Connecticut: Dore Letter and Memo to Committee

Dear Committee Members:

I am a Democrat and a lawyer in Washington State where assisted suicide is legal.  Our law is modeled on a similar law in Oregon.  Both laws are similar to H.B. No. 5326.

Below are highlights to a memo I wrote, providing a legal analysis of  H.B. No. 5326.  To view the memo, please click here.

1.  H.B. No. 5326 is a recipe for elder abuse

• "Financial considerations [are] an all too common motivation for killing someone." (memo, page 7)
• Your heir, who will financially benefit from your death, is allowed to act as a witness on the lethal dose request form.  See  H.B. No. 5326, Section 3 (allowing one of two witnesses to be an heir)
• There is a complete lack of oversight once the lethal dose is issued by the pharmacy.  Not even a witness is required.  Even if you struggled, who would know?

2.  H.B. No. 5326 encourages people to throw away their lives.

•  H.B. No. 5326 applies to patients with a "terminal illness," which is defined in terms of a doctor's prediction of less than six months to live. (memo, pages 4-5).
•  In Oregon, a similar definition is being interpreted to include people with chronic conditions such as diabetes.  (Id.)
• The six months to live is determined without treatment.  Consider, for example, my friend, Jeanette Hall, who had cancer and who was adamant that she would "do" Oregon's law.  Her doctor convinced her to be treated instead.  She is thrilled to be alive today, nearly 14 years later.  (memo, pages 5-6)

3.  H.B. No. 5326 will allow health care providers and insurers to steer people to suicide

• In Oregon, the Oregon Health Plan steers patients to assisted suicide. (Memo pages 17-20).  See also the affidavit of Oregon doctor Ken Stevens, in the appendix at A-24, which is also attached here:  http://maasdocuments.files.wordpress.com/2012/09/signed-stevens-aff-9-18-12.pdf
• See also this letter by Kathryn Judson (describing how she overheard a doctor pitching assisted suicide to her husband)  http://www.choiceillusion.org/2013/12/i-was-afraid-to-leave-my-husband-alone.html
• Do you want this to happen to you or your family?

4.  I have had two clients whose fathers signed up for the lethal dose. 

• In the first case, one side of the family wanted the father to take the lethal dose, while the other did not.  He  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.  (Memo, page 22)
• 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 father refused to take the lethal dose when it was  delivered (?You?re not killing me.  I?m going to bed?), but then took it the next night when he was high on alcohol.  The man who told this to my client later recanted.  My client did not want to pursue the matter further. (Memo, pages 22-3)
• Do you want this to happen to you or your family?

5.  Two weeks ago, a similar bill was defeated by a 3 to 1 margin

•  On March 6, 2014, the New Hampshire House, which is controlled by the Democrats, defeated a bill similar to H.B. No. 5326.  
• The vote was 219 to 66. 
•  Please click here. 

I urge you to not make Washington's mistake.

Please vote No on H.B. 5326.

Thank you.

Margaret Dore
Law Offices of Margaret K. Dore, P.S.
www.margaretdore.com
www.choiceillusion.org
1001 4th Avenue, 44th Floor
Seattle, WA  98154
206 389 1754 main reception line
206 389 1562 direct line

Live Free or Die! New Hampshire Obliterates Oregon-Style Death with Dignity Act!

Today, the New Hampshire House of Representatives defeated HB 1325. The bill had sought to enact an Oregon-style assisted suicide law in New Hampshire. The bipartisan vote was an overwhelming 219 to 66.

To view a short testimony against the bill, click here.

New Hampshire: Pro-Assisted Suicide Bills Go Down in Flames!

Today, HB 1216, which sought to decriminalize soliciting a suicide, and HB 1292, creating an affirmative defense for a person who causes or aids another in committing suicide, went down in flames!  The votes were 259 to 45 and 232 to 59, respectively.

"Older people are no longer valued as they were before."

http://www.nhregister.com/opinion/20140304/letters-to-the-editor-time-to-rethink-who-our-leaders-are (second letter)

Dear Editor:  

I am a high school student in Washington state, where assisted suicide is legal. I want to become a doctor. My mother is a caregiver. Sometimes, I help her with her clients.

I am writing to tell you about how older people are at risk in Washington, 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.

I grew up in an adult family home. An adult family home is a small elder care facility located in a residential home. The caregivers live in the home with the clients.

My parents and two of my brothers lived in the home. With the clients there, it was like having six grandparents at once. It was a very happy environment.

This was true for the clients, too, no matter what their condition was or how long they had to live. My mom could make them happy even when they were dying. The clients’ family members were supportive and seemed happy, too, and never suggested that one of the clients should die.

Today, in 2014, we no longer live in an adult family home. My mother is a caregiver for private clients. She also now fears for her clients, especially in the hospital. She is afraid that the hospital will begin “comfort care” (that’s morphine) and her patient will suddenly die. This has already happened. She tries to never leave her patients alone in the hospital. Either she or a family member will be there.

She has also had one client where a family member wanted the client to do the assisted-suicide.

In short, older people are no longer valued as they were before.

I hope that you will not follow our path.

— Elizabeth Poianna 

The High Financial Cost of (Regular) Suicides.

Dear New Hampshire House Members:

I am an attorney in Washington State where physician-assisted suicide is legal.  Our law is based on a similar law in Oregon.  I previously sent you materials, which can be viewed here

I write to discuss another factor for your consideration: Government reports from Oregon, showing a positive correlation between the legalization of physician-assisted suicide and an increase in other (regular) suicides. Of course, a statistical correlation does not prove causation.  The statistical correlation described herein, is, however, consistent with a suicide contagion (legalizing and thereby normalizing one type of suicide encouraged other suicides).  Please consider the following.

Oregon's assisted suicide act went into effect in 1997.  See top line at this link: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx

By 2000, Oregon's regular suicide rate was "increasing significantly"  See second paragraph, http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf ("After decreasing in the 1990s, suicide rates have been increasing significantly since 2000"). 

By 2007, Oregon's other (regular) suicide rate was 35% above the national average. See second page at "A-57) http://maasdocuments.files.wordpress.com/2013/02/oregon-suicide-info_001.pdf

In 2010, the most recent report, Oregon's other (regular) suicide rate was 41% above the national average. http://choiceisanillusion.files.wordpress.com/2014/02/oregon-suicide-report-2012-through-2010-pdf.pdf  Moreover and per this report, the financial cost of these other (regular) suicides is huge.  The report, page 3, elaborates:

In 2010, there were 685 Oregonians who died by suicide and more than 2,000 hospitalizations due to suicide attempts.  Suicide is the second leading cause of death among Oregonians ages 15-34, and the 8th leading cause of death among all ages in Oregon.  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.  The loss to families and communities broadens the impact of each death.  (Footnotes omitted).

Oregon is the only state where there has been legalization of physician-assisted suicide long enough to have valid statistics showing this positive statistical correlation between assisted suicide legalization and other (regular) suicides.

The enormous cost of increased (regular) suicides in Oregon, positively correlated to physician-assisted suicide legalization, is a significant factor for the House to consider in its vote on HB 1325, which seeks to legalize physician-assisted suicide.

For this and other reasons, I urge you to vote No in HB 1325.

Thank you.

Margaret Dore, Esq., MBA, President
Law Offices of Margaret K. Dore, P.S.
Choice is an Illusion, a nonprofit corporation
www.margaretdore.com
www.choiceillusion.org
1001 4th Avenue, 44th Floor
Seattle, WA  98154
206 389 1754 main line
206 389 1562 direct line

"I hope that Connecticut does not repeat Oregon's mistake."

http://www.journalinquirer.com/opinion/letters_to_the_editor/march-letters/article_ccb4e384-a2bb-11e3-b9c8-001a4bcf887a.html (second letter)

I have been a professor of family medicine and a practicing physician in Oregon for more than 30 years. I write to provide some insight on the issue of assisted suicide, which is legal in Oregon, and which has been proposed for legalization in Connecticut (raised bill No. 5326).

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 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.

This illustrates a great problem with our law — it encourages people with years to live, to throw away their lives.

I am also concerned that by starting to label people with chronic conditions “terminal,” there will be an excuse to deny such persons appropriate medical treatment to allow them to continue to live healthy and productive lives.

These factors are something for your legislators to consider. Do you want this to happen to you or your family? Furthermore, in my practice I have had many patients ask about assisted-suicide. In each case, I have offered care and treatment but declined to provide assisted suicide. In one case, the man’s response was “Thank you.”

To read a commentary on the most recent Oregon government assisted-suicide report, which lists chronic conditions as the “underlying illness” justifying assisted suicide, please go here:  http://www.noassistedsuicideconnecticut.org/2014/02/oregons-new-assisted-suicide-report.html

To read about some of my cases in Oregon, please go here:  http://www.choiceillusion.org/p/what-people-mean_25.html

I hope that Connecticut does not repeat Oregon’s mistake.

William L. Toffler
Portland, Ore.

Don’t make Oregon’s mistake

http://www.journalinquirer.com/opinion/letters_to_the_editor/march-letters/article_ea92adaa-a38d-11e3-9790-001a4bcf887a.html (last letter)

I am a doctor in Oregon, where physician assisted-suicide is legal. I understand that Connecticut’s legislature is considering taking a similar step.

I was first exposed to this issue in 1982, shortly before my first wife died of cancer. We had just visited her doctor. As we were leaving, he had suggested that she overdose herself on medication. I still remember the look of horror on her face. She said, “Ken, he wants me to kill myself.”

Our assisted-suicide law was passed in 1997. In 2000, one of my patients was adamant she would use our law. Over three or four visits, I stalled her and ultimately convinced her to be treated instead. Nearly 14 years later she is thrilled to be alive.

In Oregon, the combination of assisted-suicide legalization and prioritized medical care based on prognosis has created a danger for my patients on the Oregon Health Plan (Medicaid). Helpful treatments are often not covered. The plan will cover the patient’s suicide.

For more details, read my affidavit filed on behalf of the Canadian government at http://maasdocuments.files.wordpress.com/2012/09/signed-stevens-aff-9-18-12.pdf

Protect your health care. Tell your legislators to vote no on assisted suicide. Don’t make Oregon’s mistake.

Kenneth Stevens

Sherwood, Ore.

Sign the Petition

http://ireneogrizek.ca/2014/02/26/14654/

Assisted Suicide: Sign the Petition

By Irene Ogrizek on February 26, 2014

Citizens of all countries are free to sign this petition. My politics, for the record, are left and centrist. I believe in a view of society that is not simply utilitarian: every sentient life deserves our protection and care. My focus is not religious or moral — I am not religious — it is about the risk assisted suicide poses for the disabled and the elderly. 

When it comes to assisted suicide, I am a conscientious objector. Like those who oppose war, I oppose killing, even when it’s ‘mercy killing’. This is because I feel that mercy, like beauty, is in the eye of the beholder. Vulnerable individuals in our healthcare system may die prematurely — if we stop valuing their lives, we send the wrong message to policy-makers and healthcare workers.

Please click here to sign.

It almost happened to my mother. It is now 2014 and she is still alive, even though we were strongly urged to ‘let her go’ in 2008. After going public with our hospital experience and speaking to other Canadian families, I discovered we were not alone. The elderly in Canada (and the U.K. and U.S.) are often hastened toward death, even when they are not terminally ill. I have spoken to many family members who believe this has happened to a parent or grandparent. 

Our Canadian government and national media outlets are not allowing for a full discussion of all the risks of assisted suicide. Attempts to do so have been discouraged and our arguments are not reaching the wider public. Even our nation’s broadcaster, the CBC, is unwilling to be impartial. It seems a concerted effort is being made to ‘manufacture consent’ in favour of assisted suicide.

A frank discussion about its risks is in order. 

Allowing our nation’s healthcare workers — physicians and nurses — to euthanize patients endangers all of us. And so I am a conscientious objector: I do not want a system that endangers my life and the lives of others. Canada is a first world nation and we have the resources to manage illnesses humanely. Patients have the right to refuse treatment or to ask for terminal sedation; good options already exist. 

I’m not sure what actions will follow from this petition, but objecting is a start. We need to get talking.

Concerns about assisted suicide include hiding malpractice and "lazy doctoring."

http://helenair.com/news/opinion/readers_alley/against-physician-assisted-suicide/article_7b17e3b6-9b57-11e3-ab51-001a4bcf887a.html

I am a general medical practitioner, with 30 years experience. I was glad to see that Montanans Against Assisted Suicide has decided to appeal its case with the Montana Medical Examiner Board to the Montana Supreme Court. My hope is that the appeal will end the controversy about assisted suicide possibly being legal in Montana.

My concerns about legalizing assisted suicide include that it will encourage "lazy doctoring." I say this because it is easier for a doctor to write a prescription (to end the patient's life,) as opposed to doing the sometimes hard work of figuring out what is wrong with a patient and providing treatment. I am also concerned that legalization will give bad doctors the opportunity to hide malpractice by convincing a patient to take his or her life.

The American Medical Association, Ethics Opinion No. 2.211, states: "Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks."

I agree with this statement. Allowing legalization of physician-assisted suicide in Montana will compromise and corrupt my profession. Legalization will also put the lives and well-being of my patients at risk.

Carley C. Robertson, MD
Havre MT

New Swiss Study Misses the Obvious: Wealthy Older People May Have been Targeted for Their Money.

"How sharper than a serpent's tooth it is
To have a thankless child!"

- William Shakespeare
King Lear Act 1, Scene 4

Below is post from Medical Xpress, regarding a new study finding that people from wealthier areas are more likely to die from assisted suicide.  The post also says:  "Having children was associated with a lower risk of assisted suicide in younger people, although not in older people."  The "inheritance factor" is completely overlooked.

More educated people from wealthier areas, women, more likely to die from assisted suicide

http://medicalxpress.com/news/2014-02-people-wealthier-areas-women-die.html

Researchers in Switzerland, where assisted suicide is legal, have conducted a study – published online in the International Journal of Epidemiology today – that shows assisted suicide is more common in women, the divorced, those living alone, the more educated, those with no religious affiliation, and those from wealthier areas.

While euthanasia is prohibited in Switzerland, the penal code states that assisted suicide is legal if no selfish interests are involved. Assisted suicides in Switzerland involve volunteers working for "right-to-die" associations. The role of physicians is restricted to assessing the decisional capacity of the person requesting assistance and to prescribing the lethal drug. Notably, the person requesting assistance does not need to have a terminal illness.

In this study Professor Matthias Egger and colleagues at the University of Bern linked data from three right-to-die organisations to the Swiss national Cohort, a longitudinal study of mortality based on linkage of census and mortality records. The study followed those aged 25 to 94 from 1 January 2003 until their death, emigration, or the end of the study: a total of 5,004,403 people. Anonymous data on 1,301 cases of assisted suicide between 2003 and 2008 were provided by the three right-to-die organisations.

Study findings showed assisted suicide was more common in women than men, in people with secondary or tertiary rather than compulsory education, in those living alone, and in those with no religious affiliation. The rate was also higher in urban compared to rural areas, in wealthier neighbourhoods, and in the French rather than German or Italian speaking areas of the country. Having children was associated with a lower risk of assisted suicide in younger people, although not in older people.

In 84% of cases the death certificates listed at least one underlying cause of death. In the age group 25-64 years the majority had cancer ( 57%), followed by diseases of the nervous system (21%). Eleven individuals had a mood disorder listed as the first underlying cause, and three had another mental or behavioural disorder. For all causes, except Parkinson's disease, the percentage of assisted suicides was higher in women than men. In the 65-94 years age group, cancer was again the most common underlying cause (41%), followed by circulatory (15%) and diseases of the nervous system (11%). Thirty people had a mood disorder, and six had another mental or behavioural disorder.

Dr Egger says, "Our study is relevant to the debate on a possibly disproportionate number of assisted suicides among vulnerable groups. The higher rates among the better educated and those living in neighbourhoods of higher socio-economic standing does not support the 'slippery slope' argument but might reflect inequities in access to assisted suicide. On the other hand, we found a higher rate among people living alone and the divorced. Social isolation and loneliness are well known risk factors for non-assisted suicides and our results suggest that they may also play a role in assisted suicide. Also, the observation that women die more frequently by assisted suicide than men is potentially of concern. Interestingly, though, studies from the Netherlands and Oregon in the USA reported more men than women among assisted deaths."

16% of death certificates did not register an underlying cause. A previous study of suicides by two right-to-die organizations showed that 25% of those assisted had no fatal illness, instead citing "weariness of life" as a factor. In 2013 the European Court of Human Rights asked Switzerland to clarify whether and under what conditions individuals not suffering from terminal illnesses should have access to help in ending their lives, suggesting that Switzerland should more precisely regulate assisted dying.

Dr Egger says: "We believe that such new regulation should mandate the anonymous registration of assisted suicides in a dedicated database, including data on patient characteristics and underlying causes, so that suicides assisted by right-to-die associations can be monitored."

Explore further: Swiss groups fear study undercuts assisted suicide

More information: 'Suicide assisted by Right-to-Die Associations: Population based cohort study' by Nicole Steck, Christoph Junker, Maud Maessen, Thomas Reisch, Marcel Zwahelen, and Matthias Egger, International Journal of Epidemiology, DOI: 10.1093/ije/dyu010

Journal reference: International Journal of Epidemiology

Margaret Dore writes the New Hampshire Judiciary Committee: Vote "No" on HB 1325

Madame Chair and Members of the Committee,

During the recent hearing on assisted suicide, I mentioned that there had been a significant increase in other suicides in Oregon after assisted suicide legalization.  This is consistent with a suicide contagion (legalizing and thereby normalizing one type of suicide encouraged other suicides). 

Of course, a correlation does not prove causation. 

However, as set forth below, there is a significant statistical correlation between the two events.  Moreover, the financial cost to Oregon from the other suicides is enormous.  Please see the data below:

Oregon's assisted suicide act went into effect in 1997. See top line at this link: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx

By 2000, Oregon's regular suicide rate was "increasing significantly"  See http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf ("After decreasing in the 1990s, suicide rates have been increasing significantly since 2000")

In 2010, Oregon's other suicide rate was 35% above the national average.  http://maasdocuments.files.wordpress.com/2013/02/oregon-suicide-info_001.pdf

In 2012, the most recent report, Oregon's other suicide rate was 41% above the national average.  http://choiceisanillusion.files.wordpress.com/2014/02/oregon-suicide-report-2012-through-2010-pdf.pdf  Moreover, this report, page 3, states:

"Suicide is the second leading cause of death among Oregonians ages 15-34, and the 8th leading cause of death among all ages in Oregon.  The cost of suicide is enormous.  In 2010 alone, self-inflicted injury hospitalization changes exceeded 41 million dollars; and the estimate of total lifetime cost of suicide in Oregon was over 680 million dollars.  The loss to families and communities broadens the impact of each death."

The report, itself, does not address the possible influence of assisted suicide legalization.  But, again, the significant statistical correlation is there.  The cost to the state is enormous.

Please feel free to contact me for any further information.

Thank you.

Margaret Dore
Law Offices of Margaret K. Dore, P.S.
www.margaretdore.com
www.choiceillusion.org
1001 4th Avenue, 44th Floor
Seattle, WA  98154
206 389 1754 main line