The Cost of Physician-Assisted Suicide.

By Margaret Dore, Esq., MBA*
Updated November 25, 2015 

It is often assumed that legalizing physician-assisted suicide will save states money. Don’t be so sure. In Oregon, legalization is correlated with an increase in other suicides, the cost of which is "enormous."

More Suicide

Oregon's law legalizing physician-assisted suicide went into effect “in late 1997.”[1] Since then, Oregon has reported a small, but steadily rising number of deaths.[2]

Oregon's other suicides, which are tracked separately, have also increased. Indeed, by 2000, Oregon's suicide rate for other suicides was "increasing significantly."[2] By 2007, Oregon's suicide rate for other suicides was 35% above the national average.[3] By 2010, Oregon's suicide rate for other suicides was 41% above the national average.[4]

The Financial Cost

The financial cost of these other suicides (and suicide attempts) is huge for Oregon, a smaller population state. The Oregon Health Authority 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. (Footnotes omitted).[5]

People With Disabilities Are a High Risk Group for Suicide; Legal Assisted Suicide Discussed as a Contributing Factor.

By Margaret Dore

Thank you Stephen Mendelsohn, of Second Thoughts Connecticut, for providing this important

Stephen Mendelsohn

news.

The State of Connecticut Suicide Prevention Plan for 2020 includes people with disabilities and chronic health conditions as a high-risk group (similar to military veterans or the LGBT community) and discusses assisted suicide as a possible contributing factor to the problem. The Plan states:

Until recently, the [Connecticut Suicide Advisory Board] CTSAB was considering assisted suicide of the terminally ill as a separate issue from suicide prevention. The active disability community in Connecticut, however, has been vocal on the need for suicide prevention services for people with disabilities. 

The Plan goes on:

There may be unintended consequences of assisted suicide legislation on people with disabilities. Peace (2012) writes that "Many assume that disability is a fate worse than death. So we admire people with a disability who want to die, and we shake our collective heads in confusion when they want to live.” People with disabilities have a right to responsive suicide prevention services. The CTSAB intends to continue to explore the needs of the disability community for such services. (Emphasis added).

Plan, p. 44.

The Plan concludes with "Targeted Recommendations,"which push back against the idea of rational suicide for people with disabilities:

• Do not "assume" suicide is a "rational" response to disability.

• Treat mental health conditions as aggressively as with a person without disability. (Emphasis added)

Id.

German Jewry applauds defeat of liberalized assisted suicide laws

http://www.jta.org/2015/11/10/news-opinion/world/german-jewry-cheers-defeat-of-liberalized-assisted-suicide-laws

November 10, 2015 6:20am

(JTA) Assisted suicide laws will not be liberalized in Germany, a move that the country's Jewish community had vigorously opposed.

The Bundestag decided not to legalize organizations that promote or offer assisted suicide and to continue barring doctors from offering such assistance as a regular medical service.

Lawmakers instead toughened the national stance against commercialized assisted suicide. Such acts will now be punished with up to three years in jail, even if a doctor claims to have acted to relieve a patient's suffering. The bill was passed on Friday with 360 out of 602 votes, Reuters reported.

Dr. Josef Schuster, president of the Central Council of Jews in Germany, told the Bayerischen Rundfunk broadcasting company that he was "relieved" at the decision on easing assisted suicide laws "after a long, serious, and sometimes emotional debate."

Euthanasia is a particularly sensitive topic in Germany, as an estimated 200,000 people, most of them mentally and physically disabled, were murdered in the Nazi "euthanasia" program, their lives considered "unworthy" by the state.

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

By Margaret Dore, Esq

This is an updated version of an article I wrote three years ago in response to HIV/AIDS groups that had endorsed Ballot Question 2, seeking to legalize assisted suicide in Massachusetts. The ballot question failed, but there is now a similar proposal pending in the Massachusetts legislature (H.1991). I suggest that these groups and persons living with HIV/AIDS give the new proposal a close look. 

1.  "Terminal" does not mean dying. 

H.1991 applies to persons with a "terminal illness," defined in terms of less than six months to live with or without treatment.[1] 

In the 1980's, HIV/AIDS was a death sentence. Today, we have people living with HIV/AIDS, who do well, but who are dependent on treatment to live. Some of these persons are "terminal" under H.1991, i.e., if, without treatment, they "can reasonably be expected to die within 6 months."[2] 

2.  The significance of a terminal label.

Once a person 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, where assisted suicide is legal, "terminal" patients have not only been denied treatment, they have been offered assisted suicide instead. In a 2012 affidavit, Oregon doctor Kenneth Stevens put it this way:

Under the Oregon Health Plan [Medicaid], 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 [two years] median survival with treatment" and fit other criteria. . . . 

All such persons . . .  will . . . be denied treatment. Their suicides under Oregon’s assisted suicide act will be covered."[3]

He also noted that some persons denied treatment as "terminal" would, if treated, in fact have years, even decades, to live. He stated: 

Some of the patients living longer than two years will likely live far longer than two years, as much as five, ten or twenty years depending on the type of cancer. This is because there are always some people who beat the odds.[4] 

Dore Professional Commentary

http://jurist.org/hotline/2015/10/margaret-dore-physician-assisted-suicide.php

California's New Assisted Suicide Law: Whose Choice Will it Be?

JURIST Guest Columnist, Margaret Dore, Esq., MBA

Editor, Maria Coladonato; 

©  WikiMedia (Christopher Padalinski)

California has passed a bill to legalize physician-assisted suicide, which is scheduled to go into effect during 2016. "The End of Life Option Act" was sold as giving patients choice and control at the end of life. The bill, in fact, is about ending the lives of people who are not necessarily dying anytime soon and giving other people the "option" to hurry them along. The bill is a recipe for elder abuse and family trauma. 

New York Daily News: Judge Rules Against Assisted Suicide

http://www.nydailynews.com/new-york/judge-rules-n-y-die-assisted-physician-article-1.2403502

BY Leonard Greene, NEW YORK DAILY NEWS Monday, October 19, 2015, 8:54 PM

A Manhattan judge has denied the dying wish of three New Yorkers who wanted their doctors off the hook if they assisted in their suicides.

Steve Goldenberg, Sara Myers and Eric Seiff, who are all terminally ill, said they want nothing more than to be able to die in peace.

But for that, they said they need a little help, and don’t want their doctors to face any flak.

But state civil judge Joan Kenney said that while she was sympathetic to their plight, their doctors would have to stay on the sidelines.

Kenney said in her ruling that the U.S. Supreme Court has already found that New York state laws prohibit assisted suicide, and the statutes are not in violation of a patients civil rights.

“In New York, as in most states, it is a crime to aid another to commit or attempt suicide,” Kenney said in her ruling. “But patients may refuse lifesaving medical treatment.”

California Killin'

by Paul © -- with apologies to the Mamas and Papas.


Signed by Jerry Brown on an autumn day.

Silencing the lambs, slaughter on the way.

It ain't safe no more; Redding to L.A.

California killin' such a tragic day.

Tennessee Decision Upholding Assisted Suicide Law.

Click here to view the Tennesee Chancery Court decision upholding criminal statute prohibiting assisted suicide, entered yesterday, September 29, 2015.

Judge rules against legalizing assisted suicide in Tennessee

http://www.tennessean.com/story/news/local/davidson%20/2015/09/29/judge-rules-against-tn-assisted-suicide/73048034/

Lucas L. Johnson II, Associated Press, and Stacey Barchenger, The Tennessean6:12 p.m. CDT September 29, 2015

A former Democratic gubernatorial candidate who is terminally ill cannot die by assisted suicide, a judge ruled Tuesday, saying doctors engaging in such a practice are committing "criminal conduct."

John Jay Hooker has terminal cancer and has doctors who have expressed a willingness to prescribe him a lethal dosage of painkillers.

Why California's ABX2-15 Must be Vetoed.

ABX2-15 seeks to legalize physician-assisted suicide and euthanasia in California. The bill is a recipe for elder abuse in which a "qualifying" individual may be legally murdered for the money. For more detail, see this memorandum and its attachments.  

KEY POINTS

1. ABX2-15 applies to people with a "terminal disease," which is defined as having a medical prognosis of less than six months to live. (Memo, p.9). Such persons can, in fact, have years, even decades, to live. The more obvious reasons being misdiagnosis and the fact that predicting life expectancy is not an exact science. (Id., pp. 11-12). Doctors can sometimes be widely wrong. (Id.).

2. In Oregon, which has a nearly identical definition of “terminal disease,” eligible persons include young adults with chronic conditions such as insulin dependent diabetes. (Memo, p. 9-11). Such persons, with appropriate medical care, can have years, even decades, to live. 

3. ABX2-15 allows the patient's heir, who will financially benefit from his/her death, to actively participate in signing the patient up for the lethal dose. (Memo, p. 7). This is an extreme conflict of interest.

4. Once the lethal dose is issued by the pharmacy, there is no oversight. Not even a witness is required when the lethal dose is administered. If the patient protested or even struggled against administration, who would know? (Memo, pp. 8-9).

5. Assisted suicide can be traumatic for family members as well as patients. (Memo., pp. 12-13)

6. If California follows Washington State, the death certificate is required to be falsified to reflect a natural death. (Memo, pp. 16-18). The significance is a lack of transparency and an inability to prosecute for murder even in a case of outright murder for the money. Id. 

California: Contact the Governor now to stop assisted suicide/euthanasia.

Outright Lies to Trusting Legislators Gets California Bill to Governor's Desk.  Tell Jerry Brown to Veto ABX2-15 Now! 

• Call 916-445-2841!
• Fax 916-558-3160 
• Use this form to send an e-mail to Governor Brown:  https://govnews.ca.gov/gov39mail/mail.php  (US Mail will be too slow)

On Friday, September 11th, ABX2-15 passed the Senate just weeks after its initial introduction during a special session called for another purpose. During its short and expedited life, proponents ran roughshod on the facts to induce busy legislators to vote yes. This was evident during the final floor debate in the Senate where proponents repeatedly stated or implied the following, which are not true:

1.  That the bill is limited to people who are actively dying and in pain. The bill doesn't say this anywhere. The bill, instead, applies to people with a "terminal disease" defined as having a prediction of less than six months to live. (Memo, pp.9 -12). Such persons can, in fact, have years, even decades, to live.  (Id.) In Oregon, which has a nearly identical definition, "eligible" persons include young adults with chronic conditions such as insulin dependent diabetes. (Id).

2.  That the bill is "one of the strongest bills regarding patient protections." The bill, however, doesn't even require a witness when the lethal dose is administered.[1] If the patient protested or struggled, who would know?[2] In addition, the bill's various legal "requirements" are not actually "required." This is because participants are merely held to a "good faith" standard.[3] This standard is not defined in the bill, but common meanings include that participants need not comply with legal technicalities when they have honest intent.  See, for example, this legal dictionary definition:

[Good faith means] honest intent to act without taking an unfair advantage over another person or to fufill a promise to act, even when some legal technicality is not fulfilled.  (Emphasis added).[4] 

For these and other reasons, tell Jerry Brown to veto ABX2-15. For more information, see: Dore letter discussing why the Baker amendments did not fix the bill's problems; Dore memo why the financial cost of ABX2-15 could be "enormous"; and a formal memo regarding the bill generally, including "key points," an index, aformal memo and an appendix.

* * *
[1]  See ABX2-15 in its entirety.
[2]  Id.
[3]  ABX2-15, Sections 443.19(d), 443.14(b), 443.14(d)(1) and 443.15(c).
[4]  "Hill" citation at http://legal-dictionary.thefreedictionary.com/good+faith

Governor Brown must veto assisted suicide legislation.

FOR IMMEDIATE RELEASE                                                                                           
September 11, 2015        

Contact: Margaret Dore
206-697-1217

Sacramento, CA -- In light of today's final passage of assisted suicide legislation by the California State Senate, a national expert on assisted suicide and euthanasia made the following comments. 

"The legislation passed today is a wolf in sheep's clothing," said Margaret Dore, president of Choice is an Illusion, regarding ABX2-15, which seeks to legalize physician-assisted suicide (and euthanasia) in California. "The bill is deceptively written to make it look as if there are substantial patient protections; there are not. The bill is sold as giving people choice and control at the end of life: Instead, it's stacked against the patient and applies to people with years, even decades, to live."

"In my law practice, I started out working in guardianships, wills and probate, and saw abuse of all kinds, especially where there was money involved (where there's a will, there are heirs)," Dore explained. "ABX2-15 sets up the perfect crime: your heir can actively participate in signing you up for the lethal dose and once the lethal dose is in the home, there's no oversight --not even a witness is required. If you resisted or even struggled, who would know?"

Dore concluded, "The ball is now in the governor's court to protect the people of California by vetoing ABX2-15. As a lawyer and a former attorney general, Jerry Brown has the expertise to see the bill for what it really is.  He has all the right reasons to veto this deceptive and unsafe legislation.

For documentation, see www.choiceillusion.org and www.californiaagainstassistedsuicide.org

California Assisted Suicide Bill Narrowly Passes Assembly.

NEWS RELEASE

For the original print version, please click here.

FOR IMMEDIATE RELEASE
September 9, 2015

Contact: Margaret Dore
206-697-1217

Sacramento, CA – In light of today’s narrow passage of assisted suicide legislation by the California State Assembly, a national expert on assisted suicide and euthanasia points out a fundamental flaw with today’s floor debate.

“The assemblymembers didn’t focus on the bill’s language,” said Margaret Dore, president of Choice is an Illusion, regarding ABX2-15, which is modeled on similar laws in Oregon and Washington State.  "The bill is sold as giving people choice and control at the end of life. Yet the bill’s language is stacked against the patient and applies to people with years, even decades, to live.”

No on ABX2-15: Voices Against Assisted-Suicide!

1. Carolyn McMurray:"Not everyone has family members to protect them."

2.  Will Johnston, MD, "[My] young adult patient became actively suicidal after watching a Brittany Maynard video.”

3.   Oregon doctor, Kenneth Stevens, MD, "Vote against ABX2-15, in order to save people’s lives!"

4. Margaret Dore, Esq., MBA (“Legal assisted-suicide can be traumatic for patients and tear families apart”).

5. Kate Kelly (“Doctors are already abusing the power they have").

6. Elizabeth Poiana (“Older people are no longer valued”)

Carolyn McMurray:"Not everyone has family members to protect them."

Dear Assemblymembers:

My husband and I recently moved from Vermont because we fear growing old in a state with legal assisted suicide.

Will Johnston, MD: "[My] young adult patient became actively suicidal after watching a Brittany Maynard video.”

Dear Assemblymembers:

I am a doctor whose young adult patient became actively suicidal after watching a  Brittany Maynard video.

I urge you to vote against legalizing assisted suicide so as to not encourage other young adults to seek this path.  

In the first week of December 2014, a mother brought in her twenty year old son for an emergency appointment.  She had told me that he had been acting oddly and talking about death.

Oregon Doctor Kenneth Stevens: "Vote against ABX2-15, in order to save people’s lives.”

Dear Assemblymembers:

I have been a cancer doctor in Oregon for 49 years.  I am opposed to legalized assisted suicide.

It encourages people to prematurely throw away their lives. The California bill ABX-15 is modeled after the Oregon law. It applies to people predicted to have less than six months to live.  That does not necessarily mean that they are dying.

Fifteen years ago I had a patient with inoperable anal cancer who wanted assisted suicide for herself, and who was refusing radiation and chemotherapy.  Because she was refusing treatment she was eligible for assisted suicide.  I encouraged her to be treated, which she later agreed to, and now she is very alive and happy 15 years later.

Dore: "Legal assisted-suicide can be traumatic for patients and tear families apart”

Dear Assemblymembers:

I am a lawyer in Washington State where assisted-suicide is legal. Our law is similar to a law in Oregon. Both laws are similar to ABX2-15, scheduled for hearing tomorrow.

I had two clients whose fathers signed up for assisted-suicide. In the first case, one side of the family wanted the father to take the lethal dose, while the other did not. The father spent the last months of his life caught in the middle and traumatized over whether or not he should kill himself. My client, his adult daughter, was also traumatized. The father did not take the lethal dose and died a natural death.

In the other case, it's not clear that administration of the lethal dose was voluntary. A man who was present told my client that the client’s father refused to take the lethal dose when it was delivered (“You’re not killing me. I’m going to bed”), but then he took it the next night when he was high on alcohol.

Legal assisted-suicide can be traumatic for patients and tear families apart.

Kate Kelly: “Doctors are already abusing the power they have."

Dear Assemblymembers:

Please vote "No"on ABX2-15 (assisted suicide/euthanasia). Doctors are already abusing the power they have.  This bill, which will give doctors even more power to medically kill patients, can only make a bad situation worse.

In 2009, my mother died after a young doctor encouraged my brother, who held power of attorney, to begin “comfort care.”  My mother, who was NOT DYING, had had a mild stroke.  She had been trying to speak and had indicated that she would like some water.  Instead, on the order of this doctor, she was medically killed  (starved and dehydrated, with massive doses of morphine).

In that same year, I published my mother’s story . Since then, I have been contacted by other adult children in the US and Canada whose parents were  involuntarily killed via starvation, dehydration and overdose..

These involuntary deaths of people who were not dying are not isolated incidents.

Elizabeth Poiana to California Assembly: "“Older people are no longer valued.”

Dear Assemblymembers:

I am a college student in Washington State where assisted suicide is legal.

My mother is a caregiver.  I also  work as a caregiver for typically older people.

I am writing to tell you about how older people are now at risk in Washington State, from doctors and hospitals. I will also talk about how attitudes about older people have changed for the worse.  This is especially true since our assisted-suicide law was passed in 2008.

Updated California Materials Against ABX2-15

To view new materials against ABX2-15, seeking to legalize physician-assisted suicide, click here.

If the document is "too big," click here and here for the memo and its appendix as separate documents.

Overview 

ABX2-15, the “End of Life Option Act,” seeking to legalize physician-assisted suicide in California is a recipe for elder abuse.  The bill is not limited to people who are dying.  Indeed, “eligible” persons can have years, even decades, to live.

In Oregon, which has a similar law, that state’s Medicaid program uses coverage incentives to steer people to suicide.  If ABX2-15 is enacted, California’s Medicaid program, as well as private insurers, will be able to engage in this same conduct.  Do you want this to happen to you or your family?

The bill has a myriad of other problems.  Please vote “No” on ABX2-15.

Prosecutor Press Release on FEN Sentencing in Minnesota; Charges Still Pending.

Final Exit Network, Inc. Sentenced in Assisting with Suicide.

8/24/15 

Dakota County Attorney James Backstrom announced that Final Exit Network, Inc. (FEN) was sentenced today by Judge Christian Wilton to a stay of execution of 21 months in prison (while a corporate entity cannot be sent to prison, under Minnesota law this sanction establishes that the offense is a felony) and 15 years of probation, and ordered to pay a fine of $30,000 and approximately $3,000 in restitution in connection with assisting Doreen Dunn in committing suicide on May 30, 2007, at her home in Apple Valley.  FEN will remain on probation until the fine and restitution is paid.  On May 14, 2015, a Dakota County Jury found Final Exit Network, Inc. guilty of Assisting Another to Commit Suicide and Interference with a Dead Body or Death Scene.

Additional facts pertaining to this case can be found online at: Criminal Complaint Search.  To view prior news releases, go to: Attorney News Releases.

Final Exit Network Receives Maximum Sentence for Assisting Suicide

http://www.startribune.com/final-exit-network-fined-30-000-for-assisting-apple-valley-woman-s-suicide/322700141/

A Dakota County judge on Monday ordered Final Exit Network, a national right-to-die group, to pay a $30,000 fine and nearly $3,000 in funeral costs for assisting an Apple Valley woman’s 2007 suicide.

The sentence was the maximum Judge Christian S. Wilton could impose on the corporation for assisting a suicide.