Monday, May 4, 2015

California: Memo to Senate Appropriations Committee: "Vote 'NO' on SB 128: The financial impact is potentially 'enormous.'"

By Margaret K. Dore, Esq., MBA
To view a pdf version,  please click here.

A. Introduction

SB 128 seeks to legalize physician-assisted suicide.  The bill is based on a similar law in Oregon, which was enacted in 1997.  In Oregon, the law is rarely used, but since passage, there has been a significant increase in other (conventional) suicides.  This increase is consistent with a suicide contagion in which legalization and promotion of physician-assisted suicide has led to an increase in other suicides.  Moreover, the financial cost is “enormous.”  A government report from Oregon states:
In 2010 alone, self-inflicted injury hospitalization charges exceeded 41 million dollars.
This Committee must vote NO unless the proponents can show that California will not have a similar increase in conventional suicides. Otherwise, the financial cost in California could be “enormous.”

B. Suicide and Physician-Assisted Suicide.

“Suicide” is “the intentional taking of one’s own life.”[1] “Physician-assisted suicide” occurs when:
[A] physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide).[2]
C. Most States Have Rejected Physician-assisted Suicide.

Most states that have considered legalizing physician-assisted suicide, have rejected it.[3] There are just three states where the practice is legal via statutes similar to SB 128. These states are Oregon, Washington and Vermont:  Oregon’s act was passed by a ballot measure in 1997; Washington’s act was passed by a ballot measure in 2008; Vermont’s act was passed by legislative enactment in 2013.[4]

In two other states, New Mexico and Montana, proponents claim legality under case law.[5] In both states, however, controversy over physician-assisted suicide is ongoing.[6]  There is also an active repeal movement in Vermont.[7]  In the last four years, four states have strengthened their laws against assisted suicide.  These states are: Arizona, Idaho, Georgia and Louisiana.[8]

D.  Use of Physician-Assisted Suicide Is Rare.  

In Oregon, there were 105 deaths under Oregon’s act in 2014.[9]  This was out of 33,931 deaths.[10] In Washington, there were 159 deaths under Washington’s act in 2013.[11] This was out of 51,052 deaths.[12]  In Vermont, where there is no government reporting, there have apparently been six prescriptions written since enactment two years ago.[13]

E.  Suicide Contagion.

It is well known that suicide is contagious.  A famous example is Marilyn Monroe.[14]  Her widely reported suicide was followed by “a spate of suicides.”[15]

With the understanding that suicide is contagious, groups such as the National Institute of Mental Health and the World Health Organization have developed guidelines for the responsible reporting of suicide, to prevent contagion.  Key points include that the risk of additional suicides increases:
[W]hen the story explicitly describes the suicide method, uses dramatic/graphic headlines or images, and repeated/extensive coverage sensationalizes or glamorizes a death.[16]
F.  Physician-Assisted Suicide in Oregon.

In Oregon, prominent cases of physician-assisted suicide  include: Lovelle Svart; and Brittany Maynard.

Lovelle died in 2007.[17]  The Oregonian, which is Oregon’s largest paper, violated the recommended guidelines for the responsible reporting of suicide by explicitly describing her suicide method and by employing “dramatic/graphic images.”  Indeed, visitors to the paper’s website were invited “to hear and see when Lovelle swallowed the fatal dose.”[18]  There were also photos of her lying in bed, dying.[19]

Brittany Maynard died from physician-assisted suicide, in Oregon, on November 1, 2014.  Contrary to the recommended guidelines, there has been “repeated/extensive coverage” in multiple media.[20]

G. The Financial Cost of Suicide.

The financial cost to state and local governments associated with suicide can include expenditures for burial/cremation services and police investigations.  In the case of “suicide by cop,” in which a suicidal person threatens police or civilians in order to be killed by the police, there can also be costly litigation over the use of force, and in some cases damages paid to the suicidal person’s family.[21] In California, this phenomenon is already not rare.[22]  In the case of attempted suicides (that fail), there can be significant costs for: hospitalizations; psychological and physical rehabilitation; and nursing home care.

H.  In Oregon, Other Suicides Have Increased with Legalization of Physician-Assisted Suicide.

In Oregon, government reports show a positive statistical correlation between the legalization of physician-assisted suicide and an increase in other suicides. This statistical correlation is consistent with a suicide contagion in which the  legalization and promotion of physician-assisted suicide has encouraged these other suicides.  Please, consider the following:

  • Oregon's legalized physician-assisted suicide “in late 1997.”[23]  
  • By 2000, Oregon's conventional suicide rate was "increasing significantly."[24]
  • By 2007, Oregon's conventional suicide rate was 35% above the national average.[25]
  • By 2010, Oregon's conventional suicide rate was 41% above the national average.[26]

I.  In Oregon, the Financial Cost of Suicide is “Enormous.” 

In Oregon, the financial cost of non-physician-assisted suicide is “enormous.”  An Oregon government report states:
The cost of suicide is enormous.  In 2010 alone, self-inflicted injury hospitalization charges exceeded 41 million dollars; and the estimate of total lifetime cost of suicide in Oregon was over 680 million dollars.[27]
J.  Oregon Is the Only State with Statistics over Time.

Oregon is the only state where there has been legal physician-assisted suicide long enough to have statistics over time. The enormous cost of increased non-physician-assisted-suicides in Oregon, positively correlated to physician-assisted suicide legalization, is a significant factor for this body to consider regarding SB 128, which seeks to legalize physician-assisted suicide in California.  

K.  Conclusion.

SB 128 seeks to legalize physician-assisted suicide. The bill is based on a similar law in Oregon, which was enacted in 1997. In Oregon, the law is rarely used, but there has been a significant increase in other suicides.  This is consistent with a suicide contagion in which legalization and promotion of physician-assisted suicide has led to an increase in other (conventional) suicides. The financial cost is “enormous.”

This Committee must vote NO unless the proponents can show that California will not have a similar increase in conventional suicides. Otherwise, the financial cost in California could be “enormous.”  I urge you to vote “NO” on SB 128.

Margaret Dore, Esq., MBA
Law Offices of Margaret K. Dore, PS
Choice is an Illusion, 
1001 4th Avenue, Suite 4400
Seattle, WA 98154

* * *
[1]  Definition of “suicide” by Medical Dictionary, http://medical-dictionary.thefreedictionary.com/Suicide.
[2]  AMA Code of Medical Ethics, Opinion 2.211 - Physician-Assisted Suicide, available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page.
[4]  See Or. Rev. Stat. §§ 127.800-995; Wash. Rev. Code Ann. §§ 70.245.010-904; and 18 V.S.A. § 5289 also known as Act 39.
[5]  In New Mexico, proponents rely on Morris v. New Mexico.  In Montana, proponents rely on Baxter v. State, 2009 MT 449, 354 Mont. 234, 224 P.3d 1211.
[6]  Morris v. New Mexico, is ongoing.  In Montana, there have been proposals every legislative session since 2011, to both clarify that physician-assisted suicide is not legal, and also, to legalize physician-assisted suicide.  This year, HB 447, seeking to clarify that physician-assisted suicide is not legal, passed the House; SB 202, seeking to legalize physician-assisted suicide, did not get out of committee.
[7]  See e.g., “Sixty legislators make valiant effort to repeal Act 39,” April 29, 2015, at http://www.truedignityvt.org/sixty-legislators-make-valiant-effort-to-repeal-act-39/
[8]  Appendix, Tab 1, pp. 1-4, available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-1-pages-1-4.pdf
[9]  Appendix, Tab 2, page 1, Oregon Public Health Division: Oregon’s Death with Dignity Act-2014 (Annual report for 2014), available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-2-oregon-2014-report.pdf.
[10]  Id., footnote 1.
[11]  Appendix, Tab 3, page 1, Washington State Department of Health, 2013 Death with Dignity Act Report, Executive Summary. Available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-3-page-1-washington-report.pdf
[12]  Appendix, Tab 4, State Population Census Estimates: 2013 Births, Deaths, Migration Totals for 2013.  Available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-4-page-1-washington-total-deaths.pdf
[13]  Appendix,Tab 5, Written testimony of Linda Waite-Simpson, Compassion & Choices, prepared for the Vermont Senate Health and Welfare Committee, February 18, 2015 (describing six prescriptions written since the inception of Vermont’s Act 39 “nearly two years ago”).  Available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-5-page-1-vermont-prescriptions.pdf
[14]  Appendix, Tab 6, Margot Sanger-Katz, “The Science Behind Suicide Contagion,” The New York Times, August 13, 2014, at http://www.nytimes.com/2014/08/14/upshot/the-science-behind-suicide-contagion.html?_r=0&abt=0002&abg=1 and https://choiceisanillusion.files.wordpress.com/2015/05/tab-6-the-science-behind-suicide-contagion-nytimes.pdf
[15]  Id., p.6
[16] Appendix, Tab 7, page 1, “Recommendations for Reporting on Suicide, The National Institute of Mental Health.  See also “Preventing Suicide: A Resource for Media Professionals, World Health Organization, at http://www.who.int/mental_health/prevention/suicide/resource_media.pdf
[17]  Appendix, Tab 8, page 1, Ed Madrid, The Oregonian, “Lovelle Svart, 1945 - 2007. Available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-8-page-1.pdf
[18]  Appendix, Tab 8, page 2, https://choiceisanillusion.files.wordpress.com/2015/05/tab-8-page-2-lovelle-dying.pdf
[19]  Appendix, Tab 8, page 3, https://choiceisanillusion.files.wordpress.com/2015/05/tab-8-page-3-lovelle-dying.pdf
[20]  Coverage of Ms. Maynard’s death by physician-assisted suicide has included print and social media.  See e.g., Appendix, Tab 9, available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-9-page-1-maynard.pdf
[21]  See: Appendix, Tab 10, pages 1-2 Bernard J. Farber, Suicide by Cop, 2007(8) AELE Monthly Law Journal, Civil Liability Section, August 2007, p. 101; and Tab 11, Suicide by Cop, Ann Emerg. Med., 1998 Dec.: 32(6):665-9 (Abstract).  Available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-10-suicde-by-cop.pdf and https://choiceisanillusion.files.wordpress.com/2015/05/tab-11-page-1-abstract.pdf
[22]  Id.  See also Tab 12 for articles reporting recent examples of suicide by cop in California, available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-12-suicide-by-cop.pdf
[23]  Appendix, Tab 2, page 1, line one, available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-2-oregon-2014-report.pdf.
[24]  Appendix, Tab 13, page 1, Oregon Health Authority News Release, September 9, 2010, at  http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf ("After decreasing in the 1990s, suicide rates have been increasing significantly since 2000").  See also https://choiceisanillusion.files.wordpress.com/2015/05/tab-13.pdf
[25]  Id. and Appendix Tab 14, page 2, “Suicides in Oregon: Trends and Risk Factors,” issued September 2010 (data through 2007), available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-14.pdf
[26]  Appendix, Tab 15, page 2, “Suicides in Oregon: Trends and Risk Factors, 2012 Report (data through 2010).Available at https://choiceisanillusion.files.wordpress.com/2015/05/tab-15.pdf
[27]  Id., page 3.
Labels: , ,