Not what Vermont needs

http://www.timesargus.com/apps/pbcs.dll/article?AID=/20130517/OPINION02/705179982?template=printart

May 17, 2013

By Rep. Anne Donahue
 
Wake up, Dorothy. You’re not in Oregon anymore.

The final week of the political path to death with dignity in Vermont was a reminder of how a cadre of politicians can want something so desperately that they push it through even if abandoning key promises.

For months — no, for years — Vermonters have been told that Oregon’s experience of physician-assisted suicide has demonstrated that extending this compassionate option to persons who want it comes at no risk to the vulnerable.

The mantra has been Oregon. Oregon protections. Oregon data. Everything has worked flawlessly in Oregon, so if we follow the exact model as Oregon, we can ignore the fears of the naysayers.

When the Senate was short one vote in February to pass the Oregon model, it sent a narrow bill to the House that focused instead on independent actions of a patient rather than on prescriptions for intentionally lethal medication. It was roundly criticized for lacking the protections of the Oregon bill.

The House restored the Oregon, active-prescription version. Proponents were emphatic on the House floor that it was because every one of the Oregon protections were locked into place that members could be assured there could be no coercion, no errors in diagnosis, and no one making the choice lacking full informed consent.

When it pingponged back, the Senate still couldn’t muster the votes to pass it. So a few backers patched and pasted an assorted set of new and old language together directed exclusively at gaining the one extra vote needed.

Gone were both the Oregon model and any model that left the doctor out of the role of prescribing lethal drugs. Enter the land of political Oz.

Sen. Claire Ayer, who had been the most vigorous in attacking what the Senate had passed via a floor amendment in February, now pressed for the new hybrid, though acknowledging that it was drafted “on the fly.”

Eradicated by the Senate were fully 29 separate protective provisions that the House had required in its Oregon version, some of them small, some of them huge. Among the huge ones:

— There is no longer any written informed consent required.

— A guardian or an agent for an advance directive is no longer barred from taking the place of a direct patient request.

— There is no longer any requirement that the patient actually be able to “self-administer.”

— There is no longer a second opinion required to assess whether a patient has the rational judgment capacity to make an informed decision.

— There are no requirements for follow-up by the Department of Health. The required review of patient files is gone. The requirement to collect statistical data and publish annual reports is gone.

This last is particularly ironic, because it has been the patient information and report data from Oregon that has been the basis for assuring Vermonters that all is well in Oregon.

The new Vermont bill sunsets even the “Oregon-lite” approach in 2016, then eliminates all remaining structural protections. But there isn’t any data being required to assess how the process works in those first three years.

Despite all this, House members who wanted to see a bill pass stuck by what they had so strongly criticized before: a bill that no longer maintained many of the long-promised protections. Only a few looked twice and voted against accepting what the Senate had done. The winning vote margin dropped from 17 to 10.

Our radical new social policy that endorses having doctors write prescriptions that will kill their patients, cobbled together by just a few individuals from bits and pieces of language drafted on the fly, was passed by two votes in the Senate and 10 votes in the House.

But no, Dorothy. We’re no longer in Oregon.

Rep. Anne Donahue, a Republican from Northfield, is a member of the House Human Services Committee, which passed the Oregon-style bill on a 7-4 vote in April. She was an opponent.

---

Vermont: House Passes Irresponsible Assisted Suicide Law

By Margaret Dore, Esq.

A.  Introduction

Yesterday, the Vermont House passed S.77, which if signed by the Governor, will create new legal paths of abuse and exploitation against persons who fall within its terms.  This article focuses on two of those paths.

B.  Abuse and Exploitation in the United States

Met Life Mature Market Institute has issued two landmark studies on elder abuse in the United States.  In the first study, from 2009, the estimated annual financial loss by victims was $2.6 billion.[1]  In the second study, from 2011, the estimated annual loss was increased to $2.9 billion.[2]  Again, these are yearly figures.

The Met Life studies also describe how financial abuse can be a catalyst for other types of abuse.  These are three examples from the second report:

• Two elderly women were beaten to death with a crowbar by their trusted handyman.  He took and pawned all of their valuables.
• A 74-year-old man was stomped to death during a home invasion burglary.
• A son and his two friends extracted money from his dying mother by threatening to burn down her home and throw her dog against a wall.[3]

Abuse and exploitation are not limited to the elderly.  Last year, a 46 year old lottery winner died the day after receiving his winnings.[4] The cause of death was found to be cyanide poisoning.[5]

C.  S.77

1.  Patients may have years to live

S.77 legalizes physician-assisted suicide, which means that a doctor writes a prescription for a lethal dose of medication for the purpose of a patient's committing suicide.[6]  Under S.77, the patient is required to have a "terminal condition," defined as having a medical prediction of less that six months to live.[7]  Such patients are not necessarily dying and can have years to live.  This is because doctor predictions of life expectancy can be wrong and because the requirement of six months to live is based on the patient' s not being treated.[8]  

2.  How S.77 works

Under S.77, there is a formal application process to obtain a lethal dose.[9]  S.77 also requires that in 2016, that this formal process be replaced with a streamlined procedure with these five requirements:

(1) the physician determines that the patient is capable and does not have impaired judgment;

(2) the physician informs the patient of all feasible end-of-life services, including palliative care, comfort care, hospice care, and pain control;

(3) the physician prescribes a dose of medication that may be lethal to the patient;

(4) the physician advises the patient of all foreseeable risks related to the prescription; and

(5) the patient makes an independent decision to self-administer a lethal dose of the medication.[10]

Also, when applying for the lethal dose, patients may be requesting it "just in case." i.e., without a definite intent to take it.[11]

Once the lethal dose is picked up at the pharmacy, there is no oversight.[12]  The death is not required to be witnessed.[13] Indeed, no one is required to be present.[14] 

D.  New Paths of Abuse

1.  No witnesses at the death

As noted above, S.77 does not require witnesses at the death. Without disinterested witnesses, the opportunity is created for the patient’s heir, or for another person who will benefit financially from the patient's death, to administer the lethal dose to the patient without his consent.  Even if he struggled, who would know? 

2.  An expansion of scope 

Under the streamlined procedure scheduled to come into effect in 2016, the scope of S.77 will be expanded to patients who have no intention of engaging in assisted suicide.  As described below, patients prescribed medication for the purpose of cure or treatment will be at risk of being killed under S.77. 

Consider this scenario in which all five requirements of the streamlined procedure are met:

The patient is a competent woman with cancer.  Without surgery, she is terminal as defined in S.77 (she is expected to die in less than six months).  But, with surgery, her  prospects are good.  As part of informed consent, the doctor informs her about the risks of the surgery and end of life services including palliative care, comfort care, hospice care, and pain control.

With the stress of her situation, the woman has been experiencing insomnia, for which the doctor prescribes Pentobarbital (nembutal).[15]   If taken in excess, Pentobarbital may be lethal.[16].  He prescribes a month's supply and advises the woman of the foreseeable risks.  She obtains the prescription but doesn't take any.  The bottle with the unused prescription is in her home. She is scheduled for surgery in a few days.  She has no intention of killing herself.  The doctor has no intention of her killing herself.

A family member, interested in an inheritance, tricks the woman into drinking the pentobarbital mixed with water by saying that it's another medication - say for sinus congestion.[17]

He leaves.  She dies.

The situation looks like a suicide.

If it comes out later that the family member was present when the woman "self-administered" the drug, he's  immune from liability. This is because S.77 states:

"[N]o person shall be subject to civil or criminal liability solely for being present when a patient with a terminal condition self-administers a lethal dose of medication or for not acting to prevent the patient from self-administering a lethal dose of medication."[18]

So the woman was not in control of her fate.  She is legally murdered by her heir.

E.  Conclusion

S.77, as passed by the House for the Governor's signature, is a dangerous and irresponsible bill, in which there is no oversight over administration of the lethal dose such that it can be administered without the patient's consent.  Once the streamlined procedure goes into effect, patients engaged in drug treatments will also be unwittingly under its scope.  Their doctors and the medical profession will also be compromised.  Even if you are for assisted suicide, not this bill.

Footnotes
[1]  The MetLife Study: "Broken Trust:  Elders, Family and Finances, " 2009, available at https://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf
[2] "The MetLife Study of Elder Financial Abuse:  Crimes of Occasion, Desperation, and Predation Against America's Elders," 2011, available at https://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf
[3]  Id., page 17.
[4]  Associated Press, "Urooj Khan Update:  Widow, siblings of poisoned Chicago lottery winner battle over estate, documents say," available at http://www.cbsnews.com/2102-504083_162-57563293.html
[5]  Id.
[6]  Cf. AMA Code of Medical Ethics, Opinion 2.211, available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page 
[7]  A copy of S.77, "An act relating to patient choice and control at end of life," as passed by the Senate and the House, can be viewed here:  http://choiceisanillusion.files.wordpress.com/2013/05/s-77-house-final-version-05-13-13.pdf  The definition of "terminal condition" is in § 5281(a)(10)("Terminal condition" means an incurable and irreversible disease which would, within reasonable medical judgment, result in death within six months).
[8]  See Nina Shapiro, Terminal Uncertainty — Washington's new 'Death with Dignity' law allows doctors to help people commit suicide — once they've determined that the patient has only six months to live. But what if they're wrong?, Seattle Weekly, January 14, 2009, available at www.seattleweekly.com/2009-01-14/news/terminal-uncertainty.  See also Affidavit of Kenneth Stevens, MD, September 18, 2012, available at http://choiceisanillusion.files.wordpress.com/2012/10/signed-ken-stevens-affidavit_001.pdf ; and Affidavit of John Norton (when he was eighteen years old, he was told that he would die of ALS and paralysis in three to five years; he is now 75 years old).  Available at http://www.massagainstassistedsuicide.org/2012/09/john-norton-cautionary-tale.html
[9]  In S.77, the formal application process is contained in § 5283, Requirements for Prescription and Documentation, available at http://choiceisanillusion.files.wordpress.com/2013/05/s-77-senate-version-as-of-05-08-13.pdf and http://choiceisanillusion.files.wordpress.com/2013/05/s-77-house-final-version-05-13-13.pdf
[10]  S.77, Sec. 2, Repeal (stating that 5283 will be repealed on July 1, 2016).  See also S.77, Sec. 3 (providing that § § 5289 and 5290 will take effect on July 1, 2016)
[11]  I have had two cases in which my client's parent signed up for the lethal dose.  In both cases, the parents did not have a set wish to take the lethal dose. They signed up "just in case."
[12]  See S.77 in its entirety, at http://choiceisanillusion.files.wordpress.com/2013/05/s-77-senate-version-as-of-05-08-13.pdf and http://choiceisanillusion.files.wordpress.com/2013/05/s-77-house-final-version-05-13-13.pdf
[13]  Id.
[14]  Id.
[15]  See http://www.drugs.com/mtm/pentobarbital.html
[16]  Id.
[17]  Pentobarbital is water and alcohol soluble so that it could be put in a cold medicine solution.  See http://www.drugs.com/pro/nembutal.html 
[18]  S.77 § 5284 

Man given incorrect death diagnosis of six months to live by VA doctor awarded $59,000

http://helenair.com/news/local/crime-and-courts/man-given-incorrect-death-diagnosis-by-va-doctor-awarded/article_647c5fae-b833-11e2-86ce-0019bb2963f4.html

May 09, 2013 12:00 am  •  By EVE BYRON Independent Record

A man who thought he would be dead within six months after being incorrectly diagnosed with brain cancer at the Fort Harrison VA Medical Center has been awarded $59,820 for the grief and stress it caused him and his family.

In documents filed this week, U.S. District Court Judge Donald Molloy wrote that Mark Templin and his family’s distress was caused by Dr. Patrick Morrow’s “negligent failure to meet the standard of care” while Templin was a patient of Morrow’s at the VA.

“It is difficult to put a price tag on the anguish of a man wrongly convinced of his impending death,” Molloy wrote. “Mr. Templin lived for 148 days … under the mistaken impression that he was dying of metastatic brain cancer.”

Molloy noted that at one point, Templin considered suicide so that his family wouldn’t have to watch him wither away.

The case began on Jan. 28, 2009, when Templin arrived at the VA northwest of Helena complaining of acute chest pain. He had a stent inserted and appeared to be recovering well, but a week later he developed problems with his memory, vision and speech, and was having headaches.

Morrow, an internist at the VA, referred Templin to an ophthalmologist, who suspected Templin had suffered a stroke and recommended a CT scan, which was administered. The scan showed brain abnormalities, which Morrow discussed with a neuroradiologist, who told him Templin could be suffering from a variety of diagnoses, including a brain tumor or a stroke.

The neuroradiologist added that further diagnostic testing was needed be more definitive. However, later that day, Morrow met with the VA’s tumor board and presented the case as a strong suspicion of brain cancer, but apparently didn’t mention that it could have been a stroke, according to court documents.

Morrow testified that he told Templin and his family that his “greatest fear” was brain cancer and that further diagnostics were needed, and that he advised Templin to undergo an MRI.

However, Molloy wrote that there was no indication in Templin’s medical records that Morrow suggested any further diagnostic workup and that Templin and his family understood that he had brain cancer and was expected to die within six months.

Molloy wrote that one of Templin’s daughters asked Morrow how her father would die and “he explained one of the tumors would grow ‘like cauliflower’ and Templin would die from a brain bleed.”

They talked about cancer treatment, but after learning that it would only ease his pain and not cure him, Templin decided that he didn’t want to sacrifice the “quality of his life for any potential increase in quantity,” according to court documents.

Templin was prescribed two drugs used to treat brain cancer, one of which is not supposed to be given to stroke patients. He also was ordered hospice care, which is for terminally ill patients not expected to live longer than six months.

He sold his truck, quit his job and put his affairs in order, which included prominently displaying a “Do Not Resuscitate” notice on his refrigerator so any emergency medical responders would let him die. His family held a “last birthday” dinner from him and he arranged and paid for his funeral service. His son-in-law made a wooden box for his ashes.

Molloy wrote that after Templin’s discharge in February 2009, hospice records say he was “very depressed and preoccupied with his diagnosis.” Templin testified at a recent court hearing that he cried often and considered shooting himself to spare his family from going through the pain and distress associated with his diagnosed terminal illness.

“While under the impression that he was afflicted with metastatic brain cancer, Mr. Templin wondered each day whether it would be his last,” Molloy wrote.

Yet he started feeling better, and in June he terminated hospice care. In July, he underwent additional testing at Fort Harrison, and this time a doctor told him the CT scan showed multiple small strokes, but no brain cancer. An MRI in December 2009 confirmed that it was a stroke, not brain cancer, that caused his symptoms earlier in the year.

Molloy wrote that Faust Alvarez, the chief of staff at the VA at the time, sent Templin a letter confirming that he suffered a stroke, not brain cancer, although Faust later testified that the statements weren’t an admission of fault or that the diagnosis was faulty.

“Dr. Alvarez’s testimony regarding investigation and fault is not credible,” Molloy added. “The letter intended to communicate and actually did communicate an acceptance of fault by Fort Harrison VA Medical Center for the misdiagnosis of Mark Templin.”

Molloy decided to award $500 per day for the initial period of severe mental and emotional distress from Feb. 4, 2009 to April 15, 2009, and $300 per day for the latter period until his new diagnosis. He also ordered the VA to repay Templin for the cost of his “last” birthday celebration and for the prearranged funeral service.

Assistant U.S. Attorney Jessica Fehr, with the U.S. Attorney’s Office in Billings, which represents the VA, said they have 30 days to decide whether to file an appeal and hadn’t made a decision yet on whether to do so.

Reporter Eve Byron: 447-4076 or eve.byron@helenair.com Follow Eve on Twitter @IR_EveByron

Vermont: Vote "NO" on New Senate Version of S.77, Passed May 8, 2013

This memo to the Vermont House of Representatives details some of the major flaws of the amended version of S.77 passed by the Senate on May 8, 2013.  To view the memo's index and text,  click here  To see the attachments, click here .  Below is the memo's text:


I. OVERVIEW

I am an attorney in Washington State where physician-assisted suicide is legal.[1]  Our law is similar to S.77, which seeks to legalize physician-assisted suicide.[2]  Moreover, it’s well known that financial reasons are “an all too common motivation for killing someone.”[3]

S.77 allows an heir, or another person who will benefit financially from a patient’s death, to help the patient sign up for the lethal dose.  S.77 also allows an heir, or someone else who will benefit financially from the death, to pick up the lethal dose at the pharmacy.  Once the lethal dose is in the house, there is no oversight.

S.77 is sold as promoting patient choice and control.  The bill is instead a recipe for elder abuse.  Don’t make Washington’s mistake.


II. FACTUAL AND LEGAL BACKGROUND

A. Physician-assisted Suicide

The American Medical Association (AMA) defines physician-assisted suicide as occurring “when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act.”[4]  An example would be a doctor’s prescription of a lethal dose to facilitate a patient’s suicide.[5]  The AMA rejects this practice, stating:  "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."[6]


B. Most States Reject Assisted Suicide

Oregon and Washington are the only states where physician-assisted suicide is legal.  Oregon’s law was enacted by a ballot initiative in 1997.[7]  Washington's law was enacted by another initiative in 2008 and went into effect in 2009.[8]  No such law has made it through the scrutiny of a legislature despite more than 100 attempts.[9]  In a third state, Montana, there is a court decision that gives doctors who assist a suicide a defense to prosecution for homicide.  The meaning of this decision is subject to ongoing litigation.[10]

In the last two years, three states have strengthened their laws against assisted suicide.[11]  These states are: Idaho; Georgia; and Louisiana.[12]


III. THE BILL  

A. Patients are Not Necessarily Dying; They May Have Years to Live

S.77 applies to patients with a “terminal condition,” defined as having a medical prediction of less than six months to live.[13]  Such patients are not necessarily dying and may have years to live.  This is because doctor predictions of life expectancy can be wrong and because the requirement of six months to live is based on the patient’s not being treated.[14]  Consider Oregon resident, Jeanette Hall, who was diagnosed with cancer in 2000 and wanted to do assisted suicide.[15]  Her doctor convinced her to be treated instead.[16]  In a 2012 affidavit, she states:

"This July, it was 12 years since my diagnosis.  If [my doctor] had believed in assisted suicide, I would be dead."[17]

B. How S.77 Works

S.77 has an application process to obtain a lethal dose, which includes a written request with two required witnesses.[18]

Once the lethal dose is picked up at the pharmacy, there is no oversight.[19]  The death is not required to be witnessed.  No one, not even a doctor, is required to be present.[20]


IV. ARGUMENT

A. Patient “Control” is an Illusion

1. No witnesses at the death

As noted above, S.77 does not require witnesses at the death.  Without disinterested witnesses, the opportunity is created for the patient’s heir, or for another person who will benefit financially from the death, to administer the lethal dose to the patient without his consent.  Even if the patient struggled, who would know?

Without disinterested witnesses, the patient’s choice and control over his death is not guaranteed.

2. Someone else is allowed to talk for the patient

Under S.77, patients obtaining the lethal dose are required to be “capable.”[21]  This is, however, a relaxed standard in which someone else is allowed to talk for the patient.  S.77 states:

"'Capable' means that a patient has the ability to make and communicate health care decisions to a physician, including communication through persons familiar with the patient’s manner of communicating . . .”  (Emphasis added).[22]

The person talking for the patient is not required to be a trusted person designated by the patient, for example, an agent under an advanced directive.[23]  The person talking for the patient is allowed to be an heir.[24]  With this circumstance, the patient is not necessarily in control of his fate.

3. An heir is allowed to procure the patient’s request for the lethal dose

S.77 prohibits an heir from acting as a witness on the written request for the lethal dose.[25]  S.77 does not, however, prohibit an heir from procuring that request.[26]  An example of procuring would be: providing the written request to the patient; recruiting the witnesses; and supervising the signing.  S.77, which allows an heir to procure the request, does not promote patient choice and control.  It invites coercion.

4. An heir is allowed to pick up the lethal dose at the pharmacy

S.77 allows the lethal dose to be picked up at the pharmacy by “an expressly identified agent of the patient.”[27]  S.77 does not prohibit an heir, or another person who will benefit financially from the death, from being this agent.[28]


B. Legalization will Create New Paths of Elder Abuse

 In Vermont, there are an estimated 3,750 cases of violence and abuse against elders each year.[29]  Nationwide, elder financial abuse is a crime growing in intensity, with perpetrators often family members.[30]  There are also victims reported murdered for their funds.[31]

Elder abuse is often difficult to detect.  This is largely due to the unwillingness of victims to report. “Shame, dependence on the abuser, fear of retribution, and isolation from the community are significant obstacles that discourage elders from reporting these crimes.”[32]

In Vermont, preventing abuse of vulnerable adults, which includes the elderly, is official state policy.[33]  If assisted suicide is legalized via S.77, new paths of abuse will be created against the elderly, which is contrary to that policy.  Alex Schadenberg, chair for the Euthanasia Prevention Coalition, International, states:

"With assisted suicide laws in Washington and Oregon, perpetrators can . . . take a 'legal' route, by getting an elder to sign a lethal dose request.  Once the prescription is filled, there is no supervision over the administration. . . . [E]ven if a patient struggled, “who would know?”[34]


C. Any Study Claiming that Oregon’s Law is Safe, is Invalid

During Montana’s 2011 legislative session, the lack of oversight over administration in Oregon’s law prompted Senator Jeff Essmann to make the following observation: The Oregon studies are invalid.  Senator Essmann, who is now President of the Senate, stated:

"[All] the protections end after the prescription is written. [The proponents] admitted that the provisions in the Oregon law would permit one person to be alone in that room with the patient.  And in that situation, there is no guarantee that that medication is self administered.

So frankly, any of the studies that come out of the state of Oregon’s experience are invalid because no one who administers that drug . . . to that patient is going to be turning themselves in for the commission of a homicide."[35]

D. 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 struggling over the decision of whether or not to kill himself.  My client, who was fearful that the other side of the family would use the lethal dose to kill the parent, who was no longer competent, was also torn and 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 his second party.  The person who told this to my client subsequently recanted.  My client did not want to pursue the matter further.  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, he would have got the house.  This way, she got everything.

V. CONCLUSION

If S.77 is enacted, patients affected by its passage will not necessarily be dying and may have years to live.  S.77's assurance of patient choice and control is also untrue.  The bill is instead a recipe for elder abuse.  The most obvious problem is a complete lack of oversight over administration of the lethal dose.  No doctor, not even a lay witness is required.  Even if the patient struggled, who would know?

Don’t make Washington’s mistake.  Reject S.77.

Respectfully submitted May 10, 2013

__________________________________

Margaret Dore, Attorney at Law    

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  

Footnotes:
[1]  I am an elder law/appellate attorney in Washington state who has been licensed to practice law since 1986.  I am a former Law Clerk to the Washington State Supreme Court.  I am a former Chair of the Elder Law Committee of the American Bar Association Family Law Section.  I am also President of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide.  See www.margaretdore.com and www.choiceillusion.org
[2]  S.77, as passed by the Senate on May 8, 2013, can be viewed at this link: http://choiceisanillusion.files.wordpress.com/2013/05/s-77-senate-version-as-of-05-08-13.pdf
[3]  People v. Stuart, 67 Cal. Rptr. 3rd 129, 143 (2007).
[4]   AMA Code of Medical Ethics, Opinion 2.211, available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page
[5]  Id.
[6]  Id.
[7]  Oregon’s physician-assisted suicide act was passed as Ballot Measure 16 in 1994 and went into effect after a referendum in 1997.
[8]  Washington’s act was passed as Initiative 1000 on November 4, 2008 and went into effect on March 5, 2009.  See http://www.doh.wa.gov/dwda/default.htm
[9]  See tabulation at http://epcdocuments.files.wordpress.com/2011/10/attempts_to_legalize_001.pdf
[10]  See Matt Gouras, Associated Press, “Fight over assisted suicide moves back to court,” Billings Gazette, May 8, 2013, available at 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
[11]  See Margaret Dore, “US Overview,” updated July 30, 2012, at http://www.choiceillusion.org/p/us-overview.html
[12]  Id.
[13]  S.77, § 5281(a)(10).
[14]  See Nina Shapiro, Terminal Uncertainty — Washington's new 'Death with Dignity' law allows doctors to help people commit suicide — once they've determined that the patient has only six months to live. But what if they're wrong?, Seattle Weekly, January 14, 2009, available at www.seattleweekly.com/2009-01-14/news/terminal-uncertainty.  See also Affidavit of Kenneth Stevens, MD, September 18, 2012, available at http://choiceisanillusion.files.wordpress.com/2012/10/signed-ken-stevens-affidavit_001.pdf ; and Affidavit of John Norton (when he was eighteen years old, he was told that he would die of ALS and paralysis in three to five years; he is now 75 years old).  Available at http://www.massagainstassistedsuicide.org/2012/09/john-norton-cautionary-tale.html
[15].  Affidavit of Kenneth Stevens, MD, ¶¶ 3-7, at http://choiceisanillusion.files.wordpress.com/2012/10/signed-ken-stevens-affidavit_001.pdf   Affidavit of Jeanette Hall Opposing Assisted Suicide, August 17, 2012, at http://choiceisanillusion.files.wordpress.com/2013/05/jeanette-hall-affidavit.pdf
[16]  Id.
[17]  Affidavit of Jeanette Hall, ¶ 4, at http://choiceisanillusion.files.wordpress.com/2013/05/jeanette-hall-affidavit.pdf
[18]  See § 5283(a)(4)
[19]  See S.77 in its entirety, at http://choiceisanillusion.files.wordpress.com/2013/05/s-77-senate-version-as-of-05-08-13.pdf
[20]  Id.
[21]   § 5281(a)(2)
[22]   § 5281(a)(2) states: "'Capable' means that a patient has the ability to make and communicate health care decisions to a physician, including communication through  persons familiar with the patient's manner of communicating if those persons are available."
[23]  See S.77 in its entirety, at http://choiceisanillusion.files.wordpress.com/2013/05/s-77-senate-version-as-of-05-08-13.pdf.
[24]  S.77 does not prohibit heirs, or other persons who benefit financially from the patient’s death, to talk for the patient during the lethal dose request process.  See S.77 in its entirety.
[25]  See § 5281(a)(6)(defining “interested persons,” including an heir) and § 5283(a)(4)(regarding “interested persons”).
[26]  See S.77 in its entirety.
[27]  § 5283(a)(13)(B)(ii)
[28]  See S.77 in its entirety.
[29]  Elder Abuse Public Education Campaign, Vermont Center for Crime Victim Services, at http://www.ccvs.state.vt.us/pub_ed/index.html  (last visited April 29, 2013).
[30]  See MetLife Mature Market Institute, Broken Trust: Elders, Family and Finances, A Study on Elder Abuse Prevention, March 2009, at http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf (last visited April 29, 2013); Miriam Hernandez, ‘Black Widows’ in court for homeless murders, March 18, 2008, ABC Local, http://abclocal.go.com/kabc/story?section=news/local&id=6027370 (last visited October 2, 2010) (elderly homeless men killed as part of an insurance scam); and People v. Rutterschmidt, 98 Cal.Rptr.3rd 390 (2009) (regarding this same case).  
[31]  Id.  See also People v. Stuart, 67 Cal. Rptr. 3d 129, 143 (where daughter killed her mother with a pillow, “financial considerations [are] an all too common motivation for killing someone . . .”).
[32]  Elder Abuse Public Education Campaign, supra at note 29.
[33]  See, e.g., Vermont Adult Protective Services Statute, “Reports of Abuse, Neglect and Exploitation of Vulnerable Adults,” 33 V.S.A. § 6902(14)(D)(defining a “[v]ulnerable adult" as a person 18 years of age or older who “is impaired due to . . . infirmities of aging . . .”  
[34]  Alex Schadenberg, Letter to the Editor, Elder abuse a growing problem, The Advocate, the official publication of the Idaho State Bar, October 2010, page 14, available at http://www.margaretdore.com/info/October_Letters.pdf
[35]  See link to hearing transcript for SB 167, February 10, 2011,  http://www.margaretdore.com/pdf/senator_essmann_sb_167_001.pdf

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