Washington Post Puts the Spotlight on Hospice/Palliative Care Abuse

By Margaret Dore, Esq., MBA

Choice is an Illusion, President

Below and finally, a comprehensive article in a major paper describing what a lot of us know already, that non-consenting, non-dying people are being killed with morphine and other drugs under the guise of hospice/palliative care.  The article, excerpted below from the Washington Post, describes cases in the US. There are similar cases in Canada and the UK (e.g, the former "Liverpool Pathway").

There are a myriad of reasons why these cases occur, including mistakes and negligence, which is described in the Post article.  The wishes of heirs interested in a speedy inheritance and/or to get dad out of the way before he changes his will, can also be at play.  For a particularly egregious example, see William Dotinga, "Grim Complaint Against Kaiser Hospital," at http://www.courthousenews.com/2012/02/06/43641.htm

With hospice, eligibility is determined by a prediction of less than six months to live.  This is the same eligibility cutoff used for legal assisted suicide in Oregon and Washington State.  This is, however, just a prediction and there are many people deemed eligible who live longer than that and/or who are not dying.  See, e.g., the Washington Post article excerpted below and this article from the Seattle Weekly: "Terminal Uncertainty."  See also this affidavit from Oregon doctor Kenneth Stevens, MD and this affidavit from John Norton.

This hospice/palliative care abuse issue is important for itself, as well, as for its implications in the larger debate over assisted suicide/euthanasia legalization.  Consider, for example, the letter below from Washington State.  The author, the owner of a care facility, describes how since passage of Washington's assisted suicide law, doctors more readily resort to morphine, sometimes without consent.  He states:

Since [Washington's assisted suicide law] passed, we have . . .  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. http://www.choiceillusion.org/2013/12/it-wasnt-father-saying-that-he-wanted.html

He also describes a general devaluation of older people, as follows:

Since our [assisted suicide] law was passed, 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.  (Id.).

He concludes by asking readers to not make Washington's mistake of legalizing assisted suicide. He states:

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. Don't make our mistake.  (Id.).

* * *
Below, the excerpt from the Washington Post article.

As More Hospices Enroll Patients who Aren't Dying, Questions About Lethal Doses Arise

http://www.washingtonpost.com/news/storyline/wp/2014/08/21/as-more-hospices-enroll-patients-who-arent-dying-questions-about-lethal-doses-arise/?

By Peter Whoriskey at peter.whoriskey@washpost.com

Mother was deprived of choice to live; assisted suicide would lead to more patient abuse

http://ravallirepublic.com/news/opinion/mailbag/article_09c08760-817c-571a-ada1-d42a0e2a3450.html?comment_form=true

August 18, 2014 6:15 am  

The letter by Gail Bell rang true to my own experience (“Mother’s death provided painful, personal example of need to stop assisted suicide,” Aug. 5).

In 2009, my mother died a painful death. It wasn’t from her condition or a disease. You see, my mother was starved and dehydrated to death with massive doses of morphine after she’d had a mild stroke. It had not mattered that she had been trying to speak and had indicated that she wanted water. The family member holding power of attorney, affirmed by a young doctor, had decided that it was time for her to die.

I watched my mother die, day and night for six days. She tried to fight, to wake up, but to no avail, and she suffered. To use the vernacular of assisted suicide proponents, she did not get her choice.

If these terrible deaths happen when aid in dying (assisted suicide and euthanasia) is not legal, what will happen if these practices are made legal? Doctors will have even more power to take away patient choice. If we can’t stop the abuse now, how will we be able to stop the abuse then?

In 2009, I first published my mother’s story, which can be viewed here www.choiceillusion.org/p/mild-stroke-led-to-mothers-forced.html.

I have since been contacted by adult children in both the U.S. and Canada whose parents were involuntarily starved and dehydrated to death. I hope that this practice can be stopped before it is too late. I offer my heartfelt condolences to Gail Bell.

Kate Kelly,
Delta, British Columbia, Canada

Minnesota prosecutors try to prove man's online chats assisted in suicides of depressed people

http://www.startribune.com/local/270494691.htm

By Associated Press, Updated: August 8, 2014 - 2:20 PM

Nadia Kajouji,

FARIBAULT, Minn. — Prosecutors in Minnesota argued Friday that a former nurse should be convicted of assisting suicide for sending emails and other online communications in which he urged two people to kill themselves and gave them information on how to do it.

William Melchert-Dinkel, 52, of Faribault, was back in court more than three years after he was convicted of encouraging suicides. The Minnesota Supreme Court earlier this year reversed those convictions, saying the state's law against encouraging or advising suicides was too broad.

The high court however upheld part of the law that makes it a crime to assist someone's suicide, and attorneys for both sides returned to Rice County District Court to argue over whether Melchert-Dinkel's conduct qualified.

Melchert-Dinkel was originally convicted in 2011 in the deaths of Nadia Kajouji, 18, of Brampton, Ontario, and Mark Drybrough, 32, of Coventry, England. Kajouji jumped into an icy river in 2008 and Drybrough hanged himself in 2005.

Evidence at that trial showed Melchert-Dinkel was obsessed with suicide and sought out depressed people online, posing as a suicidal female nurse, faking compassion and offering detailed instructions on how they could kill themselves. Police said he told them he did it for "the thrill of the chase."

Montana's Law Protected Me

Lucinda Hardy

I [Lucinda Hardy] have read the guest column, "People living with disabilities support death with dignity" (July 25), which advocates for legalizing assisted suicide and/or euthanasia for the disabled. I could be described as such a person and this opinion does not speak for me. I am strongly against legalizing these practices.

When I was in high school, I was on track to get a basketball scholarship to college. And then, I was in a car accident. The accident left me in a wheelchair, a quadriplegic. In addition to my paralysis, I had other difficulties. Over the next two or three years, I gave serious thought to suicide. And I had the means to do it, but both times I got close, I stopped myself.

Others Dictated For Her

http://missoulian.com/news/opinion/mailbag/mother-s-death-provided-painful-personal-example-of-need-to/article_3c8a1d98-1a9c-11e4-bb8e-001a4bcf887a.html

The July 25 guest column by Sara Myers and Dustin Hankinson begins with a discussion of pain, “great pain,” specifically. The paragraph goes on to use the phrase “great pain” to justify “death with dignity,” meaning assisted suicide and euthanasia.

With their column, I couldn’t help but think of my mother’s last years and the decision of others that it was time for her to die. Pain was used as a justification for increases in her medication – to get the job done. This happened three times before she finally died in the hospital on Sept. 6, 2010. The coroner’s report, case No. 100906, lists the cause of death as congestive heart failure with oxygen deprivation and “fentanyl therapy.” The manner of death is listed as “accident.”

Fentanyl is reported “to be 80 to 200 times as potent as morphine.” It’s also well known that fentanyl patch problems cause overdoses, injuries and deaths. See www.aboutlawsuits.com/fentanyl-patch-problems-continue-overdose-deaths-55136. A 100 mcg/hour fentanyl patch has a range within 24 hours of 1.9-3.8 ng/mL. Mom’s death result was 2.7 ng/mL on/or about 48 hours.

A complaint was filed by me with the Montana Board of Medical Examiners, No. 2012-069-MED. The screening panel dismissed the complaint with prejudice, which means that the board may not consider the complaint in the future.

Since then, I have talked with other people who have had similar experiences involving the death of a family member via a medical overdose. Please see here: http://www.choiceillusionmontana.org/2013/04/dont-give-doctors-more-power-to-abuse.html

The column by Myers and Hankinson states, “I believe one should have control of one’s life including its ending.“

I agree with that statement. However, my mother did not have that control. Others dictated for her. Please rethink legalizing assisted suicide and euthanasia so that we do not give others even more power to kill.

Gail Bell,
Bozeman

Vermont: Repeal physician-assisted suicide, now

http://www.burlingtonfreepress.com/story/opinion/comment-debate/2014/07/30/repeal-physician-assisted-suicide-now/13334997/

I'm confused. Years ago we did away with the death penalty in Vermont (and rightly so) because we understood that despite the care and precision of our legal system, mistakes could be made and an innocent person could be wrongly put to death. The Legislature wasn't willing to take that chance and so abolished the death penalty.

Now we have Act 39 (physician-assisted suicide), another law whose only purpose is to result in the death of one of our citizens. Yet this law, with shockingly few protections and no oversight at all by our judicial system, passed the Legislature.

What is the difference here? A wrongful death is a wrongful death is a wrongful death.

Does the Legislature honestly believe our health care system is so perfect that there is absolutely no chance for error? It doesn't appear so since the Legislature is spending almost all their time trying to reform health care. That doesn't leave me feeling confident that the system is working 100 percent perfectly.

So, if the death penalty is wrong because an innocent person might die, why does the Legislature magically believe that no one will ever wrongfully die under Act 39?

Physician-assisted suicide is just as bad a law as the death penalty, and the Legislature needs to repeal it.

Now!

Michele Morin lives in Burlington.

A suggestion that Bishop Tutu confuses assisted suicide with “switching off life support.” If so, perhaps we are to blame.

By Margaret Dore, Esq., MBA*

www.margaretdore.com

www.choiceillusion.org

An assisted suicide bill is coming up for a vote in the UK House of Lords.  The bill, HL Bill 6, is based on similar laws in Oregon and Washington State, USA.

Assisted Suicide and HL Bill 6

HL Bill 6, like the Oregon and Washington laws on which it is based, applies to patients who have been given 6 months or less to live.  Such patients may, in fact, have years to live.  One reason is that doctors’ predictions of life expectancy can be wrong.  See Margaret Dore, “Falconer Assisted Suicide Bill: ‘Eligible’ Patients May Have Years, Even Decades, to Live,” Choice is an Illusion, July 12, 2014.

Bishop Tutu’s Remarks

I don't know Bishop Tutu, but I have seen him speak and I admire him very much.  He has now, however, voiced his support for “assisted dying”, with reference to the death of Nelson Mandela.

According to a New Zealand blog post, Bishop Tutu may be confusing the withdrawal of life support with assisted suicide.  The post says in part:

Interesting that Bishop Tutu now admits publicly that Mandela was indeed on life support and that “prolonging his life was an affront to his dignity”, according to an article on BBC.com.

Switching off life support is, regardless, different from euthanasia and assisted suicide.  When life support is switched off the patient doesn't necessarily die. Consider, for example, this case from Washington State reported in the Seattle Weekly:

[I]nstead of dying as expected, the man slowly began to get better. [Dr. J. Randall Curtis] doesn't know exactly why, but guesses that for that patient, "being off the ventilator was probably better than being on it.  He was more comfortable, less stressed." Curtis says the man lived for at least a year afterwards. 

With assisted suicide and euthanasia, the patient deliberately kills himself or is killed by another person.  See e.g., AMA Code of Medical Ethics, Opinion 2.21 (defining euthanasia).  Moreover, that patient could have had years to live.

The Blame is on us

Perhaps the blame for the confusion should be placed on us and the language of the debate in which both sides have been referring to assisted suicide and euthanasia as “assisted dying.”  Perhaps it’s time for those of us who oppose legalization to call a spade a spade and eliminate the misleading term, “assisted dying” from our vocabulary. Our very lives may depend on it.

*  Margaret Dore is an attorney in Washington State USA where assisted suicide is legal.  She is also President of Choice is an Illusion, a human rights organization opposed to assisted suicide and euthanasia. Her publications include Margaret K. Dore, "''Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009 (regarding Washington's law).  See also Margaret Dore, Quick Facts About Assisted Suicide, at http://www.choiceillusion.org/2013/11/quick-facts-about-assisted-suicide_11.html

UK: Falconer Assisted Suicide Bill: "Eligible" Patients May Have Years, Even Decades, to Live

By Margaret Dore, Esq., MBA

www.margaretdore.com

www.choiceillusion.org

In the UK, HL Bill 6 is an assisted suicide law proposed by Lord Falconer, which is based on the Oregon and Washington assisted suicide laws.  Bill 6 would legalize assisted suicide for persons with a "terminal illness," defined in terms of a prediction of less than six months to live.[1]  The Oregon and Washington laws have a similar six months to live criteria.[2]

Under all three laws, "eligible" patients may have years, even decades, to live.  This is true for the following the following reasons: 

1.      Predictions of life expectancy can be wrong.  

Patients may have years or even decades to live because predicting life expectancy is not an exact science.  Consider John Norton who was diagnosed with ALS.  He was told that he would get progressively worse (be paralyzed) and die in three to five years.  Instead, the disease progression stopped on its own.  In a 2012 affidavit, at age 74, he states:

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.  http://www.massagainstassistedsuicide.org/2012/09/john-norton-cautionary-tale.html [3]

2.      The six months to live is determined without treatment. 

Consider Oregon resident, Jeanette Hall, who was diagnosed with cancer and decided to "do" Oregon's law.  Her doctor, Kenneth Stevens, didn't believe in assisted suicide and encouraged her to be treated instead.  It is now 14 years later and she is "thrilled" to be alive.  This is Dr. Steven's affidavit filed by the Canadian government in Leblanc v. Canada, now dismissed, discussing Jeanette.  http://choiceisanillusion.files.wordpress.com/2013/07/signed-stevens-aff-9-18-12-as-filed.pdf   This is Jeanette's affidavit, also filed by the Canadian government:  http://choiceisanillusion.files.wordpress.com/2013/05/jeanette-hall-affidavit.pdf  

3.      In Oregon, the six months to live criteria is now being interpreted to include chronic conditions such as diabetes.  

Oregon doctor, William Toffler, explains: 

Our law applies to “terminal” patients who are predicted to have less than six months to live. In practice, this idea of terminal has recently become stretched to include people with chronic conditions such as chronic lower respiratory disease and diabetes. Persons with these conditions are considered terminal if they are dependent on their medications, such as insulin, to live. They are unlikely to die in less than six months unless they don’t receive their medications. Such persons, with treatment, could otherwise have years or even decades to live.[4]  

* * *
[1]  See HL Bill 6, Sections 2, at http://services.parliament.uk/bills/2014-15/assisteddying.html (defining "terminal illness" as an "inevitably progressive condition which cannot be reversed by treatment," and for which the patient "is reasonably expected to die in six months.").
[2]  See ORS 127.800 s.1.01(12) and RCW 70.245.010(13) at    http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx and http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245.010  (both stating:  "'Terminal disease' means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.").
[3]  See also:  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? The Seattle Weekly, January 14, 2009 http://choiceisanillusion.files.wordpress.com/2013/10/terminal-uncertainty.pdf and http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty
[4]  Letter from William Toffler, MD, to the New Haven Register, published February 26, 2014, 2^nd letter at http://www.nhregister.com/opinion/20140226/letters-to-the-editor-dying-deserve-right-to-choice  See also, Dore Memo at pp 6-7, at http://choiceisanillusion.files.wordpress.com/2014/06/nj-a2270-legal-analysis_001.pdf and Margaret Dore, “Oregon's new assisted suicide report: chronic conditions;  people with money and more,” February 19, 2014, at http://www.choiceillusion.org/2014/01/oregons-new-assisted-suicide-report.html 

What results from assisted suicide laws

http://www.washingtonpost.com/opinions/what-results-from-assisted-suicide-laws/2014/07/11/2704d612-0768-11e4-9ae6-0519a2bd5dfa_story.html

July 11 at 5:42 PM 

As a former three-term state representative in New Hampshire, I was alarmed to see that Maryland is being urged to adopt an assisted-suicide law similar to those in Oregon and Washington state [" Controlling the end of life, Local Opinions, July 6]. 

Four months ago, the New Hampshire House rejected such a law by a 219 to 66 vote. Many representatives in the Democratic-controlled House initially thought they were for the bill but became uncomfortable when they studied the issue further. 

Contrary to promoting "choice" for older people, assisted-suicide laws are a prescription for abuse. They empower heirs and others to pressure and abuse older people to cut short their lives, especially when they have money. No assisted-suicide bill could correct this huge problem.

Nancy Elliott, Merrimack, N.H.

Washington’s ‘Death with Dignity’ law imperils the poor

http://realchangenews.org/index.php/site/archives/9122

Last week’s article by an assisted suicide/euthanasia advocate struck me as a bizarre article for Real Change, which advocates for the dignity and self-determination of the poor. (“Terminally ill patients face shortage of right-to-die drug amid controversy over capital punishment,” Real Change, June 18)

Washington’s assisted suicide law was passed in 2008 and went into effect in 2009. This was after a deceptive initiative campaign promised us that “only” the patient would be allowed to take the lethal dose. Our law does not say that anywhere. See Margaret K. Dore, “’Death with Dignity,” What Do We Advise Our Clients?,” King County Bar Association, Bar Bulletin, May 2009, available at https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm.

In Oregon, which has a similar law, there are documented cases of that state’s Medicaid program using the law to steer patients to suicide. In other words, indigent patients are offered suicide in lieu of desired treatments to cure or to extend life. The most well-known cases are Barbara Wagner and Randy Stroup.  See: Susan Donaldson James, “Death Drugs Cause Uproar in Oregon,” ABC News, August 6, 2008, at http://abcnews.go.com/Health/story?id=5517492&page=1; and “Letter noting assisted suicide raises questions,” KATU TV, July 30, 2008, at http://www.katu.com/news/specialreports/26119539.html  See also the Affidavit of Kenneth Stevens, MD, filed by the Canadian government in Leblanc v. Canada, available at http://maasdocuments.files.wordpress.com/2012/09/signed-stevens-aff-9-18-12.pdf.

Finally, consider this quote from a March 8, 2012 Jerry Large column in the Seattle Times. He says that at least a couple of his readers suggested euthanasia “if you couldn’t save enough money to see you through your old age.” http://seattletimes.com/text/2017693023.html  For the poor, this would be non-voluntary or involuntary euthanasia. 

So much for the dignity and self-determination of the poor.

Margaret Dore, Esq., MBA *

Seattle

* www.margaretdore.com & www.choiceillusion.org