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

Theresa Schrempp Letter to the Boston Globe: "Even the composition of the photo is the same"

Dear Editor:

I am a lawyer in Washington State where assisted suicide was unfortunately legalized by an initiative in 2008.  I couldn't help but notice that your article promoting a similar initiative in Massachusetts follows the same template as articles that ran here.  Even the composition of the photo is the same.  ["Dying Wishes, April 29, 2012]

Benedetto Letter to Boston Globe

Dear Editor:

My wife and I operate an elder care facility in Washington State where assisted-suicide is legal.  I am writing to urge your readers to vote against assisted-suicide.

Washington's law was passed by a ballot measure in November 2008.  Four days after the election, an adult child of one of our clients asked about getting "them 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.

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.  I hope that you can prevent assisted suicide.

Juan Carlos Benedetto

Boston Globe: Philip Moran & Karen Schneiderman

May 13, 2012  http://articles.boston.com/2012-05-13/magazine/31664040_1_human-life-physicians-suicide

ON DEATH AND DYING

“Dying Wishes” in the April 29 Globe Magazine refers to “Death with Dignity” instead of what it really is: “physician-assisted suicide.” As stated by then chief justice William Rehnquist in the 1997 case of Washington v. Glucksberg, “An examination of our Nation’s history, legal traditions, and practices demonstrates that Anglo American common law has punished or otherwise disapproved of assisted suicide for over 700 years.” He goes on to state that there are at least five government interests to support that history.  They are prohibiting killing and preserving human life; preventing the serious public health problem of suicide, especially among the young, the elderly, and those suffering from untreated pain or depression; protecting the medical profession’s integrity; protecting the poor, elderly, disabled, and persons in other vulnerable groups from pressure to end their lives; and avoiding a possible slide toward voluntary and even involuntary euthanasia. I submit these are more than sufficient reasons to vote “No” on this ballot question.
Philip D. Moran / Salem 

With fear and rage I respond to the article “Dying Wishes.” A ballot question? The idea of people voting on the worth of a human being is sickening, but my greatest fear has to do with the notion that if a person chooses to request assistance dying, that person is clearly depressed. During such depression it is impossible to make a clear decision. We all have such periods, sick or not, but almost always, with time or therapy or medication or support, that feeling goes away. As a person with a lifelong disability, I have had serious health crises and wished to terminate my life, but I have been fortunate to have medical care and family and friends to help me through my struggles. Those who are not so fortunate rely on the medical establishment. For those of us with disabilities and for elderly folks, our value in this society is already less significant, and we need to rely on physicians to help keep us alive, rather than kill us in the name of compassion.
Karen Schneiderman / Jamaica Plain

Washington State's Annual Report: No Information About Consent

By Margaret Dore

Washington assisted suicide act is similar to the proposed assisted suicide initiative in Massachusetts.[1]  


Washington's act was enacted via a ballot initiative in 2008 and went into effect in 2009.[2]  During the election, proponents claimed that its passage would ensure individuals control over their deaths.  A glossy brochure declared, "Only the patient — and no one else — may administer the [lethal dose]."[3]  The Act, however, does not say this anywhere.


Today, the Washington State Department of Health issued its annual report about Washington's act.[4]  That report, similarly, does not demonstrate that individuals are in control. The report provides no information as to whether the people who died under the act consented and/or acted voluntarily at the time of death.  The report instead talks about "ingestion" of the lethal dose.  A drug can be "ingested" while a person is asleep, sedated and/or not aware of his or her surroundings.


For more information about Washington's act, See Margaret Dore, "'Death with Dignity': What Do We Advise Our Clients?," Bar Bulletin, May 2009.[5]  

* * *

[1]  See RCW 70.245.010 et seq.
[2]  Washington's act was passed by in November 2008 as Initiative 1000 and was now been codified as RCW chapter 70.245.
[3]   I-1000 color pamphlet, "Paid for by Yes! on 1000."
[4]  See News Release here and report here.
[5]  Further information can be viewed here.

Meeting Against Assisted Suicide, Sat, May 19th!

Second Thoughts is a disability rights group opposed to the assisted suicide initiative.  Second Thoughts will be holding an educational and organizational meeting on Saturday, May 19, 2 PM-4:30 PM, at the Cambridge Senior Center In Central Sq., Cambridge. 

The meeting will be in the  first floor "ballroom," no elevator necessary.  For more information: info@second-thoughts.org 

Cambridge Citywide Senior Center
806 Massachusetts Avenue
Cambridge, MA 02139

(617) 349-6060 for directions only

Not Dead Yet: A Deeper Look at Elderly Homicide-Suicides

From Not Dead Yet:  "society cannot lose sight of the fact that a person's life was taken, often without their consent." 

May 1, 2012

Last September, this blog discussed an article from a Pennsylvania newspaper that took a thoughtful, in-depth look at the tragically growing trend of elderly homicide/suicides.  When that story was written, there had been three such cases in the state since June of that year.

The number is now up to at least 6 in the last year.  Terrie Morgan-Besecker takes another in-depth look at elderly homicide/suicides and interviews a number of people about the larger picture (including me) to get beyond the 'mercy killing' theme that dominates the coverage of these tragedies.

An excerpt that includes a bit from my interview is below.  From TheAbington Journal, here is a sample of 'Loved to Death': 

But researchers who have studied murder-suicides among the elderly say they're troubled by society's tendency to view such deaths as mercy killings.

"One of the concerns is you don't want to make it sound like it's a viable thing to do," said Sonia Salari, a professor in the Department of Family and Consumer Studies at the University of Utah."  If we romanticize it, it makes it sound like it's OK."

Statistics regarding the number of elderly murder-suicides committed each year are difficult to come by, as no agency specifically tracks that category of deaths, Salari said.

In a 2005 study, Salari analyzed 225 intimate partner murder-suicides involving couples where either the victim or perpetrator was at least age 60. She gathered the data from news reports, police reports and obituaries published from 1999 to 2005.

The research showed that in 55 percent of the cases, health issues   involving either the victim or perpetrator were cited as a contributing factor. Approximately 7.5 percent of the victims had some sort of dementia.

Compassion or murder?

Salari said that, while she sympathizes with survivors who view the deaths as an act of compassion, society cannot lose sight of the fact that a person's life was taken, often without their consent.

"Some people don't consider it domestic violence, but we need to see it as that," she said. "You have two deaths. Most of the time the victim is not in on the plan."

Stephen Drake, a spokesman for Not Dead Yet, a nonprofit group that opposes assisted suicide laws, also expressed concern over how murder-suicides among the elderly are viewed.

"These are acts usually of desperation, not compassion," he said. "These are people who are feeling depressed or overwhelmed. It's often a consequence of an emotional crisis."

Please read the rest of the article here.  --Stephen Drake 

Bob Joyce: "Details of Mass. assisted-suicide bill raise concerns"

http://articles.boston.com/2012-04-20/letters/31366522_1_assisted-suicide-bill-ballot-question-life-ending-drugs

THIS STORY APPEARED IN the Boston Globe, April 20, 2012

I was glad to see that lawmakers in Vermont defeated an assisted suicide bill similar to the pending ballot question initiative here in Massachusetts. The article bringing the good news, however, risks conveying an inaccurate impression about how the Massachusetts proposal would work (“Mass. group hails defeat of Vermont suicide bill,” Boston.com, April 14).

The article suggests that the proposed ballot question would allow patients to “self-administer” life-ending drugs. The use of this term could lead the casual reader to think that self-administration is required. It is not. I am a lawyer who has read the proposal. It merely states that a patient “may” self-administer the lethal dose. There is no requirement that administration must be by self-administration.

Also of concern is the fact that the proposal does not require that administration be by disinterested people. Disinterested witnesses are also not required. These factors increase the risk of elder abuse by heirs and other people who stand to benefit from the death.

As a lawyer who has seen my older clients abused, I am hopeful that this Massachusetts proposal will follow the Vermont proposal to the grave.

Robert W. Joyce

Newton

A "Doctor & Heir Protection Bill"

By Margaret Dore

On April 2, 2012, the Attorney General issued draft ballot question title and draft yes/no statements for the assisted suicide initiative.  Below please find my objection based on the initiative's being a doctor and heir protection bill.  For a print copy, please click here.  

I.  INTRODUCTION
The proposed act in Petition 11-12 protects persons who cause or assist the death and/or suicide of another person.  This memo discusses why the draft title and one-sentence statements for the act are misleading and should be amended.


II.  THE ACT


A.  The Act Protects People who Cause or Assist a Patient’s Death and/or Suicide


Under current law, people who cause or assist another person’s death or suicide face serious legal consequences.  They can be convicted of a crime, including murder.[1]  They can be found civilly liable for assisting a suicide, committing malpractice and/or causing a wrongful death.[2]  They can also be deprived of an inheritance or life insurance proceeds payable due to the death.[3] 


With the proposed act, however, persons who cause or assist another person’s death and/or suicide are protected from these consequences.  The act also opens the door to new paths of elder abuse.


How the act works, some of its protections and how it will promote elder abuse are described below.

Fact Check for the Initiative, H.3884

  

Margaret Dore

March 1, 2012

1.  Legalization will Empower the Government

Proponents claim that legalizing assisted suicide will keep the government out of people's lives.  The opposite is true.

Fact check:  In Oregon, where assisted suicide is legal, legalization has allowed the Oregon Health Plan, a government entity, to steer people to suicide.  The most well known cases involve Barbara Wagner and Randy Stroup.  Each wanted treatment.  The Plan denied treatment and steered them to suicide by offering to pay for the suicides. Neither Wagner nor Stroup saw this as a celebration of their control. Wagner said: "I’m not ready to die." Stroup said: "This is my life they’re playing with."  See  See Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, August 6, 2008; and "Letter noting assisted suicide raises questions," KATU TV, July 30, 2008.

2.  The Initiative Allows Someone Else to Administer the Lethal Dose

Proponents claim that only the patient may administer the lethal dose.  This is not true.

Fact check:  The initiative, H.3884, states that patients "may" self-administer the lethal dose. There is no language stating that administration “must” be by self-administration.  "Self-administer" is also a specially defined term that allows someone else to administer the lethal dose to the patient.  See here.

3.  An Heir is Allowed to Witness the Lethal Dose Request

Proponents claim that the lethal dose request form must be "independently witnessed" by two people.  This is not true. 

Fact check:  The initiative, Sections 3 and 21, provides that one of two witnesses on the lethal dose request form cannot be a patient’s heir or other person who will benefit financially from the patient's death; the other witness can be an heir or other person who will benefit financially from the death.

4.  Substantial Compliance

Proponents claim that the initiative has "strict safeguards" to protect patients.  The initiative, however, only requires "substantial compliance" with its provisions.  Section 18(1)(a) states:  "A person who substantially complies in good faith with provisions of this chapter shall be deemed to be in compliance with this chapter." 

5.  Assisted Suicide is a Recipe for Elder Abuse

Proponents claim that the initiative is safe, which is not true.

Fact check: The initiative does not require witnesses at the death.  Without disinterested witnesses, the opportunity is created for an heir, or someone else who will benefit financially from the death, to administer the lethal dose to the patient without the patient's consent.  Even if he struggled, who would know?  

6.  Patients are not Necessarily Dying

Proponents imply that the initiative only applies to people in their "final days."  This is untrue.

Fact check:  See Nina Shapiro, "Terminal Uncertainty — Washington's new 'Death with Dignity' law allows doctors to help people commit suicide — once they've determined that the patient has only six months to live. But what if they're wrong?," Seattle Weekly, January 14, 2009; and Jeanette Hall, "She pushed for legal right to die, and - thankfully - was rebuffed," Boston Globe, October 4, 2011.

7.  Assisted Suicide is a Wedge Issue

Proponents deny that assisted suicide is a "wedge issue" to legalize direct euthanasia of non-terminal people.

Fact check:  In Washington state, where assisted suicide has been legal since 2009, there has been a proposal to expand Washington's law to direct euthanasia for non-terminal people.  See Brian Faller, "Perhaps it's time to expand Washington's Death with Dignity Act," The Olympian, November 16, 2011.

8.  Legal Assisted Suicide Threatens People with Disabilities 

Proponents claim that people with disabilities are not at risk from legalization of assisted suicide, which is untrue.

Fact check:  Disability rights groups such as Not Dead Yet oppose assisted suicide as a threat to their lives.  In Oregon and Washington, official government forms for assisted suicide acts in those states promote disability as a reason to commit suicide.[1]  People with disabilities are thereby devalued.  In 2009, there was a proposed assisted suicide bill in New Hampshire that squarely applied to people with disabilities.[2]  If the initiative were to be passed now, people with disabilities see themselves as potentially next in line under a future expansion of that law.  As noted above, there has already been a proposal in Washington state to expand its law to direct euthanasia for non-terminal people. 

* * * 

[1]  See e.g. "Oregon Death with Dignity Act Attending Physician Follow-up Form," question 15, providing seven suggested answers as to why there was a lethal dose request.  Some of the answers are written in terms of disability being an acceptable reason to kill yourself.  These answers include:  "[A] concern about . . . the loss of control of bodily functions."

[2]  Stephen Drake and Not Dead Yet, "New Hampshire Poised to Redefine "Terminally Ill" - to PWDs and others for Assisted Suicide Eligibility," January 30, 2009 (regarding New Hampshire's 2009 assisted suicide bill, HB 304, which applied to people with disabilities, people with HIV/AIDS and other non-dying people).

Teen Suicide: "Assisted Suicide Law Sends Contradictory Message"

From Vermont where the legislature is considering a bill similar to the Massachusetts assisted suicide initiative.

http://vtdigger.org/2012/02/01/page-assisted-suicide-law-sends-contradictory-message/

Editor’s note: This op-ed is by Guy Page, a parent and resident of Cambridge.

In the Jan. 19 mail I received a letter from Lamoille Union High School, where my daughter is enrolled. It begins with the following sentence: “Over the last few years Vermont has seen an increase in suicide among young people.” It went on to describe a school initiative to hopefully address this awful development. I hope they are successful. All of my children have friends, or friends of friends, who have taken their own lives.

My eldest son, Tim, was a constant suicide risk through his teens. Through the wise, compassionate help of state social workers, Tim escaped his teen years alive. I can tell you that he was personally shaken by the implications, to him, of the proposed assisted suicide law several years ago. When he heard about it, my brilliant, troubled son began to shake in anger and almost despair. “Those hypocrites,” he said. “They’ve been telling me all this time that suicide is never OK.” It didn’t matter when I said the law is meant to address another set of problems – his teenaged hypocrisy-o-meter had already pegged assisted suicide as another example of “do as I say, not as I do, it’s all right for adults, not OK for kids.”

Recently I researched teen suicide in Oregon, where assisted suicide became legal in 1998. According to the Oregon health department website, there were more teen suicides after the law passed than before — 1999: 29 suicides. 2000: 44 suicides. 2001: 31. 2002: 37. 2003: 46. 2004: 52. The last two years were the highest two-year period in their survey. Furthermore, 94 percent of teen suicide attempts leading to hospitalization were caused by ingesting drugs – the only form of assisted suicide permitted by Oregon state law. Kids learn from their elders. 

Does this “prove” a link between the Oregon physician-assisted suicide law and teen suicide? No. But the burden of proof is on those who say, “Don’t worry, it will all be OK, none of our teens will think that.” As a parent of an at-risk child, I think this law may unintentionally tell other troubled teens “when it gets too hard it’s okay to end it all.” As the letter from my daughter’s high school says, the real world is a very hard place for some teens right now, and I think this law will just make it harder.

There are plenty of other reasons to oppose this bill. Before my wife passed in February 2011, she was appalled and upset at end-of-life questions asked of her in the ICU that to her seemed motivated by hospital cost-control. It drove a (thankfully temporary) wedge of distrust between her and her caregivers. So Vermont Insurance Commissioner Steve Kimball’s newspaper comments connecting this end-of-life issue with the high cost of health care were chilling. By contrast, Orange County Sen. Mark MacDonald’s daughter was one of Diane’s nurses and provided skilled, affirming care that should be the goal of the state’s health policy. But for me the teen suicide connection is reason enough for the Senate to drop this bill before it does irreversible harm.

---

Article printed from VTDigger: http://vtdigger.org/
URL to article: http://vtdigger.org/2012/02/01/page-assisted-suicide-law-sends-contradictory-message/
URLs in this post:

[1] : http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5635a2.htm

Massachusetts Voters, reject Petition 11-12

http://www.washingtontimes.com/news/2012/jan/11/massachusetts-voters-reject-petition-1112/

If adopted this November, a ballot initiative in Massachusetts will legalize physician-assisted suicide for patients whose conditions are predicted to produce death within six months. Initiative Petition 11-12 claims to ensure that the patient's decision to commit suicide is voluntary. That claim, however, is misleading.

The initiative petition requires that two persons witness the patient's written request for a lethal prescription. One witness, however, can have a financial interest in the patient's death. That person can be the only witness present when the lethal drug is taken. Thus, an interested heir could pressure the patient, and no one would know because no objective witness is required when the drug is taken. Also, the petition would require the death certificate fraudulently to list the patient's underlying condition, rather than the lethal drug, as the cause of death.

Initiative Petition 11-12 uses terms like life-ending "medication" and death in a "humane and dignified manner." But there is nothing medicinal about poison and nothing dignified about the prospects for the abuse the initiative petition would allow. It is a bad law that the voters of Massachusetts should reject decisively.
 STEPHEN L. MIKOCHIK
Professor emeritus
Temple Law School