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 Legislator's Question

By Margaret Dore, Esq.
Updated February 5, 2014

A legislator considering an assisted suicide law asked me this question:  "Is there a way to allow a person to end his life without making someone else a criminal?"

This was my (slightly edited) response:

People take their lives all the time.  One of my cousins shot himself and another threw himself in front of a train.  There was no criminality involved.  Also, if people are in pain, palliative care laws allow medical personnel to give patients copious amounts of drugs, including up to sedation, which can hasten the patient's death. This is the principal of double effect.  This is legal.  For more information, read the Affidavit of Kenneth Stevens, MD, page 3, paragraph 13.

There is also palliative care abuse in which no one seems to be held accountable, except for maybe one case in California where doctors relied on a wealthy patient's daughters, who said that their father was really bad off and didn't want treatment, which was not the case.  At least, that's what's claimed by the man's son. See William Dotinga, "Grim Complaint Against Kaiser Hospital," Court House News Service, February 6, 2012.

I've had like 15-20 contacts in the past year by people upset about their family member being suddenly off'd by medical personnel and/or having DNR's put on family members/friends without the patient's consent.  My caregiver friends also talk about guarding their patients in the hospital.  Here are some letters from Montana.  http://www.montanansagainstassistedsuicide.org/2013/04/dont-give-doctors-more-power-to-abuse.html

Here's a letter from Washington State where assisted suicide is legal. The letter talks about doctors being quick with the morphine and also regarding the conduct of an adult son shortly after our assisted suicide law was passed ("an adult child of one of our clients asked about getting the pills [to kill the father].  It wasn't the father saying that he wanted to die").  http://www.montanansagainstassistedsuicide.org/2012/07/dear-montana-board-of-medical-examiners.html  Here's a letter from a wife about how she was afraid to leave her husband alone after a doctor pitched assisted suicide to her husband. http://www.montanansagainstassistedsuicide.org/2013/01/i-was-afraid-to-leave-my-husband-alone.html

There is also the issue that people who say they want to die don't mean it, as with any suicide.  See http://www.montanansagainstassistedsuicide.org/p/what-people-mean-when-they-say-they.html

I've had two clients whose fathers signed up for the Oregon/Washington assisted suicide acts.  With the first case, one side of the family wanted the father to use the act and the other side didn't.  He spent the last months of his life torn over whether of not he should kill himself.  His daughter was also traumatized.  He died a natural death.  There is a Swiss study that you might be interested in, that 1 out of 5 family members were traumatized by witnessing the legal assisted suicide of a family member.  See http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf

In my other case, the father had two suicide parties and it's not clear that it was voluntary.  My client, his son, was told that his dad had said "You're not killing me, I'm going to bed").  Regarding the next day, my client was told that his dad was already high on alcohol when he drank the lethal dose.  But then the person telling him this changed his story.  In Montana, Senator Jeff Essman, made a relevant observation regarding this point:

"[All] the protections [in Oregon's law] end after the prescription is written.  [The proponents] admitted that the provisions in the Oregon law would permit one person to be alone in that room with the patient. And in that situation, there is no guarantee that that medication is self-administered.

So frankly, any of the studies that come out of the state of Oregon's experience are invalid because no one who administers that drug . . . to that patient is going to be turning themselves in for the commission of a homicide."

Senate Judiciary Hearing on SB 167 on February 10, 2011

I, however, doubt that a person in Oregon could be prosecuted.  If you read the act carefully, there is no requirement of patient consent to administration of the lethal dose, and to the extent that's ambiguous, there's the rule of lenity.  In Washington State, prosecutors are required to report assisted suicide deaths as "Natural" - no matter what - at least, that's what the regulation says:  http://www.doh.wa.gov/portals/1/Documents/5300/DWDAMedCoroner.pdf   How can you prosecute someone for homicide if the death is required to be reported as "Natural?"

Here in Washington, we have already had some informal proposals to expand the scope of our assisted suicide act.  One in particular disturbed me.  A Seattle Times column suggested euthanasia as a solution for people unable to support themselves, which would be involuntary euthanasia.  See Jerry Large, "Planning for old age at a premium," March 8, 2012, which states:

"After Monday's column,  . . . a few [readers] suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out. At least a couple mentioned euthanasia as a solution."  (Emphasis added)

So, if you worked hard and paid taxes all your life and then your company pension plan goes belly up, this is how you want society to pay you back?

As a Democrat, I see us as looking out for the little guy, not passing laws to protect perpetrators, healthcare systems, etc. from legitimate claims.  I hope that you will vote against any effort to legalize assisted suicide/euthanasia.

Thank you for writing me back.

Margaret Dore

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.

New Board Member Kate Kelly!

Welcome to our newest Board member, Kate Kelly!

Kate Kelly, B.Ed., B.A.

Kate Kelly grew up in Halifax Nova Scotia, Canada.  She is the daughter of self-educated working-class parents, who instilled in her a love of books, music, nature, old movies, and compassion for "the average Joe" and all vulnerable creatures. Kate dropped out of high-school, becoming well-acquainted with minimum-wage jobs. She eventually attended university as a mature student, graduating with a B.Ed. in English and a B.A. in Drama.  

Kate has been a travel  agent, salesclerk, child care worker, actress, cab driver, art model, gas jockey, reporter, cleaning woman, teacher, jazz singer and office clerk. She has lived and worked in 6 Canadian provinces and 1 territory, and travels extensively. Kate is passionate about seniors' rights, rescuing dogs, and singing. She hopes to live to at least 100, and die without being "pushed along."  

Kate's publications include "Mild Stroke Led to Mother's Forced Starvation."

Board Member William Reichel, M.D.

Below is an updated biography for Choice is an Illusion Board Member, William Reichel MD.

As noted below, he was recently named as one of five Pioneers in Geriatric Medicine.  Thank you for your work Dr. Reichel!


William Reichel, M.D.

William Reichel, M.D. is Vice President and a Board member of Choice is an Illusion.  He is also an Affiliated Scholar with the Center for Clinical Bioethics, Georgetown University School of Medicine. Dr. Reichel received his M.D. from Columbia University College of Physicians and Surgeons in 1961. His residency in Internal Medicine was at Stanford Medical Center. He provided leadership in Geriatrics, serving 13 years on the Board of Directors of the American Geriatrics Society, including serving as its President. He was recently named as one of five Pioneers in Geriatric Medicine.  The 6th Edition of a Cambridge University Press text, "Reichel's Care of the Elderly: Clinical Aspects of Aging," was released in February 2009, and the 7th Edition is in preparation.

In his practice, Dr. Reichel saw the many ethical dilemmas that occur in patient care. He thus pursued a study of ethics, at first at Georgetown in 1984, and then as a Visiting Scholar in Medical Ethics at Harvard Divinity School, 1988-1990. At Harvard Divinity School, he concentrated on euthanasia, both in Germany before and during World War II, and in the Netherlands, publishing on assisted suicide and euthanasia. In 1998, Dr. Reichel was appointed to the Center for Clinical Bioethics at Georgetown where he continued his scholarly work that included the study of assisted suicide and euthanasia. Now retired from practice, Dr. Reichel continues as an Affiliated Scholar at the Center for Clinical Bioethics and he continues to participate in the public debate against legalization of assisted suicide and euthanasia. His commentaries in letters to the editor have been published throughout the United States, in Canada, the UK and New Zealand. For example, click here.