Monday, October 29, 2012

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? 

Saturday, October 27, 2012

Ballot Question 2: A Recipe for Elder Abuse

A repeat post brought back by popular demand; for a more in depth analysis, please  click here.

By Margaret Dore
December 2, 2011

A ballot initiative to legalize physician-assisted suicide is pending in Massachusetts.[1]

Physician-assisted suicide is legal in just two states: Oregon and Washington.  In both states, acts to legalize the practice were enacted via sound-bite ballot initiative campaigns.[2]  In a third state, Montana, there is a court case that gives doctors a potential defense to prosecution for homicide.  No such law has made it through the scrutiny of a legislature.  Just this year, bills to legalize assisted suicide were defeated in Montana, New Hampshire and Hawaii.[3] Just this year, Idaho enacted a statute to strengthen its law against assisted suicide.[4]

The proposed Massachusetts act is a recipe for elder abuse.  Key provisions include that an heir, who will benefit financially from a patient's death, is allowed to participate as a witness to help sign the patient up for the lethal dose.  See Section 21 of the act, allowing one of two witnesses on the lethal dose request form to be an heir, available here.  This situation invites undue influence and coercion.

Once the lethal dose is issued by the pharmacy, there is no oversight.  See entire proposed act, available here.  For example, there are no required witnesses when the lethal dose is administered.  See act here.  Without disinterested witnesses, an opportunity is created 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.  Even if he struggled who would know?

In Massachusetts, proponents are framing the issue as religious.  In Washington state, proponents used a similar tactic and even religious slurs to distract voters from the pitfalls of legalization.  What the proposed law said and did was all but forgotten.
        
Do not be deceived.
* * *

Margaret Dore is an attorney in Washington State where assisted suicide is legal.  She is also President of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide.  Her publications include Margaret K. Dore, "Physician-Assisted Suicide: A Recipe for Elder Abuse and the Illusion of Personal Choice," The Vermont Bar Journal, Winter 2011.
* * *
[1]  To view the proposed Massachusetts initiative, click here:  http://choiceisanillusion.files.wordpress.com/2011/10/ma-initiative.pdf 
[2]  Oregon's physician-assisted suicide act was enacted via Ballot Measure 16.  Washington's act was enacted via Initiative 1000.
[3]  In Montana, SB 167 was tabled in Committee and subsequently died on April 28, 2011.  In New Hampshire, HB 513 was defeated on March 16, 2011.  In Hawaii, SB 803 was defeated on February 7, 2011 .
[4]  On July 1 2011, Idaho's new statute strengthening Idaho law against assisted suicide went into effect:   http://www.choiceillusionidaho.org/2011/07/idaho-strengthens-law.html

Wednesday, October 24, 2012

Legalization Will Not Prevent 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")

Thursday, October 18, 2012

Robert Joyce on Elder Abuse, Other Reasons to Vote No on Question 2

"The referendum shockingly increases the risk of abuse to elders ..."


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

Wednesday, October 17, 2012

People Living with HIV/AIDS: Is This What You Want?

By Margaret Dore, Esq.
Updated August 16, 2016

Some HIV/AIDS groups have endorsed Ballot Question 2, which seeks to legalize assisted suicide in Massachusetts.  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, could be "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 nonvoluntary or 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?

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

* * *


[1]  The proposed Massachusetts act, Section 1(13) states:  "'Terminal disease" means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.  To view the entire act, go here:  http://www.massagainstassistedsuicide.org/p/initiatives-text.html
[2]  For an example, see the affidavit of Oregon doctor Ken Stevens describing his patient Jeanette Hall.  She had been given six months to a year to live by another doctor, i.e. without treatment, and had decided that she would use Oregon's law.  Dr. Stevens convinced her to be treated instead.  His affidavit can be viewed here:  http://choiceisanillusion.files.wordpress.com/2012/10/signed-ken-stevens-affidavit_001.pdf  Oregon's definition of "terminal disease" can be viewed here: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx
[3]  Dr. Stevens affidavit can be viewed here: http://choiceisanillusion.files.wordpress.com/2012/10/signed-ken-stevens-affidavit_001.pdf 
[4]  Id.
[5]  Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, August 6, 2008, available at http://abcnews.go.com/Health/Story?id=5517492&page=1 and "Letter noting assisted suicide raises questions,"  KATU TV, July 30, 2008, available at http://www.katu.com/news/26119539.html
[6]  KATU TV article at Note 5.
[7]  ABC News article at Note 5.
[8]  Washington State's assisted suicide law can be viewed here:  http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245
[9]  See e.g.,  Brian Faller, "Perhaps it's time to expand Washington's Death with Dignity Act, The Olympian, November 16, 2011, available at http://www.theolympian.com/2011/11/16/1878667/perhaps-its-time-to-expand-washingtons.html
[10]  Jerry Large, "Planning for old age at a premium," The Seattle Times, March 8, 2012 at http://seattletimes.nwsource.com/text/2017693023.html  ("After Monday's column, some readers were unsympathetic [to people who couldn't afford their own care], a few 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.")

Saturday, October 13, 2012

Vote No on Question 2

"Ignoring any moral issues, the initiative is vulnerable to abuse and should not be passed into law."

By Anthony Speranza


http://www.salemnews.com/opinion/x1684126269/Column-Vote-no-on-Question-2

This year in Massachusetts, voters will decide on Question 2: an initiative petition to legalize physician-assisted suicide in the commonwealth. Ignoring any moral issues, the initiative is vulnerable to abuse and should not be passed into law.

Dignity 2012, a group in support of the issue referred to as "Death with Dignity," claims the proposed law "contains strict safeguards to ensure that the patient is making a voluntary and informed decision." The safeguards written into the law, however, are insufficient. First, nearly all responsibility rests in the hands of a patient's physician. Section 6 of the initiative states that no patient shall be prescribed the life-ending medication if either of two physicians deem that the patient suffers from a "psychiatric or psychological disorder or depression." While the theory behind this precaution is practical, it falls short of effective. Only 15 days separate the date of request from the date of prescription of the lethal dose. There is no clear definition of what tests must be run in this time to check a patient's mental capacity. According to Jennifer Popik, a medical ethics attorney, "There is no requirement that the patient be given a psychiatric evaluation... This means that a physician ... can prescribe suicide to that patient without even a specialist's evaluation." The "safeguard" concerning mental health is rendered useless because a psychiatric evaluation is not compulsory. A similar law in Oregon serves as a warning: According to a report by the Oregon Public Health Department, of the 71 patients who chose physician-assisted suicide last year, only one was referred for psychiatric evaluation.

Friday, October 5, 2012

Study: Assisted suicide helpers distressed

http://worldradio.ch/wrs/news/wrsnews/study-assisted-suicide-helpers-distressed.shtml?32735

Thursday, October 4, 2012

One in four people who accompany someone to commit assisted suicide suffer massive psychological distress, according to a new study by the University of Zurich.

Researchers at the university spoke to 85 people who went with a family member or close friend to an EXIT euthanasia clinic.

A quarter suffered from post traumatic stress disorder while 16 percent had depression. Five percent were found to have long-term grief.

The interviews were carried out one to two years after the assisted death of loved ones.

The results state that problems can surface 14 to 24 months later and that a death not from natural causes was a heavy burden for those who supported the deceased.

Although the research didn’t include a direct comparison with the effects of a natural death on a loved one, the study was compared to others.

This showed the researchers that post traumatic stress disorder was more common for people close to an assisted suicide case rather than a natural death.

The results have been published in the October issue of the journal European Psychiatry.

Wednesday, October 3, 2012

Don't Make Washington's Mistake

My wife and I operate two adult family homes in Washington State where assisted suicide is legal. I am writing to urge you to not make Washington's mistake.

Our assisted suicide law was passed via a ballot initiative in November 2008. During the election, that law was promoted as a right of individual people to make their own choices. That has not been our experience. We have also noticed a shift in the attitudes of doctors and nurses towards our typically elderly clients, to eliminate their choices.

Four days after the election, 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.

Since the act passed, we have also 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.

Since our 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.

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.

Juan Carlos


[Letter to the Montana Medical Examiner's Board, posted July, 1, 2012, at http://www.montanansagainstassistedsuicide.org/2012/07/dear-montana-board-of-medical-examiners.html ]

Tuesday, October 2, 2012

Brother "made the mistake of asking about assisted suicide"

Dear Editor:

I was disturbed to see that assisted suicide is being promoted in Massachusetts.

My brother, Wes Olfert, died last year in Washington State where assisted suicide is legal.  When he was first admitted to the hospital, he made the mistake of asking about assisted suicide.  I say a mistake, because this set off a chain of events that interfered with his care and caused him unnecessary stress in what turned out to be the last months of his life.

By asking the question, he was given a "palliative care" consult by a doctor who heavily and continually pressured him to give up on treatment before he was ready to do so.  It got so bad that Wes actually became fearful of this doctor and asked us (me, my other  brother and a friend) to not leave him alone with her. Some of the other doctors and staff members seemed to also write Wes off once they learned that he had asked about assisted suicide.

I hope that Massachusetts does not legalize assisted suicide.

Marlene Deakins, RN

[Letter sent to the Boston Globe, but not published]

Monday, October 1, 2012

Ballot Question 2: Whose Choice?

By Margaret Dore

I am an attorney in Washington State, where assisted suicide is legal.  Our law was passed by a ballot initiative in November 2008 and went into effect in March 2009.  Our law is similar to Ballot Question 2. 

In Washington State, my former clients own two adult family homes (small elder care facilities).  Four days after the election, the adult child of one of their residents asked about getting pills for the purpose of causing his father's death.  It wasn't the older gentleman asking for his "right to die."[1]

At that time, our law had not yet gone into effect; the man died before it did.  But if our law had been in effect, whose choice would it have been?  The choice of his son, or the choice of the older gentleman?

In Washington state, we have already had suggestions to expand our law to direct euthanasia for non-terminal people.[2].  More disturbing, there was this discussion in the Seattle Times suggesting euthanasia for people unable to afford care, which would be on an involuntary basis for those persons who want to live.  Columnist Jerry Large stated:

"After Monday's column, some readers were unsympathetic [to people unable to afford care], a few 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."[3]

I never saw anything like this prior to our law's being passed in 2008.  Be careful what you vote for.

* * * 

[1]  Letter from Juan Carlos to the Montana Board of Medical Examiners, posted July 1, 2012, at http://www.montanansagainstassistedsuicide.org/2012/07/dear-montana-board-of-medical-examiners.html 
[2]  See e.g., Brian Faller, "Perhaps it's time to expand Washington's Death with Dignity Act," The Olympian, November 16, 2011, available at http://www.theolympian.com/2011/11/16/1878667/perhaps-its-time-to-expand-washingtons.html 
[3]  Jerry Large, "Planning for old age at a premium," The Seattle Times, March 8, 2012 at http://seattletimes.nwsource.com/text/2017693023.html