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]

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 

John Norton: A Cautionary Tale

By Margaret Dore

In March 2012, I watched John Norton testify before the Joint Judiciary Committee of the Massachusetts Legislature.  A person with ALS, he had been told at age 18 or 19 that he would die in three to five years from paralysis.  Below find his story, at age 74, as submitted to a Canadian court yesterday via this affidavit: 

AFFIDAVIT OF JOHN NORTON IN OPPOSITION
ASSISTED SUICIDE AND EUTHANASIA

THE UNDERSIGNED, being first duly sworn on oath, STATES:

1. I live in Florence Massachusetts USA. When I was eighteen years old and in my first year of college, I was diagnosed with Amyotrophic Lateral Sclerosis (ALS) by the University of Iowa Medical School. ALS is commonly referred to as Lou Gehrig’s disease. I was told that I would get progressively worse (be paralyzed) and die in three to five years.

2. I was a very physical person. The diagnosis was devastating to me. I had played football in high school and was extremely active riding bicycles. I also performed heavy labor including road construction and farm work. I prided myself for my physical strength, especially in my hands.

3. The ALS diagnosis was confirmed by the Mayo Clinic in Rochester Minnesota. I was eighteen or nineteen years old at the time. By then, I had twitching in both hands, which were also getting weaker. At some point, I lost the ability to grip in my hands. I became depressed and was treated for my depression. If instead, I had been told that my depression was rational and that I should take an easy way out with a doctor’s prescription and support, I would have taken that opportunity.

4. Six years after my initial diagnosis, the disease progression stopped. Today, my condition is about the same. I still can’t grip with my hands. Sometimes I need special help. But, I have a wonderful life. I am married to Susan. We have three children and one grandchild. I have a degree in Psychology and one year of graduate school. I am a retired bus driver (no gripping required). Prior to driving bus, I worked as a parole and probation officer. When I was much younger, I drove a school bus. We have wonderful friends. I enjoy singing tenor in amateur choruses. I help other people by working as a volunteer driver.

5. I will be 75 years old this coming September. If assisted suicide or euthanasia had been available to me in the 1950's, I would have missed the bulk of my life and my life yet to come. I hope that Canada does not legalize these practices.

The Oregon Health Plan Steers Patients to Suicide

Yesterday, the Canadian Department of Justice filed evidence in Leblanc v. Canada, including the affidavit of Oregon doctor Ken Stevens.  Therein, Dr. Stevens talks about his patient, Jeanette Hall.  He also describes how with legal assisted suicide, the Oregon Health Plan steers patients to suicide.  His affidavit concludes:

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

If assisted suicide is legal in Massachusetts, Massachusetts could also follow Oregon's pattern.

Please find the full text of his affidavit below.  To view a hard copy of his affidavit with supporting documentation, click here. 

Assisted Suicide is Not Legal in Montana

Dear Editor:

I am a Montana State Senator.  I disagree with your article, "Redefining Physicians' Role in Assisted Dying," claiming that assisted suicide is legal in Montana.  At the very least, Montana law is unclear.

Last year, Senate Bill 167, which would have legalized assisted suicide in Montana, failed.  This leaves assisted suicide governed by a Montana Supreme Court case, Baxter v. Montana.  An analysis by attorneys Greg Jackson and Matt Bowman describes Baxter as follows:

"The Montana Supreme Court s assisted-suicide decision . . . didn't even 'legalize' assisted-suicide. . . . After Baxter, assisted-suicide continues to carry both criminal and civil liability risks for any doctor, institution, or lay person involved."[1]

Since then, competing articles have appeared in the official Montana State Bar publication disputing whether Baxter legalized assisted suicide.[2]  The editor's headline states: "Court ruling still leaves the issue open to argument." [3]

Correct reporting would be that assisted suicide is not legal in Montana and/or hotly disputed.  Thank you for your attention to this matter.

Senator Greg Hinkle
Thompson Falls, MT
 

* * * 

[1] Greg Jackson, Esq., and Matt Bowman, Esq., "Analysis of Implications of the Baxter Case on Potential Criminal Liability," Montanans Against Assisted Suicide & For Living with Dignity, April 2010, available at http://montanansagainstassistedsuicide.org/wp-content/uploads/2011/05/Analysis-of-Baxter.pdf                                                
[2] Senator Anders Blewett (pro article), Senator Jim Shockley and Margaret Dore (con article), "The aid-in-dying debate: Can a physician legally help a patient die in Montana?  Court ruling still leaves the issue open to argument," The Montana Lawyer, November 2011, available at http://maasdocuments.files.wordpress.com/2012/07/montana-lawyer-pro-con-articles-nov-2011.pdf
[3]  Id.

New England Journal of Medicine Article Misleading

Dear Editor

I am a lawyer in Washington State, one of two states where assisted-suicide is legal.  The other state is Oregon, which has a similar law.  Lisa Lehmann's article, "Redefining Physicians' Role in Assisted Dying," is misleading regarding how these laws work.

First, the Oregon and Washington laws are not limited to people in their "final months" of life.[1,2]  Consider for example, Jeanette Hall, who in 2000 was persuaded by her doctor to be treated rather than use Oregon's law.  She is alive today, twelve years later.[3]

Second, these laws are not "safe" for patients.[4][5]  For example, neither law requires a witness at the death.  Without disinterested witnesses, the opportunity is created for the patient's 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?  

Third, the fact that persons using Oregon's law are "more financially secure" than the general population is consistent with elder financial abuse, not patient safety.  Do not be deceived. 

* * *

[1]  Margaret K. Dore, "Aid in Dying: Not Legal in Idaho; Not About Choice," The Advocate, official publication of the Idaho State Bar, Vol. 52, No. 9, pages 18-20, September 2010, available at http://www.margaretdore.com/pdf/Not_Legal_in_Idaho.pdf.
[2]  Kenneth Stevens, MD, Letter to the Editor, "Oregon mistake costs lives," The Advocate, official publication of the Idaho State Bar, Vol. 52, No. 9, pages 16-17, September 2010, available at http://www.margaretdore.com/info/September_Letters.pdf 
[3]  Ms. Hall corresponded with me on July 13, 2012.
[4]  See article at note 1.  See also Margaret Dore, "Death with Dignity": A Recipe for Elder Abuse and Homicide (Albeit Not by Name)," at 11 Marquette Elder's Advisor 387 (Spring 2010), original and updated version available at http://www.choiceillusion.org/p/the-oregon-washington-assisted-suicide.html 
[5]  Blum, B. and Eth, S.  "Forensic Issues: Geriatric Psychiatry." In Kaplan and Sadock's Comprehensive Textbook of Psychiatry, Seventh Edition, B. Sadock and V. Sadock editors.  Baltimore, MD: Lippincott, Williams and Wilkins, pp. 3150-3158, 2000. 

Users of Assisted Suicide are Seniors with Money

By Margaret Dore, Esq.
Updated August 18, 2012

Users of assisted suicide "are overwhelmingly white, well educated and financially comfortable."[1]  They are also age 65 and older.[2]  In other words, users are older people with money, which would be the middle class and above, a group disproportionately at risk of financial abuse.[3]

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 financial abuse.  These acts allow heirs and other persons who will benefit from an elder's death to actively participate in the lethal dose request.[4]  There is also no oversight when the lethal dose is administered, not even a witness is required.[5]  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.  Even if he struggled, who would know?

Under the Washington act and the Massachusetts' proposal, the death certificate is required to reflect a natural death.[6]  In Oregon, a natural death is listed by custom.[7]  A concerned nephew, learning that his aunt has suddenly died and that she had a new will favoring a ne'er do will son, will thereby be mislead as to what actually happened.

This does not mean that all deaths under the Oregon and Washington acts are  abusive or without consent.  What it means is that these laws, and the similar Massachusetts proposal, invite abuse and have a distinct lack of transparency.  In Oregon, not even law enforcement is allowed to access state-collected information about these deaths.[8]  Even if the person struggled, who would know?

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

* * *
[1]  Katie Hafner, "In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide," New York Times, August 11, 2012.
[2]  See e.g., the most current official report from Oregon, "Oregon Death with Dignity Act--2011" ("Of the 71 DWDA deaths during 2011, most (69.0%) were aged 65 years or older; the median age was 70 years"), available athttp://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year14.pdf
[3]  The MetLife Study of Elder Financial Abuse, "Crimes of Occasion, Desperation, and Predation Against America's Elders," June 2011 (a follow up to MetLife's 2009 "Broken Trust: Elders, Family, and Finances"), available athttp://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf.
[4]  See Memo to Joint Judiciary Committee (regarding Bill H.3884, now ballot measure No. 2), Section III.A.2. ("Someone else is allowed to speak for the patient") and and Section II.C. ("One of the [two] witnesses [on the lethal dose request form] is allowed to be an heir who will benefit financially from the patient's death"), available at http://www.massagainstassistedsuicide.org/p/memo-to-joint-judiciary-committee.html
[5]  See above memo at Section III.A.1("No witnesses at the death").  See also entire proposed Massachusetts Act at http://choiceisanillusion.files.wordpress.com/2011/10/ma-initiative.pdf 
[6]  See proposed Massachusetts Act at Section 4 (2) ("The attending physician may sign the patient's death certificate which shall list the underlying terminal disease as the cause of death").  Washington's act, RCW 70.245.040(2) has this same language. 
[7]  See e.g., Charles Bentz, "Oregon Doctor's Letter to Massachusetts Medical Society," posted November 28, 2011 ("His death certificate listed the cause of death as melanoma.  The public record is not accurate. My depressed patient did not die from his cancer, but at the hands of a once-trusted colleague."), available at http://www.massagainstassistedsuicide.org/2011/11/oregon-doctors-letter-to-massachusetts.html#more 
[8]  See E-mail from Alicia A. Parker, Mortality Research Analyst, Center for Health Statistics, Oregon Health Authority, January 4, 2012 ("We have been contacted by law enforcement and legal representatives in the past, but
have not provided identfying information of any type"), available at http://epcdocuments.files.wordpress.com/2012/08/alicia-a-parker.pdf

Suicide Predator Conviction Upheld

Appeals Court upholds nurse's aiding suicide conviction

by Amy Forliti, Associated Press 

July 17, 2012

[To for more information, charging document click here]

[To link to Nadia's Light, click here]

http://minnesota.publicradio.org/display/web/2012/07/17/news/melchert-dinkel-aiding-suicide-conviction/

MINNEAPOLIS (AP) — The Minnesota Court of Appeals on Tuesday affirmed the convictions of a former nurse who scanned online chat rooms for suicidal people then, feigning compassion, gave a British man and a young woman in Canada instructions on how to kill themselves. 

William Melchert-Dinkel, 49, of Faribault, acknowledged that what he did was morally wrong but argued he had merely exercised his right to free speech and that the Minnesota law used to convict him in 2011 of aiding suicide was unconstitutional. 

The appeals court disagreed, saying the First Amendment does not bar the state from prosecuting someone for "instructing (suicidal people on) how to kill themselves and coaxing them to do so." 

Melchert-Dinkel's attorney, Terry Watkins, was not immediately available for comment.

Court documents show Melchert-Dinkel searched online for depressed people then, posing as a female nurse, offered step-by-step instructions on how they could kill themselves.

Melchert-Dinkel was convicted last year of two counts of aiding suicide in the deaths of 32-year-old Mark Drybrough, of Coventry, England, who hanged himself in 2005; and 18-year-old Nadia Kajouji, of Brampton, Ontario, who jumped into a frozen river in 2008.

He was sentenced to more than six years in prison but the terms of his parole meant he would only be imprisoned for about a year. His sentence was postponed pending his appeal, but at the time of sentencing, he was told that if his convictions were upheld, he'd have seven days to report to jail.

In arguing to overturn the conviction, Watkins said his client didn't talk anyone into suicide but instead offered emotional support to two people who had already decided to take their lives.

Assistant Rice County Attorney Benjamin Bejar had argued that Melchert-Dinkel wasn't advocating suicide in general, but had a targeted plan to lure people to kill themselves. Prosecutors have said he convinced his victims to do something they might not have done without him.

Bejar said Tuesday that prosecutors were pleased with the decision.

In a statement read at his sentencing last year, Melchert-Dinkel said he was sorry for his role in the suicides and that he realized he had rejected a unique opportunity to talk his victims out of killing themselves.

Melchert-Dinkel's nursing license was revoked in 2009

In Oregon, other suicides have increased with legalization of physician-assisted suicide

Scott Helman's article about legalizing assisted suicide in Massachusetts implies that doing so will eliminate violent suicides.  I am physician in Oregon where assisted suicide is legal.  Official statistics from the state of Oregon do not support this claim.

Based on an Oregon Public Health report released in 2010, Oregon's overall suicide rate, which excludes suicide under Oregon's assisted suicide act, is 35% above the national average. The report documents that the rate has been "increasing significantly since 2000." 

Just three years prior, in 1997, Oregon legalized assisted suicide.  Suicide has 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 on Oregon's website, "[f]irearms were the dominant mechanism of suicide among men."  The claim that legalization prevents violent deaths is without factual support.

Factual support for the above statistics:

Oregon Health Authority News Release September 9, 2010 at http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf and,

"Suicides in Oregon, Trends and Risk Factors," Executive Summary, p.4, at http://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/Suicide%20in%20Oregon%20Trends%20and%20risk%20factors.pdf 

William L. Toffler MD

Professor of Family Medicine

Oregon Health & Science University

Portland OR