor experiences under the LCP, which everyone acknowledges do happen. The NHS will talk to family members of people who have died on the pathway, investigate complaints and speak with clinicians. "Poor experiences must be explored, acknowledged and learnt from," says Professor Mayur Lakhani, Chair of the Dying Matters Coalition.

Will the investigation result in a thorough revision of the LCP? Even though the medical establishment admits that there are problems, it may not admit that they are due to the basic framework. The Consultant Nurses in Palliative Care Reference Group is already interpreting criticisms as dangerous and offensive. "Counter-productive comments", it says, are "deeply offensive to public servants who abide by clear codes of conduct and the law".

Las Vegas Man Sentenced After Assisted Suicide

http://www.themonitor.com/news/local/article_05c7fdd6-1fc4-11e2-9b32-001a4bcf6878.html

Posted: Friday, October 26, 2012 6:22 pm | Updated: 6:30 pm, Fri Oct 26, 2012.
Jared Taylor, Twitter: @jaredataylor The Monitor

McALLEN -  A federal judge sent to prison a Las Vegas man convicted of smuggling powerful animal tranquilizers from Mexico used in an assisted suicide in Nuevo Progreso.

Chief U.S. District Judge Ricardo Hinojosa sentenced Jeff George Ostfeld to six years in federal prison Wednesday, after he pleaded guilty to importation of a controlled substance.

But after the assisted suicide in Mexico, Hinojosa opted to follow sentencing guidelines for Ostfeld under a charge of voluntary manslaughter - not the drug charge.

U.S. Immigration and Customs Enforcement arrested Ostfeld in May 2009 as he attempted to smuggle animal tranquilizers across the Progreso International Bridge.

The arrest came moments after Mexican police discovered the body of 32-year-old Jennifer Malone at a Nuevo Progreso motel.

Ostfeld shot video of Malone as she died, investigators said. He retrieved some of her personal effects and abandoned her body in the motel room.

Mexican investigators found an empty bottle of Barbithal and a book about depression beside the body of Malone, of Roseburg, Ore.,  according to Monitor archives. The same drug was found by U.S. Customs and Border Protection officers as Ostfeld tried to return to the United States.

Ostfeld told ICE agents he had flown from Las Vegas to McAllen to buy animal tranquilizers in Nuevo Progreso for resale in the United States. The drug can sell for as little as $20 per bottle in Mexico, but can net as much as $5,000 north of the Rio Grande.

Canada: Crown files opening brief in Carter

Assisted suicide too risky, allowing it demeans value of life, federal gov't says

http://www.vancouversun.com/news/Assisted+suicide+risky+allowing+demeans+value+life+federal+says/7447066/story.html

The Canadian Press October 25, 2012 12:30 PM

 

VANCOUVER - The federal government says allowing doctor-assisted suicide demeans the value of life and puts vulnerable people at risk in moments of weakness.

Ottawa has filed its arguments in an appeal of a B.C. decision that struck down the prohibition on doctor-assisted suicide, arguing the trial judge was wrong to conclude the law is unconstitutional.

In documents filed with the B.C. Court of Appeal, the government says the law reflects a reasonable belief that allowing assisted suicide would put vulnerable people at risk of being coerced or even forced to end their lives.

The government says the law reflects Parliament's desire to discourage and prevent suicide in all cases, and it should be up to lawmakers, not the courts, to decide if that needs to change.

Ottawa argues the Supreme Court of Canada's 1993 decision upholding the law in a case involving Sue Rodriguez was final.

The B.C. case was launched by several plaintiffs, including Gloria Taylor, who won a constitutional exemption from the law but died earlier this month without resorting to assisted suicide.
Read more: http://www.vancouversun.com/news/Assisted+suicide+risky+allowing+demeans+value+life+federal+says/7447066/story.html#ixzz2AM32CGOR

Legalization And Violent Deaths

By Margaret Dore

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

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

* * *

[1]  See e.g. Lindsey Anderson, Associated Press, "Mass. Voters Consider Physician-Assisted Suicide," October 20, 2012, at http://www.wbur.org/2012/10/20/physician-assisted-suicide ("Dr. Marcia Angell ... believes [her father] would've lived longer and not turned to a pistol had assisted suicide been available").
[2]  See Don Colburn, "Recent murder-suicides follow the national pattern," The Oregonian, November 17, 2009 ("In the span of one week this month in the Portland area, three murder-suicides resulted in the deaths of six adults and two children") (Available at http://www.oregonlive.com/health/index.ssf/2009/11/recent_murder-suicides_follow.html); Baldr Odinson, "Fourth Murder-Suicide for the Eugene Area," New Trajectory:  A blog for Ceasefire Oregon, March 2, 2011, ("Harry Hanus, age 74, shot and killed his wife, Barbara, before taking his own life")

Canada: Russian bride leaves elderly man with $25 K welfare bill

Another example of an older person who was easily persuaded to act in someone else's best interests, not his own. The Canadian government, instead of helping him, is billing him.

http://ca.news.yahoo.com/russian-bride-leaves-elderly-man-25k-welfare-bill-094830580.html

An 82-year-old B.C. pensioner is on the hook to the government for $25,000, after marrying a Russian woman who left him the day after she got permanent resident status in Canada.

“Several times I thought I will have a nervous breakdown over this,” said Heinz Munz, of Black Creek.

Munz said he believes his now ex-wife used him, with the help of her daughter, to get legal status in Canada. He is going public because the B.C. government is now forcing him to pay for social assistance she collected after she left.

Massachusetts: Bob Joyce on Elder Abuse, etc. - Vote No on Question 2

Dear Editor:

It's not clear why The Bulletin titled Joe Galeota's recent column as it did ["Terrible," October 11, 2012].

If it's because the column offered no information about the content of the physician-prescribed suicide referendum, I agree. That is terrible. . . .

Let's get serious, and consider just a few of the many reasons why voters should defeat this flawed bill.

The referendum shockingly increases the risk of abuse to elders, many of whom do not have loving families and/or have lost their circle of friends and/or have no one to advocate for them. We should consider that Massachusetts had 19,500 reported cases of elder abuse in 2011. There are insufficient elder abuse investigators to keep up with the 54 new cases reported each day. One study has suggested that there are 23.5 unreported cases for every one reported case.

The referendum does not even provide the level of protection required when a person signs a will in Massachusetts (i.e., two disinterested witnesses), and there is absolutely no oversight at the time the lethal drugs would be administered. 

The Massachusetts Medical Society, representing more than 24,000 physicians and medical students, opposes the bill. So does the American Medical Society.

Insurance companies, hospitals and governmental medical providers have a clear and compelling financial interest in denying us of adequate end-of-life care.

How much do you trust insurers, hospitals and governments? Unless you answer "with my life," you should oppose physician-prescribed suicide and vote NO on Question Two.

It would indeed be "terrible"  if we allow this referendum to pass!

Robert W. Joyce

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

By Margaret Dore, Esq.

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

1.  "Terminal" Does Not Mean "Dying" 

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

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

2.  The Significance of a Terminal Label

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

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

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

Dr. Stevens concludes:

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

3.  Barbara Wagner and Randy Stroup

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

4.  Proposals for Expansion

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

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

Is this what you want?

To be just like us?

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

* * *

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

Defeating Assisted Suicide Before it Gets Started

I'm giving a lecture this weekend titled: "Arguing Smart: Defeating Assisted Suicide & Euthanasia Before it Gets Started."

The course description is below.  A hard copy of the course materials can be viewed by clicking here.

Margaret Dore

Course Description:

In 2010, assisted suicide advocates targeted Idaho for legalization of assisted suicide, which they termed "aid in dying." Their legal director owned a home there and was in the state actively meeting people, talking to newspapers and otherwise drumming up support. The legal director had also got an article published in The Advocate, the official publication of the Idaho State Bar Association. And then she was defeated by nine well-placed letters.

Ripping off Grandma: Why seniors should practice tough love

http://www.theglobeandmail.com/globe-investor/personal-finance/household-finances/ripping-off-grandma-why-seniors-should-practice-tough-love/article4614312/

ROB CARRICK, The Globe and Mail

Published Monday, Oct. 15 2012, 8:07 PM EDT
Last updated Tuesday, Oct. 16 2012, 9:18 AM EDT

The Bank of Grandma and Grandpa needs to toughen up.

It’s one thing for seniors to plan inheritances for family members and provide cash gifts when affordable.

Where they must set limits is in co-signing or guaranteeing loans for relatives.

Seniors guaranteeing loans is bad business and it also comes dangerously close to elder financial abuse, an unseen but serious problem that can leave seniors destitute.

Elder financial abuse means the illegal or unauthorized use of seniors’ assets – money or property. Laura Tamblyn Watts, a lawyer and senior fellow at the Canadian Centre for Elder Law, said research shows one in 12 seniors will experience financial abuse. Given how under-reported the problem is, she suspects the actual figure is one in eight.