Friday, December 26, 2014

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

By Margaret K. Dore, Esq., MBA
The Voice of Experience, American Bar Association
Volume 25, No. 4, Winter 2014
To view the original version, click here and here

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

My Guardianship Cases

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

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

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

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

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

The MetLife Studies 

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

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

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

Failure to Report

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

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

A New Development: Legalized Assisted Suicide

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

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

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

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

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

My Cases Involving the Oregon and Washington Assisted Suicide Laws

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

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

Conclusion

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

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

Wednesday, December 10, 2014

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

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

The Autistic Self Advocacy Network  (ASAN) has issued a statement condemning the exclusion of disabled people from testifying at yesterday’s (Dec.7) hearing on a proposed assisted suicide bill in front of the New Jersey Senate Health, Human Services and Senior Citizens Committee:
(Excerpt)
The Autistic Self Advocacy Network is deeply concerned about the omission of disabled people and representatives from disability rights organizations at yesterday’s hearing. Given that more than half of the groups in the New Jersey coalition opposing the bill are disability rights organizations and centers for independent living, it is unconscionable that the committee deliberately excluded witnesses from the disability community. Even after our community submitted a formal request for inclusion among the witnesses, the committee declined to invite a disability community representative.

Read the entire statement here.

* * *

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

Wednesday, December 3, 2014

New Jersey: Updated Legal Policy Analysis for Bill; Stacked Deck Hearing on Monday

Please click here to see an updated legal policy analysis of New Jersey's pending assisted suicide/euthanasia bill, A 2270 (3R).

The bill is scheduled to be heard before a stacked deck, invitation only, hearing, as follows: 


The Senate Health, Human Services and Senior Citizens Committee will meet on Monday, December 8, 2014 at 1:00 PM in Committee Room 1, 1st Floor, State House Annex, Trenton, NJ.

The committee will hear testimony on A2270 (3R) / S382 from invited guests only; however, members of the public are invited to submit written testimony on the bills, to OLSAideSHH@njleg.org   

Margaret Dore

Thursday, November 13, 2014

If New Jersey's Assisted Suicide Bill Is Enacted, There Will be Pressure to Expand its Reach to Broader Groups of People.

By Margaret Dore, Esq., MBA

Today, the New Jersey Assembly passed a proposed assisted suicide/euthanasia bill, which goes next to the New Jersey Senate. The bill is the "third reprint" of A2270, which has a six months to live eligibility criteria for assisted suicide and euthanasia.

If enacted, there will be pressure to expand “eligibility” to broader groups of people who are not close to death.  I say this due to what’s been happening with hospice and our experience here in Washington State regarding our similar law.  See also this legal/policy analysis of the third reprint.

Hospice

Hospice has a six months to live eligibility criteria.  In August, the Washington Post reported that there “appears to be a surge in hospices enrolling patients who aren’t close to death.”[1]  This practice is resulting in the overdose deaths of non-dying people.[2]

This is consistent with what I've been hearing from people in both the US and Canada regarding the deaths of their family members.[3]

Washington State

In Washington State, our law went into effect in 2009.  Since then, we have had informal “trial balloon” proposals to expand our law to non-terminal people.  For example, there was a column in the Seattle Times, which is our largest paper, containing this suggestion for euthanasia of people who didn't save enough for their old age. The column stated:
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.[4] 
So, you work hard all your life, pay taxes and then your pension plan goes broke, this is how society would pay you back, with non-voluntary or involuntary euthanasia?

Prior to passing our law, I never heard anyone talk like this.

Don't make Washington's mistake.

Margaret Dore is an attorney in Washington State and President of Choice is an Illusion.  For more information about problems with New Jersey's bill, please see Ms. Dore' legal/policy memo regarding that law, which can be viewed here: https://choiceisanillusion.files.wordpress.com/2014/11/nj-no-on-a2270-no-assisted-suicide-11-12-14.pdf

[1] Peter Whoriskey, “As More Hospices Enroll Patients Who Aren’t Dying, Questions About Lethal Doses Arise,” Washington Post. August 21, 2014, http://www.washingtonpost.com/news/storyline/wp/2014/08/21/as-more-hospices-enroll-patients-who-arent-dying-questions-about-lethal-doses-arise/?
[2] Id.
[3] See e.g. Carol Mungas, "I support House Bill 505, which clearly states that assisted suicide is not legal" (My husband, Dr. James E. Mungas "was effectively euthanized against his will"),  http://www.montanansagainstassistedsuicide.org/2013/03/i-support-house-bill-505-which-clearly.html; Daniela, "Euthanasia without patient consent and over the family's objection," ("Our family . . . is having emotional problems because of what we witnessed.... [N]ow I hear my grandma cry for water every night") http://www.margaretdore.org/2014/11/euthanasia-without-patient-consent-and.html and Kate Kelly, "Mild stroke led to mother's forced starvation,"("I cried much of the time, but softly, so she would not know.  I didn't want to add to her agony.")   http://www.choiceillusion.org/p/mild-stroke-led-to-mothers-forced.html
[4] To view a copy of the newspaper column, please go here: https://choiceisanillusion.files.wordpress.com/2014/10/jerry-large_001.pdf.



Tuesday, November 11, 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dore: Problems with legal assisted suicide include:

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

Don’t make Washington State’s mistake.

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

Thursday, November 6, 2014

Euthanasia without patient consent and over the family's objection

This last August, the Washington Post did a feature article on how non-dying people are being killed in hospices. See http://www.washingtonpost.com/news/storyline/wp/2014/08/21/as-more-hospices-enroll-patients-who-arent-dying-questions-about-lethal-doses-arise/?   

I have had many people contact me with similar stories.  Below, please find the latest one by a Romanian immigrant.  I hope that more doctors, nurses and other healthcare professionals can speak out about these cases, before it's too late.

Margaret Dore, Esq., MBA, President


Case in Point: 

My name is Daniela. I am 46 years old and live in Oregon. I believe my grandmother was killed in a hospital on June 24, 2014. She was in the emergency room for three hours and was given morphine after we had refused it and clearly asked for her right to die naturally. The nurse told me that it was time to say goodbye and she died almost immediately upon receiving that shot. I have the medical records, but there is no notation of the morphine she was given, which makes me believe the records were falsified. 

Elisabeta KoczurThe photograph to the left is of Elisabeth Koczur.

The last wish my grandma had was for a drink of water. I don't think I will ever forget how she looked at me expecting help. Four nurses in the room imprisoned me and I could not move. I was forced to keep looking in her eyes as she pleaded for water. Why was I not allowed to grant her last wish?

Our family is in shock and is having emotional problems because of what we witnessed. My grandma went to the hospital with abdominal pain and shortness of breath. There, according to the medical records, she was diagnosed to have congestive heart failure, but, when she went into cardiac arrest, they did not attempt to resuscitate her. If she had received proper treatment, she might be here with us today. Grana, as I called her, was 99 years old. I think they decided that she had lived too long, but they did not know this beautiful soul.