Montana: Fight Over Assisted Suicide Moves Back to Court

http://billingsgazette.com/news/state-and-regional/montana/fight-over-assisted-suicide-moves-back-to-court/article_7985baad-87a0-592a-b6dd-187073a4c47f.html?print=true&cid=print

Matt Gouras, AP

HELENA — The fight over physician-assisted suicide in Montana is moving back to the courtroom after the Legislature failed this session to clarify that the practice is specifically legal or illegal.

Montanans Against Assisted Suicide is trying to strike the state Board of Medical Examiners' policy that guides doctors in the matter.

A Helena judge has scheduled oral arguments for next month in the case. The lawsuit was filed in December.    Since then, the Montana Legislature failed in efforts to either clarify that the practice is specifically legal or illegal. It was the second straight session where lawmakers couldn't agree on which direction to take the state.

[To view the lawsuit's petition and attachments, click here , here and here]

Supporters of the procedure argue that Montanans should be allowed to decide themselves how to die when facing terminal illness. Opponents argue physician-assisted suicide is a recipe for elder abuse and the government has a responsibility to protect the vulnerable older population.

The procedure has been surrounded by various interpretations since the Supreme Court ruled in 2009 that nothing in state law prohibits physician-assisted suicide - but it did not rule on whether the practice is a constitutionally protected right. The decision said nothing in state law, or precedent, makes the procedure illegal.

A Board of Medical Examiners rule adopted last year says it would consider, on an individual basis, any complaints filed against a doctor for providing "aid-in-dying." Without formal laws guiding the procedure, there are no other state reporting or other requirements and it is unknown how common the practice is.

Montanans Against Assisted Suicide argues in its court case that it believes the Supreme Court never legalized the procedure with its 2009 decision, which it argues is much narrower than others are interpreting it. The group also argues that the board implemented its new rule without sufficient public notice.

The group argues that the board's position on the matter attempts to convince more doctors they will be protected if they assist a patient with suicide, which can be done with a prescription of drugs.

The lawsuit calls the rule "a significant toe in the door to the attempted backdoor legalization of assisted suicide."

The Montana Board of Medical Examiners has said that it wrote its position paper based on a request from a member. The board said its position does not pass judgment on the procedure one way or another.

The board said at the time it put the rule into place that the position paper was neither an administrative rule or a law, but merely informative guidance to its regulated members.

VT: Vote No on S.77 - Do Not be Fooled

Dear Senators:

This letter addresses assisted suicide and the windfall profit issue.  By this, I mean the situation where people pay for health insurance, but don't use it much.  Then, if assisted suicide is legal and they do get sick, the insurer can legally encourage them to kill themselves.  If this occurs, there is financial gravy for the insurer.

In the US, the head of the main group promoting assisted suicide is a former "managed care executive."  See http://www.margaretdore.com/info/coombs_lee_bio_001.pdf   In 2009, she wrote an op-ed defending the Oregon Health Plan after it denied coverage to a patient.  Her op-ed also encouraged readers to support a public policy discouraging patients from seeking cures, presumably by reducing coverage options.  See here:   http://www.margaretdore.com/pdf/Coombs_Lee_against_Wagner.pdf 

Here in Washington State, her group was the leading force in a ballot measure campaign that legalized assisted suicide.  Our law, like the House Version of S.77, contains coercive provisions, which make it less likely that patients will get their choices.  For example, in both laws, there is no oversight when the lethal dose is administered.  Even if the patient struggled, who would know?

To view a short analysis of the House Version of S.77, go here: http://www.choiceillusion.org/2013/04/vote-no-on-s77-legal-analysis.html 

To view a short article about Washington's law, go here:  https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm

Do not be fooled.

Please vote No.

Margaret Dore
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
206 389 1562

Vote NO on S.77, A Legal Analysis

Updated May 8, 2013

Dear Vermont Legislator:

This letter provides a legal analysis of the assisted suicide bill, S.77.  To view my memo containing that analysis, click here.  To view the memo's attachments, which include a copy of S.77, click here.

The memo's main points include:

1.  The bill is not limited to people who are dying.  Some of the people at issue will have years to live.  The bill encourages such persons to throw away their lives.

2.  The claim that the bill will assure patient control is untrue.

3.  There is a complete lack of oversight over administration of the lethal dose, which allows it to be administered without patient consent (and without anyone knowing that administration was without patient consent).

4.  The application process has problems:  (1) an heir who will benefit from death is allowed to talk for the patient during the lethal dose request process; and (2) there is nothing to prevent an heir from procuring the patient's signature under circumstances that would constitute undue influence in the context of a will. 

5.  Legalization will create new paths of elder abuse.  I give the example of Thomas Middleton in Oregon.

6.  Guardians and Conservators will not be able to protect their wards from being pushed to suicide and/or other involuntary death.

7.  Legalization will bring stress, trauma and fear (with examples from Oregon and Washington).

8.  In Washington, where we have now had legal assisted suicide for just four years, we have already had proposals to expand our law to direct euthanasia of non-terminal people.  There has also been the the suggestion that we should employ euthanasia as a solution for people who can't afford their own care, which would be involuntary euthanasia.

9.  Any claim that legalization will end murder-suicide and/or violent suicides is baloney.

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
206 389 1562 direct line 

Vermont: Vote "NO" on S.77

I am a lawyer and a Democrat from Washington State where assisted suicide is legal.  I hope that you will vote "No" on S.77, which seeks to legalize assisted suicide.

 In 2011, I published an article in the Vermont Bar Journal, titled "Physician-Assisted Suicide:  A Recipe for Elder Abuse and the Illusion of Personal Choice."  A copy can be viewed here:   http://choiceisanillusion.files.wordpress.com/2012/12/dore-vermont-bar-journal.pdf   

The flaws that I identified in the above article are present in S.77, with the most obvious being a complete lack of oversight over administration of the lethal dose.  This creates the opportunity for an heir, or someone else who will benefit from the patient's death, to administer the dose to the patient without his consent.  For example, when the patient is asleep (the drugs used are water and alcohol soluble so that they can be injected).

You may also be interested in the following: 

1.  A Legal Analysis

Two years ago, I performed a legal analysis of H.274 and S.103, which are essentially the same bill as the current S.77.  The flaws I identified in my analysis also exist in S.77 although some of the wording and citations are different.  To view that analysis, go here:  http://www.vermontagainstassistedsuicide.org/p/legal-analysis-of-h274-s103.html 

2.  The Thomas Middleton case

This is a case from Oregon in which physician-assisted suicide was part of an elder abuse fraud. See

http://www.montanansagainstassistedsuicide.org/2013/03/physician-assisted-suicide-part-of.html

3.  My cases

In my law practice, I have had two clients whose parents signed up for the lethal dose.

In one case, one side of the family wanted the parent to take the lethal dose while the other did not.  The parent spent the last months of his life traumatized and/or struggling over the decision of whether or not to kill himself.  My client was also traumatized.  The parent did not take the lethal dose and died a natural death.

In the other case, the parent reportedly refused to take the lethal dose at his first suicide party ("I'm going to bed.  You're not killing me") and was high on alcohol the next night when he took the dose at a second party.  The person who told this to my client then recanted, apparently concerned about his own criminal liability.  My client did not want to pursue the matter further.  As a lawyer, I couldn't help but notice that if the parent's much younger wife had divorced him, he would have got the house.  This way, she got everything. 

 

To learn more about our law, please read this article:  https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm

4.  Washington's "Expansion" Issue

In 2009, our assisted suicide law went into effect.  By 2011, there were newspaper proposals to expand that law to direct euthanasia for non-terminal persons.  In 2012, a friend sent me this article suggesting euthanasia for people unable to afford their own care, which would be involuntary euthanasia.  See Jerry Large, "Planning for old age at a premium," The Seattle Times, March 8, 2012, at  http://seattletimes.nwsource.com/text/2017693023.html ("After Monday's column, . . . a few [readers] suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out. At least a couple mentioned euthanasia as a solution.") (Emphasis added). 

Don't make our mistake.

Margaret Dore

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 USA

206 389 1754 

Protect Health Care; Keep Assisted Suicide Out of Montana

http://www.ravallirepublic.com/news/opinion/mailbag/article_03dfa5e3-26fa-588f-8765-b85fc6f81622.html?comment_form=true


April 22, 2013

I was disturbed to see the (April 7) opinion by Eric Kress promoting physician-assisted suicide. I am a cancer doctor with more than 40 years experience in Oregon, where physician-assisted suicide is legal. I am also a professor emeritus and former chair of the Department of Radiation Oncology at Oregon Health and Science University.

I first became involved with the assisted-suicide issue shortly before my first wife died of cancer in 1982. We had just made what would be her last visit with 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.”

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). First, there is a financial incentive for patients to commit suicide: the plan will cover the cost. Second, the plan will not necessarily cover the cost of treatment due to statistical criteria. For example, patients with cancer are denied treatment if they are determined to have “less than 24 months median survival with treatment” and fit other criteria. Some of these patients, if treated, would however have many years to live, as much as five, 10 or 20 years depending on the type of cancer. This is because there are always some people who beat the odds. The plan will cover the cost of their suicides.

In Oregon, the mere presence of legal assisted-suicide steers patients to suicide even when there is no coverage issue. One of my patients was adamant she would use the law. I convinced her to be treated instead. Twelve years later she is thrilled to be alive.

Don’t make Oregon’s mistake.

Kenneth Stevens, MD,
Sherwood, Ore.

Montana: Great News! HB 505 Voted to the Floor!!!!

This afternoon, the Montana Senate "blasted" HB 505 to the floor in a 31 to 17 Vote!!!!

Thank you to everyone else who worked so hard to get us this far!!!

Yeah!!!!!

Margaret Dore

"Once in place, this 'trend' is not controllable"

Dear Senators:

For those of you who don't know me, I am an attorney in Washington state where physician-assisted suicide is legal. I am writing to urge you to not make Washington's mistake by allowing assisted suicide/euthanasia to become part of your state's legal fabric.  Once in place, this "trend" is not controllable.  I urge you to vote "Yes" on HB 505 to clearly state that assisted suicide is not legal in Montana. 

In 2008, we voted for a law to legalize assisted suicide for persons predicted to have less than six months to live.  Voters were promised that "only" the patient could take the lethal dose.  Our law does not say that anywhere.  By 2011, there were newspaper proposals to expand our law to direct euthanasia for non-terminal persons.  Last year, a friend sent me this article in our largest paper suggesting euthanasia for people unable to afford their own care, which would be involuntary euthanasia.  See http://seattletimes.nwsource.com/text/2017693023.html ("After Monday's column,  . . . a few [readers] suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out.  At least a couple mentioned euthanasia as a solution.")  (Emphasis added).

In my law practice, I have had two clients whose parents signed up for the lethal dose.

In one case, one side of the family wanted the parent to take the lethal dose while the other did not.  The parent spent the last  months of his life traumatized and/or struggling over the decision of whether or not to kill himself.  My client was also traumatized.  The parent did not take the lethal dose and died a natural death

In the other case, it's unclear that the parent's death was voluntary.  This was due to his reportedly refusing to take the lethal dose at his first suicide party and then being high on alcohol the next night when he drank the dose at a second party.  (The person who told this to my client recanted).  But, as a lawyer who has worked on divorce cases, I couldn't help but notice that if the parent's much younger wife had divorced him, the parent would have got the house.  This way, the surviving wife got everything. 

Meanwhile, my friends who provide elder care report that they now have to "guard" their clients in the hospital to avoid the initiation of "comfort care" (morphine overdose and the sudden death of the client).   See e.g.  http://www.montanansagainstassistedsuicide.org/2012/07/dear-montana-board-of-medical-examiners.html

Montana

In Montana, you have had similar developments.  In 2007, the Baxter case was initiated seeking to legalize physician-assisted suicide for "terminally ill adult patients," the implication being that the practice would be limited to dying people.  The proposed definition of "terminally ill adult patient," however, was broad enough to include an otherwise healthy 18 year old dependent on insulin.  See http://choiceisanillusion.files.wordpress.com/2012/07/schrempp_wonderly_opn_ltr1.pdf 

In late 2009, the Baxter opinion was issued in your Supreme Court ruling that doctors who assist a suicide in certain narrowly defined circumstances have a defense to prosecution if charged with homicide.  Since then, I have been contacted by several Montanans describing the misuse or abuse of "comfort care" against their loved ones.  Three of these persons have specifically endorsed HB 505, see for example, this letter by Carol Mungas, the widow of a prominent physician who was euthanized by nurses against his will.  See http://www.montanansagainstassistedsuicide.org/2013/03/i-support-house-bill-505-which-clearly.html  

Last month in the Senate Judiciary Committee, a doctor described his assisting three suicides in Montana.  See http://www.greatfallstribune.com/apps/pbcs.dll/article?AID=2013303260026 

If he is not prosecuted, or if the prosecution fails, assisted suicides will thereby be encouraged and, given Washington's experience, there will be a push to expand the practice to less compelling cases, for example, persons with treatable diabetes.  If, instead, HB 505 is enacted, there will be a clear statement going forward that assisted suicide is not legal in Montana.

This is why HB 505 is needed now.

Thank you for your consideration.

Margaret Dore
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

Death by Dehydration and Starvation

Click here to view original letter.

My mother, Sharon Moe, was diagnosed with colon cancer in February of this year. After her surgery, I was told that she may be able to live for 6 months to 2 years. My mother was against assisted suicide and euthanasia and wanted to live as long as possible. She was placed back in the care of the nursing facility where hospice started to care for her. She was placed on a continual feed through a feeding tube because she was unable to take in anything orally due to her medical condition.

From the beginning, hospice wanted to stop the continual feed. My mother was adamant that she wanted to live and told the hospice nurse that she wanted to stay on the continual feed. My mother was able to converse and sit upright within a day or so after being taken back to the nursing facility. Her health was improving and she was doing really well after surgery despite the fact that she was underweight from not being able to eat.

The hospice nurse was still wanting to remove the continual feeding, even though my mother was doing well. My mother was able to tolerate the food and was not aspirating from it. The nurse placed a pain patch on my mother even though she wasn't in pain. They didnt ask her if she was in pain--they just administered the pain patch because she had a 'furrowed brow'. This pain patch caused my mother to hallucinate and be in a semi-comatose state. She was talkative and looking better before the patch was administered. After the patch had been in her system overnight, she started seeing things and was very scared.

My mother did not get the chance to live on longer as she had willed, but her death was hastened by dehydration and starvation after removing the continual feeding. My mother was not experiencing any pain and would tell someone if she had it....

Mike Moe, Great Falls Montana

"This ad is appalling, even by the low standards of Compassion & Choices"

Dear Montana Senate Judiciary Members:

I am a probate attorney from Washington State where assisted suicide is, unfortunately, legal.

I recently saw an ad by “Compassion and Choices” which contained an over-the-top depiction of a doctor in handcuffs.  This ad is appalling, even by the low standards of Compassion in Choices.  (Compassion and Choices is a successor organization of the Hemlock Society, originally founded by Derek Humphry.  In 2011, Humphry was keynote speaker and Compassion and Choices annual meeting here in Washington.  He was also in the news as a promoter of mail-order suicide kits after a 29 year old man used one of the kits to commit suicide).*

HB 505 is needed to protect seniors and others from the ultimate in financial and physical abuse.  I urge you to vote YES.  Thank you.

Theresa Schrempp
Seattle, WA  

*  For supporting authority and more information, go here: http://www.montanansagainstassistedsuicide.org/2012/12/compassion-choices-is-successor.html

Possible expansion of physician-assisted suicide laws in other states should concern Montana

http://missoulian.com/news/opinion/mailbag/possible-expansion-of-physician-assisted-suicide-laws-in-other-states/article_e29d5322-8b2c-11e2-aba7-001a4bcf887a.html

I am doctor in Washington state where physician-assisted suicide is legal for “terminal patients” predicted to have less than six months to live. I disagree with the letter by Kristen Wood (letter, Feb. 28) that expansion is not a concern in this context.

In Washington state, our assisted suicide law has only been in effect for four years. We have, however, already had proposals to expand that law to direct euthanasia of non-terminal people. See e.g., Brian Faller, “Perhaps it’s time to expand Washington’s Death with Dignity Act,” Nov. 16, 2011. Last year, there was also this article in the Seattle Times, suggesting euthanasia for people who cannot afford their own care, which would be involuntary euthanasia: Jerry Large, “Planning for old age at a premium,” March 8, 2012 at http://seattletimes.nwsource.com/text/2017693023.html (“After Monday’s column, . . . a few (readers) suggested that if you couldn’t save enough money to see you through your old age, you shouldn’t expect society to bail you out. At least a couple mentioned euthanasia as a solution.“)

I am very concerned with where this is all going. I hope that Montana does not follow our lead to legalize assisted suicide.

Richard Wonderly,
Seattle, Washington

"Because of my mother's experiences, I no longer believe in "physician-assisted suicide.' Support House Bill 505."

Family member's 'accidental' death provides example for opposition to assisted suicide

http://www.ravallirepublic.com/news/opinion/mailbag/article_2051b845-5a8d-5cdc-be0e-0b7bfbb5e2bf.html?comment_form=true 

This letter is being written for a right to live.  We taxpayers paid a phenomenal amount of money when others decided it was time for my mother to die.  She would not die!  Three times she defied attempts on her life, costing her bed sores, hospice and her daughter being arrested while helping her (the latter arrest record was dismissed).

Mom succumbed in the hospital on Sept. 6, 2010.  The coroner's report case No. 100906 lists congestive heart failure with oxygen deprivation and fentanyl therapy.  The manner of death: accident.

Fentanyl is reported "to be 80 to 200 times as potent as morphine."  A fentanyl patch of 100 mcg/hour has a range within 24 hours of 1.9-3.8ng/mL. Mom's death result was 2.7 ng/mL on or about 48 hours.

Complaint No. 2012-069-MED was filed with the Montana Department of Labor and Industry Board of Medical Examiners. The screening panel voted to dismiss the complaint with prejudice, which means the board may not consider the complaint in the future.

Because of my mother's experiences, I no longer believe in "physician-assisted suicide."  Support House Bill 505.

Gail Bell,
Bozeman

Doctor Effectively Euthanized Against his Will

James Mungas MD

For published version, click here.

My husband, Dr. James E. Mungas, was a respected physician and surgeon here in Great Falls. He developed amyotrophic lateral sclerosis, and I took care of him. His mind was clear and thought processes unimpaired. He was against assisted suicide and euthanasia.

I needed to travel out of town for a day and a half. We agreed he would stay at a local care facility in my absence. Once there, nurses began administering morphine. After the first dose, my husband knew that he had been overdosed and typed out a message to call respiratory therapy. None came that day. Over the next few days, he struggled to breathe and desperately struggled to remain conscious to communicate, but the nurses kept pushing the morphine button and advised our children to do the same. My children and I did not understand the extent morphine would repress the respiratory system until later.  This was neither palliative care nor managing pain; this was hastening death. He was effectively euthanized against his will. He did not get his choice. It is traumatic, still, to realize his last communications were attempts to get help....

— Carol Mungas,
Great Falls, Montana