By Margaret Dore, Esq, MBA 
Click here to view a pdf version of this document, consisting of an index, a short memo and an appendix.
I. INTRODUCTION
I am a licensed attorney in Washington State where “death with dignity” (assisted suicide and euthanasia) is legal. Washington’s law is based on a similar law in Oregon. Both laws are similar to the proposed Act set forth in HB 1659-FN.[1]
I am also a former Law Clerk to the Washington State Supreme Court and the Washington State Court of Appeals. I worked for a year with the United States Department of Justice and have been in private practice since 1990. I am also president of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia.
I have personally appeared and testified against assisted suicide and/or euthanasia in at least 20 US legislatures, including New Hampshire, and also internationally. For more information see www.margaretdore.org and www.choiceillusion.org.
II. DEFINITIONS (TRADITIONAL)
A. Physician-Assisted Suicide, Assisted Suicide, Euthanasia and Mercy Killing
The American Medical Association defines physician-suicide as occurring 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.”[2] For example:
[T]he physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide.[3]Assisted suicide is a general term in which the assisting person is not necessarily a physician. Euthanasia is the administration of a lethal agent by another person.[4] Euthanasia is also known as mercy killing.[5]
B. Withholding or Withdrawing Treatment
Withholding or withdrawing treatment (“pulling the plug”) is not euthanasia if the purpose is to remove burdensome treatment, as opposed to an intent to kill the patient. More importantly, the individual will not necessarily die. Consider this quote regarding a man removed from a ventilator:
[I]nstead of dying as expected, [he] slowly began to get better.[6]III. FACTUAL AND LEGAL BACKGROUND
A. Assisting Persons Can Have an Agenda
Persons assisting a suicide or euthanasia can have an agenda. Consider Tammy Sawyer, trustee for Thomas Middleton in Oregon. Two days after his death by legal assisted suicide, she sold his home and deposited the proceeds into bank accounts for her own benefit.[7] Consider also, Graham Morant, convicted of counseling his wife to kill herself in Australia, to get the life insurance.[8] The Court found:
[Y]ou counselled and aided your wife to kill herself because you wanted ... the 1.4 million.[9]Medical professionals too can have an agenda. New York physician, Michael Swango, got a thrill from killing his patients.[10] Consider also Harold Shipman, a doctor in the UK, who not only killed his patients, but stole from them and in one case made himself a beneficiary of the patient’s will.[11]
B. Most States Reject Assisted Suicide
Most states reject assisted suicide and euthanasia. In July 2016, the Supreme Court of New Mexico overturned a lower court ruling allowing assisted suicide.[12] In the last ten years, eight other states have strengthened their laws against assisted suicide and/or euthanasia.[13]
C. The Swiss Study: Physician-Assisted Suicide Can Be Traumatic for Family Members and Friends
A European research study addressed trauma suffered by persons who witnessed legal physician-assisted suicide in Switzerland.[14] The study found that one out of five family members or friends present at an assisted suicide was traumatized. These people,
experienced full or sub-threshold PTSD [Post Traumatic Stress Disorder] related to the loss of a close person through assisted suicide.[15]IV. HOW THE ACT WORKS
The Act has an application process to obtain the lethal dose.[16] Once the lethal dose is issued by the pharmacy, there is no oversight. No witness, not even a doctor, is required to present at the death.[17]
V. “ELIGIBLE” PERSONS WILL HAVE YEARS OR DECADES TO LIVE
A. If New Hampshire Follows Oregon Practice, the Act Will Apply to Young Adults With Diabetes
The Act applies to people with a terminal disease expected to produce death within six months. The Act states:
“Terminal disease" means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within 6 months..[18]In Oregon, a nearly identical definition is construed to include diabetes if the patient is insulin dependent.[19] Oregon doctor, William Toffler, explains:
In Oregon, chronic conditions such as insulin dependent diabetes are sufficient for assisted suicide, if, without treatment, the patient has less than six months to live.
This is significant when you consider that, without insulin, a typical insulin-dependent 20 year old will live less than a month.[20]B. Predictions of Life Expectancy Can Be Wrong, John Norton
Eligible persons may also have years or decades to live because predictions of life expectancy can be wrong. This is true due to actual mistakes (the test results got switched), and because predicting life expectancy is not an exact science.[21]
Consider John Norton, now 82 years old. Diagnosed with ALS at age 18, he was told that he would get progressively worse (be paralyzed) and die in three to five years. His affidavit, submitted to a Canadian court, states:
Consider also Jeanette Hall, who was diagnosed with cancer in 2000 and made a settled decision to use Oregon’s law.[24] Her doctor convinced her to be treated for cancer instead. Her declaration states:
The proposed Act’s “Statement of Purpose” implies that the Act will be limited to self-administered lethal medication, i.e., assisted suicide.[27] If for the purpose of argument, the Act does in fact require self-administration, any such requirement will be unenforceable due to the Americans with Disability Act (“ADA”).
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.[22]
Six years after my initial diagnosis, the disease progression stopped.... I still can’t grip with my hands.... But, I have a wonderful life.... I help other people by working as a volunteer driver.[23]C. Treatment Can Lead to Recovery, Jeanette Hall
Consider also Jeanette Hall, who was diagnosed with cancer in 2000 and made a settled decision to use Oregon’s law.[24] Her doctor convinced her to be treated for cancer instead. Her declaration states:
It has now been 19 years since my diagnosis. If [my doctor] had believed in assisted suicide, I would be dead.[26]VI. THE AMERICANS WITH DISABILITY ACT WILL REQUIRE EUTHANASIA
The proposed Act’s “Statement of Purpose” implies that the Act will be limited to self-administered lethal medication, i.e., assisted suicide.[27] If for the purpose of argument, the Act does in fact require self-administration, any such requirement will be unenforceable due to the Americans with Disability Act (“ADA”).
The ADA is “a federal civil rights law that prohibits discrimination against individuals with disabilities in every day activities, including medical services.”[28] “Medical care providers are required to make their services available in an accessible manner.”[29] This includes:
Reasonable modifications to policies, practices, and procedures to make healthcare services fully available to individuals with disabilities, unless the modifications would fundamentally alter the nature of the services (i.e., alter the essential nature of the services). (Emphasis added).[30]Here, the proposed Act legalizes assisted suicide as part of New Hampshire medical care.[31] If for the purpose of argument, the Act does in fact require self-administration, the ADA will require a reasonable accommodation for individuals unable to self-administer. This will mean administration by another person. The proposed Act will thereby allow euthanasia as traditionally defined.
VII. “EVEN IF THE PATIENT STRUGGLED, WHO WOULD KNOW?”
The proposed Act has no required oversight over administration of the lethal dose.[32] In addition, the drugs used are water or alcohol soluble, such that they can be injected into a sleeping or restrained person without consent.[33] Alex Schadenberg, Executive Director for the Euthanasia Prevention Coalition, puts it this way:
With assisted suicide laws in Washington and Oregon [and with the proposed Act], perpetrators can . . . take a “legal” route, by getting an elder to sign a lethal dose request. Once the prescription is filled, there is no supervision over administration. Even if a patient struggled, “who would know?" (Emphasis added).[34]VIII. AN UNTENABLE STANDARD
The proposed Act uses the word, “capable,” which is specially defined to allow another person to communicate on the patient’s behalf, as long as that person is “familiar with the patient’s manner of communicating.” The Act states:
“Capable” means that, in the opinion of a court or in the opinion of the patient’s attending physician or consulting physician, a patient has the ability to make and communicate health care decisions to health care providers, including communication through persons familiar with the patient’s manner of communicating if those persons are available. (Emphasis added).[35]This is an untenable standard.
Consider, for example, a doctor’s assistant who is familiar with a patient’s “manner of communicating” in Spanish, but she herself does not understand Spanish. That would be good enough for her to communicate on the patient’s behalf. The patient would not be in control of his fate.
IX. ACTIONS TAKEN IN ACCORDANCE WITH THE ACT WILL NOT CONSTITUTE SUICIDE OR HOMICIDE
The Act states:
Actions taken in accordance with this chapter [the proposed act] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing, or homicide, under the law. (Emphasis added).[36]The Act does not define accordance.[37] Dictionary definitions include “in the spirit of,” meaning “in thought or intention.” In other words, a mere thought or intention to comply with the Act is sufficient to prevent a death from being treated as suicide or homicide under the law. Actions taken in accordance with the Act will not be suicide or homicide as a matter of law.
X. DEATHS WILL BE REPORTED AS NATURAL
New Hampshire death registration forms require the manner of death to be reported as one of six categories, four of which are substantive: (1) natural; (2) accidental; (3) suicidal; and (4) homicidal.[39] The two other categories are: pending investigation; and undetermined.[40]
As noted in the preceding section, a death occurring in accordance with the Act will not constitute suicide or homicide as a matter of law. The death will also not be accidental due its having been an intended event. This leaves “natural.”
The official legal manner of death will be natural.
XI. DR. SHIPMAN AND THE CALL FOR DEATH CERTIFICATE REFORM
Per a 2005 article in the UK’s Guardian newspaper, there was a public inquiry regarding Dr. Shipman’s conduct, which determined that he had “killed at least 250 of his patients over 23 years.”[41] The inquiry also found:
that by issuing death certificates stating natural causes, the serial killer [Shipman] was able to evade investigation by coroners.[42]Per a subsequent article in 2015, proposed reforms included having a medical examiner review death certificates, so as to improve patient safety.[43] Instead, the proposed Act moves in the opposite direction to require that deaths be reported as natural. If enacted, doctors and other perpetrators will be able to kill under mandatory legal cover.
XII. PERPETRATORS WILL BE ALLOWED TO INHERIT
New Hampshire caselaw prevents a person who commits murder, from being unjustly enriched through his or her inheritance of the victim’s property. Hopwood v. Pickett, 145 N.H. 207, 208, 761 A.2d 436, 438 (2000).
Deaths occurring in accordance with the Act, however, are deemed to be natural as a matter of law. More to the point, straight up perpetrators will be allowed to inherit.
XIII. LOWER INCOME PEOPLE AND EVERYONE ELSE
In Oregon, people of all income levels are steered to suicide by health care providers. This was first highlighted by the media including ABC News, in 2008, concerning low income people.[44] See also the Seattle Times excerpt quoted below, suggesting euthanasia for those without money for their old age.[45] If you work hard all your life, pay taxes and then your pension plan goes broke, this is how society will pay you back?
IV. CONCLUSION
If passed into law, the proposed Act will apply to people with years or decades to live. This will be especially true if New Hampshire follows Oregon practice to determine life expectancies without treatment. Young adults with chronic conditions, such as insulin dependent diabetes, will be considered terminal and therefore subject to the Act.
Assisting persons, including doctors and family members, can have an agenda, with the more obvious reasons being inheritance and life insurance, but also, as in the case of Dr. Swango, the thrill of seeing someone die. The lack of required oversight at the death, coupled with the mandatory falsification of the death registration form, to report a natural death, will create a perfect crime in which perpetrators will be legally allowed to inherit.
The Act’s passage will render people with money, meaning the middle class and above, sitting ducks to their heirs and other predators. As noted above, lower income people will also be at risk. Protect yourselves and the people you care about. Say “No” to HB 1659-FN.
Respectfully Submitted,
Margaret Dore, Esq., MBA
Law Offices of Margaret K. Dore, P.S.
Choice is an Illusion, a nonprofit corporation
www.margaretdore.org
www.choiceillusion.org
1001 4th Avenue, Suite 4400
Seattle, WA 98154
206 697 1217
Footnotes:
[1] The Act, HB 1659-FN, is attached in the appendix at pp. A-1 to A-7.
[2] The AMA Code of Medical Ethics, Opinion 5.7, in the appendix, at p. A-8.
[3] Id.
[4] AMA Opinion 5.8, “Euthanasia,” attached in the appendix at page A-9.
[5] See “Mercy Killing” definition, attached hereto at page A-10.
[6] 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, 1/13/09, attached at pp. A-11 to A-14; quote at A-13.
[7] "Sawyer Arraigned on State Fraud Charges," KTVZ.COM, 08/16/16, attached in the appendix at page A-15.
[8] R v Morant [2018] QSC 251, Order, 11/02/18, excerpts in the appendix at pp. A-16 and A-17. Full opinion available here: https://archive.sclqld.org.au/qjudgment/2018/QSC18-251.pdf
[9] Morant opinion, ¶ 78, attached in the appendix at page A-17.
[10] Charlie Leduff, “Prosecutors Say Doctor Killed to Feel a Thrill,” The New York Times, 09/07/00, attached in the appendix at pages A-18 to A-20, https://choiceisanillusion.files.wordpress.com/2019/03/ny-times-killed-to-feel-a-thrill-1.pdf (“Basically, Dr. Swango liked to kill people. By his own admission in his diary, he killed because it thrilled him.”)
[11] David Batty, “Q & A: Harold Shipman,” The Guardian, 08/25/05, at https://www.theguardian.com/society/2005/aug/25/health.shipman. Attached in the appendix at pages A-21 to A-23
[12] Morris v, Brandenburg, 376 P.3d 836 (2016).
[13] Margaret Dore, “U.S. States Strengthen Their Laws Against Assisted Suicide, April 2, 2019, attached in the appendix at A-24, also available a https://www.choiceillusion.org/2019/04/in-last-ten-years-at-least-nine-us.html
[14] “Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide,” B. Wagner, J. Muller, A. Maercker; European Psychiatry 27 (2012) 542-546, available at http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf
[15] Id.
[16] The Act, §§ 137-M:3 to M:10, attached hereto at A-2 through A-4.
[17] See the Act in its entirety, attached hereto at A-1 to A-7.
[18] The Act, attached in the appendix at page A-2, 137-M:2, XIII.
[19] Oregon’s definition can be viewed in the appendix at p. A-28.
[20] Declaration of William Toffler, MD, May 1, 2018, attached in the appendix at pages A-25 through A-30; quote at page A-26. See also Oregon report excerpt, attached at page A-29 (listing diabetes as an underlying illness sufficient for assisted suicide).
[21] Cf. Jessica Firger, “12 Million Americans Misdiagnosed Each Year,” CBS NEWS, April 17, 2014, available at https://www.cbsnews.com/news/12-million-americans-misdiagnosed-each-year-study-says/ and Nina Shapiro, “Terminal Uncertainty ...,” supra, attached hereto at A-11 to A-14.
[22] Affidavit of John Norton in Opposition to Assisted Suicide and Euthanasia, 08/18/12, attached hereto at A-31 to A-33, quote at A-32.
[23] Id.
[24] Declaration of Kenneth Stevens, MD, ¶¶ 3 to 7; attached in the appendix at A-34 to A-36; Hall declaration attached at A-37, ¶ 3.
[25] Id.
[26] Hall Declaration, ¶4, attached in the appendix at A-37.
[27] The Act, ¶ 137-M:1, attached hereto at A-1 and A-2.
[28] U.S. Department of Justice, Civil Rights Division, and the U.S. Department of Health and Human Services, Office for Civil Rights, “Americans with Disabilities Act: Access to Medical Care for Individuals with Mobility Disabilities,” July 2010, available at https://www.ada.gov/medcare_mobility_ta/medcare_ta.htm
[29] Id.
[30] Id.
[31] The proposed Act, § 137-M:1, Statement of Purpose, attached at page A-1.
[32] See the Act in its entirety, attached hereto at A-1 through A-7.
[33] The drugs used include Secobarbital, Pentobarbital, Phenobarbital and Morphine Sulfate, which are water and/or alcohol soluble. See also Oregon and Washington report excerpts in the appendix at pp. A-38 and A-39 (listing these drugs). See also http://www.drugs.com/pro/nembutal.html and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2977013
[34] Alex Schadenberg, Letter to the Editor, “Elder abuse a growing problem,” The Advocate, Official Publication of the Idaho State Bar, October 2010.
[35] The Act, Definitions, § 137-M:2.III, attached hereto at page A-2.
[36] The proposed Act, 137-M:13, IV, attached hereto at A-5.
[37] See the proposed Act in its entirety, attached hereto at A-1 to A-7.
[38] See definitions in the appendix at pages A-40 and A-41.
[39] See New Hampshire Vital Records Administration, Death Registration Forms and Procedures, Section 5-C: 62 IV(c) - attached hereto at A-43, full document attached at A-42 to A-44.
[40] Id.
[41] David Batty, supra, attached in the appendix at page A-21 to A-23.
[42] Id., attached hereto at A-23.
[43] Press Association, “Death Certificate Reform Delays ‘Incomprehensible,” The Guardian, January 21, 2015, attached hereto at A-45 to A-46.
[44] ABC News, “Death Drugs Cause Uproar in Oregon, 2008 https://choiceisanillusion.files.wordpress.com/2018/08/abc-news-death-drugs-cause-uproar-in-oregon.pdf
[45] Jerry Large, “Planning for Old Age at a Premium,” The Seattle Times, March 8, 2012,, attached hereto at page A-47.
[46] Id.
[2] The AMA Code of Medical Ethics, Opinion 5.7, in the appendix, at p. A-8.
[3] Id.
[4] AMA Opinion 5.8, “Euthanasia,” attached in the appendix at page A-9.
[5] See “Mercy Killing” definition, attached hereto at page A-10.
[6] 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, 1/13/09, attached at pp. A-11 to A-14; quote at A-13.
[7] "Sawyer Arraigned on State Fraud Charges," KTVZ.COM, 08/16/16, attached in the appendix at page A-15.
[8] R v Morant [2018] QSC 251, Order, 11/02/18, excerpts in the appendix at pp. A-16 and A-17. Full opinion available here: https://archive.sclqld.org.au/qjudgment/2018/QSC18-251.pdf
[9] Morant opinion, ¶ 78, attached in the appendix at page A-17.
[10] Charlie Leduff, “Prosecutors Say Doctor Killed to Feel a Thrill,” The New York Times, 09/07/00, attached in the appendix at pages A-18 to A-20, https://choiceisanillusion.files.wordpress.com/2019/03/ny-times-killed-to-feel-a-thrill-1.pdf (“Basically, Dr. Swango liked to kill people. By his own admission in his diary, he killed because it thrilled him.”)
[11] David Batty, “Q & A: Harold Shipman,” The Guardian, 08/25/05, at https://www.theguardian.com/society/2005/aug/25/health.shipman. Attached in the appendix at pages A-21 to A-23
[12] Morris v, Brandenburg, 376 P.3d 836 (2016).
[13] Margaret Dore, “U.S. States Strengthen Their Laws Against Assisted Suicide, April 2, 2019, attached in the appendix at A-24, also available a https://www.choiceillusion.org/2019/04/in-last-ten-years-at-least-nine-us.html
[14] “Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide,” B. Wagner, J. Muller, A. Maercker; European Psychiatry 27 (2012) 542-546, available at http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf
[15] Id.
[16] The Act, §§ 137-M:3 to M:10, attached hereto at A-2 through A-4.
[17] See the Act in its entirety, attached hereto at A-1 to A-7.
[18] The Act, attached in the appendix at page A-2, 137-M:2, XIII.
[19] Oregon’s definition can be viewed in the appendix at p. A-28.
[20] Declaration of William Toffler, MD, May 1, 2018, attached in the appendix at pages A-25 through A-30; quote at page A-26. See also Oregon report excerpt, attached at page A-29 (listing diabetes as an underlying illness sufficient for assisted suicide).
[21] Cf. Jessica Firger, “12 Million Americans Misdiagnosed Each Year,” CBS NEWS, April 17, 2014, available at https://www.cbsnews.com/news/12-million-americans-misdiagnosed-each-year-study-says/ and Nina Shapiro, “Terminal Uncertainty ...,” supra, attached hereto at A-11 to A-14.
[22] Affidavit of John Norton in Opposition to Assisted Suicide and Euthanasia, 08/18/12, attached hereto at A-31 to A-33, quote at A-32.
[23] Id.
[24] Declaration of Kenneth Stevens, MD, ¶¶ 3 to 7; attached in the appendix at A-34 to A-36; Hall declaration attached at A-37, ¶ 3.
[25] Id.
[26] Hall Declaration, ¶4, attached in the appendix at A-37.
[27] The Act, ¶ 137-M:1, attached hereto at A-1 and A-2.
[28] U.S. Department of Justice, Civil Rights Division, and the U.S. Department of Health and Human Services, Office for Civil Rights, “Americans with Disabilities Act: Access to Medical Care for Individuals with Mobility Disabilities,” July 2010, available at https://www.ada.gov/medcare_mobility_ta/medcare_ta.htm
[29] Id.
[30] Id.
[31] The proposed Act, § 137-M:1, Statement of Purpose, attached at page A-1.
[32] See the Act in its entirety, attached hereto at A-1 through A-7.
[33] The drugs used include Secobarbital, Pentobarbital, Phenobarbital and Morphine Sulfate, which are water and/or alcohol soluble. See also Oregon and Washington report excerpts in the appendix at pp. A-38 and A-39 (listing these drugs). See also http://www.drugs.com/pro/nembutal.html and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2977013
[34] Alex Schadenberg, Letter to the Editor, “Elder abuse a growing problem,” The Advocate, Official Publication of the Idaho State Bar, October 2010.
[35] The Act, Definitions, § 137-M:2.III, attached hereto at page A-2.
[36] The proposed Act, 137-M:13, IV, attached hereto at A-5.
[37] See the proposed Act in its entirety, attached hereto at A-1 to A-7.
[38] See definitions in the appendix at pages A-40 and A-41.
[39] See New Hampshire Vital Records Administration, Death Registration Forms and Procedures, Section 5-C: 62 IV(c) - attached hereto at A-43, full document attached at A-42 to A-44.
[40] Id.
[41] David Batty, supra, attached in the appendix at page A-21 to A-23.
[42] Id., attached hereto at A-23.
[43] Press Association, “Death Certificate Reform Delays ‘Incomprehensible,” The Guardian, January 21, 2015, attached hereto at A-45 to A-46.
[44] ABC News, “Death Drugs Cause Uproar in Oregon, 2008 https://choiceisanillusion.files.wordpress.com/2018/08/abc-news-death-drugs-cause-uproar-in-oregon.pdf
[45] Jerry Large, “Planning for Old Age at a Premium,” The Seattle Times, March 8, 2012,, attached hereto at page A-47.
[46] Id.