"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

Dr. Toffler Writes the New Hampshire Judiciary Committee: "Vote NO on HB 1325"

Dear Members of the Committee:

I am a doctor in Oregon where assisted suicide is legal.  As a professor of Family Medicine and practicing physician in Oregon for over 30 years, I write to urge you to not make Oregon's mistake and vote No on HB 1325.

I understand that there was a question during your recent hearing regarding the appropriateness of suicide prevention with a terminal patient.  Terminal patients, like other patients, will sometimes express suicidal desires and ideation.  Terminal patients, like other patients do not necessarily mean it and may even want you to say "no."  They may also be clinically depressed, i.e., colloquially not in their "right minds."  With this situation, suicide prevention is not only appropriate, but necessary to provide good medical care and to avoid discrimination based on the patient's quality of life as perceived by the doctor.

In my practice, I have had well over twenty patients ask me about participating in their suicides or giving them information about assisted suicide.  In every case I have explored the issues behind their request, and then assured them that I will provide their medical care to the best of my ability. At the same time, I also strive to reflect and convey their inherent worth and my inability to collude with their request to help end their life.  I remember one case in particular, the man's response was "Thank you." 

To read more about that case and some of my other cases in Oregon, please read my statement to the BBC, since re-titled as "What do People Mean When They Say they Want to Die?"  http://www.choiceillusion.org/p/what-people-mean_25.html

Please vote No on HB 1325,

Thank you,

William L. Toffler MD
Professor of Family Medicine
3181 SW Sam Jackson Park Road
Portland, OR 97239
503-494-5322
503-494-8573 (patient care)
503-494-4496 (fax)
toffler@ohsu.edu

Preventing Abuse and Exploitation: A Personal Shift in Focus. An article about guardianship, elder abuse and assisted suicide.

http://www.americanbar.org/publications/voice_of_experience/2014/winter/preventing_abuse_and_exploitationa_personal_shift_focus.html

http://choiceisanillusion.files.wordpress.com/2014/02/dore-preventing-abuse-and-exploitation-aba.pdf

By Margaret K. Dore, Esq., MBA

The Voice of Experience, American Bar Association

Volume 25, No. 4, Winter 2014

I graduated from law school in 1986.  I first worked for the courts and then for the United States Department of Justice.  After that, I worked for other lawyers, and then, in 1994, I officially started my own practice in Washington State.  Like many lawyers with a new practice, I signed up for court-appointed work in the guardianship/probate context.  This was mostly guardian ad litem work.  Once in awhile, I was appointed as an attorney for a proposed ward, termed an “alleged incapacitated person.”  In other states, a guardianship might be called a “conservatorship” or an “interdiction.”  A guardian ad litem might be called a “court visitor.”

My Guardianship Cases

Most of my guardianship cases were straightforward.  There would typically be a elderly person who could no longer handle his or her affairs.  I would be the guardian ad litem.  My job would be to determine whether the person needed a guardian, and if that were the case, to recommend a person or agency to fill that role.

My work also included private pay cases with moderate estates.  With these cases, I would sometimes see financial abuse and exploitation.  For example, there was an elderly woman whose nephew took her to the bank each week to obtain a large cash withdrawal.  She had dementia, but she could pass as “competent” to get the money.  In another case, “an old friend from 30 years ago” took “Jim,” a 90 year old man, to lunch.  The friend invited Jim to live with him in exchange for making the friend sole beneficiary of his will.  Jim agreed.  The will was executed and he went to live with the friend in a nearby town.  A guardianship was started and I was appointed guardian ad litem.  I drove to the friend’s house, which was dilapidated.  Jim did not seem to have his own room.  I asked him if he would like to go home.  He said “yes” and got in my car.  He was not incompetent, but he had allowed someone else to take advantage of him.  In another case, there was a disabled man whose caregiver had used his credit card to remodel her home.  He too was competent, but he had been unable to protect himself.

In those first few years, I loved my guardianship cases.  I had been close to my grandmother and enjoyed working with older people.  I met guardians and other people who genuinely wanted to help others.

But then I got a case involving a competent man who had been railroaded into guardianship.  The guardian, a company, refused to let him out.  The guardian also appeared to be churning the case, i.e., causing conflict and then billing for work to respond to the conflict and/or to cause more conflict.  I have an accounting background and also saw markers of embezzlement.  I tried to tell the court, but the supervising commissioner didn’t know much about accounting.  She allowed the guardian to hire its own CPA to investigate the situation, which predictably exonerated the guardian.  The guardian had many cases and if what I said had been proved true, there would have been political fallout.  There were also conflicts of interest among the lawyers.

At this point, the scales began to fall from my eyes.  My focus started to shift from working within the system to seeing how the system itself sometimes facilitates abuse.  This led me to write articles addressing some of the system’s flaws.  See e.g., Margaret K. Dore, Ten Reasons People Get Railroaded into Guardianship, 21 AM. J. FAM. L. 148 (2008), available at www.margaretdore.com/pdf/Dore_AJFL_Winter08.pdf; Margaret K. Dore, The Time is Now: Guardians Should be Licensed and Regulated Under the Executive Branch, Not the Courts, WASH. ST. B. ASS’N B. NEWS, Mar. 2007 at 27-9, available at http://maasdocuments.files.wordpress.com/2013/08/dore-the-time-is-now-ashx.pdf

The MetLife Studies 

In 2009, the MetLife Mature Market Institute released its landmark study on elder financial abuse. See https://www.giaging.org/documents/mmi-study-broken-trust-elders-family-finances.pdf  The estimated financial loss by victims in the United States was $2.6 billion per year.

The study also explained that perpetrators are often family members, some of whom feel themselves “entitled” to the elder’s assets.  The study states that perpetrators start out with small crimes, such as stealing jewelry and blank checks, before moving on to larger items or coercing elders to sign over the deeds to their homes, change their wills or liquidate their assets.

In 2011, Met Life released another study available at www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf, which described how financial abuse can be catalyst for other types of abuse and which was illustrated by the following example.  “A woman barely came away with her life after her caretaker of four years stole money from her and pushed her wheelchair in front of a train.  After the incident the woman said, “We were so good of friends . . . I’m so hurt that I can’t stop crying.”

Failure to Report

A big reason that elder abuse and exploitation are prevalent is that victims do not report.  This failure to report can be for many reasons.  A mother being abused by her son might not want him to go to jail.  She might also be humiliated, ashamed or embarrassed about what’s happening.  She might be legitimately afraid that if she reveals the abuse, she will be put under guardianship.

The statistics that I’ve seen on unreported cases vary, from only 2 in 4 cases being reported, to one in 20 cases.  Elder abuse and exploitation are, regardless, a largely uncontrolled problem.

A New Development: Legalized Assisted Suicide

Another development relevant to abuse and exploitation is the ongoing push to legalize assisted suicide and euthanasia in the United States.  “Assisted suicide” means that someone provides the means and/or information for another person to commit suicide.  If the assisting person is a physician who prescribes a lethal dose, a more precise term is “physician-assisted suicide.”  “Euthanasia,” by contrast, is the direct administration of a lethal agent with the intent to cause another person’s death.

In the United States, physician-assisted suicide is legal in three states:  Oregon, Washington and Vermont.  Eligible patients are required to be “terminal,” which means having less than six months to live.  Such patients, however, are not necessarily dying.  One reason is because expectations of life expectancy can be wrong.  Treatment can also lead to recovery.  I have a friend who was talked out of using Oregon’s law in 2000.  Her doctor, who did not believe in assisted suicide, convinced her to be treated instead.  She is still alive today, 13 years later.

Oregon’s law was enacted by a ballot measure in 1997.  Washington’s law was passed by another measure in 2008 and went into effect in 2009.  Vermont’s law was enacted on May 20, 2013.  All three laws are a recipe for abuse.  Onw reason is that they allow someone else to talk for the patient during the lethal dose request process.  Moreover, once the lethal dose is issued by the pharmacy, there is no oversight over administration.  Even if the patient struggled, who would know? [See e.g., http://www.choiceillusion.org/2013/11/quick-facts-about-assisted-suicide_11.html]

Here in Washington State, we have already had informal proposals to expand our law to non-terminal people.  The first time I saw this was in a newspaper article in 2011.  More recently, there was a newspaper column suggesting euthanasia “if you couldn’t save enough money to see yourself through your old age,” which would be involuntary euthanasia.  Prior to our law being passed, I never heard anyone talk like this.

I have written multiple articles discussing problems with legalization, including Margaret K. Dore, "Death with Dignity”: What Do We Advise Our Clients?," King Co. B. ASS’N, B. BuLL., May 2009, available at  www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm; Margaret K. Dore, Aid in Dying: Not Legal in Idaho; Not About Choice, 52 THE ADVOCATE [the official publication of the Idaho State Bar] 9, 18-20 (Sept. 2013) available at www.margaretdore.com/pdf/Not_Legal_in_Idaho.pdf  

My Cases Involving the Oregon and Washington Assisted Suicide Laws

I have had two clients whose parents 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.

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.

Conclusion

In my guardianship cases, people were financially abused and sometimes treated terribly, but nobody died and sometimes we were able to make their lives much better.  With legal assisted suicide, the abuse is final.  Don’t make Washinton’s mistake.

Margaret K. Dore (margaretdore@margaretdore.com) JD, MBA, is an attorney in private practice in Washington State where assisted suicide is legal.  She is a former Law Clerk to the Washington State Supreme Court and the Washington State Court of Appeals.  She worked for a year with the U.S. Department of Justice and is president of Choice is an Illusion, www.choiceillusion.org, a nonprofit corporation opposed to assisted suicide and euthanasia.

Oregon's new assisted suicide report: chronic conditions; people with money and more

By Margaret Dore, Esq.
Updated February 19, 2014

Oregon's assisted suicide report for 2013 has been released to the public.[1]  Per the report, the number of deaths from ingesting a lethal dose is low when compared to overall deaths, just 71 out of 32,475 total.[2] The report is nonetheless significant for the following reasons.

Per the report, some people who died from a lethal dose under Oregon's assisted suicide act had chronic conditions such as diabetes.[3] People with these conditions, and other conditions such as cancer, can have years to live.[4]  Jeanette Hall, the woman in the photo, had cancer and was talked out of assisted suicide 13 years ago.[5]  Her doctor convinced her to be treated instead.[6] Legalization, regardless, encourages people with years to live to throw away their lives.

Per the report, most of the people who died from a lethal dose were white, aged 65 or older, and well-educated. See note [7].  People with these attributes are typically well off, i.e., the middle class and above.  The report's introduction implies that their deaths were voluntary, stating that Oregon's act "allows" residents to obtain a lethal dose for self-administration.  There is, however, nothing in the report stating that the specific deaths described in the report were self-administered and/or voluntary.[8] Older well-off people are, regardless, in a vulnerable demographic for abuse and exploitation.  This includes murder.  A 2009 MetLife Mature Market Institute Study states:

"Elders’ vulnerabilities and larger net worth make them a prime target for financial abuse . . . Victims may even be murdered by perpetrators who just want their funds and see them as an easy mark."[9]

Oregon's act was passed in 1997.[10]  Just three later, Oregon's suicide rate for other suicides was "increasing significantly."[11]  Last year, an article in Oregon's largest paper reported:

"New figures show a sharp rise in suicides among middle-aged Americans, and an even bigger increase in Oregon. A Centers for Disease Control and Prevention report shows suicides among men and women aged 35-64 increased 49 percent in Oregon from 1999-2010, compared to 28 percent nationally."[12] 

This "significant increase" is consistent with a suicide contagion in which legalizing one type of suicide encouraged other suicides.[13]

The new Oregon report also lists "concerns" as to why the people who died requested the lethal dose.[14]  The data for these concerns is originally generated by the prescribing doctor who uses a check-the-box form developed by suicide proponents.[15] One listed concern is "inadequate pain control or concern about it."[16]  There is, however, no claim that anyone who ingested the lethal dose was actually in pain.[17]

A copy of Oregon's new report can be viewed at this link: http://choiceisanillusion.files.wordpress.com/2014/01/year16-2013.pdf  For more information, please see the footnotes below.

Margaret Dore is an attorney in Washington State where assisted suicide is legal.  She is President of Choice is an Illusion, a human rights organization opposed to assisted suicide and euthanasia.  She is one of the attorneys of record in the Montana assisted suicide case, Montanans Against Assisted Suicide (MAAS) v. Montana Board of Medical Examiners.  The case has already resulted in the removal of an official policy statement implying that assisted suicide is legal in Montana.  For more information, please click here.  Funds are needed for an upcoming appeal to the Montana Supreme Court.  Please consider a generous donation to MAAS and/or Choice is an Illusion, by clicking here and/or here. Thank you.

[1]  Oregon's Death with Dignity Act-2013, available at http://choiceisanillusion.files.wordpress.com/2014/01/year16-2013.pdf
[2]  Id., Report, page 2, first paragraph and footnote 1.
[3]  Id., Report, page 6 (underlying illness, listing chronic conditions such as "chronic lower respiratory disease" and "other illnesses"). See also page 7, footnote 6 (listing "diabetes mellitus").
[4]  See e.g., Opinion letter of and Dr. Richard Wonderly and Attorney Theresa Schrempp (regarding a young adult with diabetes and other chronic conditions such as HIV/AIDS, "each of these patients could live for decades"), available at http://choiceisanillusion.files.wordpress.com/2012/07/schrempp_wonderly_opn_ltr1.pdf
[5]  See Affidavit of Ken Stevens MD, available at: http://choiceisanillusion.files.wordpress.com/2013/07/signed-stevens-aff-9-18-12-as-filed.pdf  See also, Affidavit of Jeanette Hall, available at:  http://choiceisanillusion.files.wordpress.com/2013/05/jeanette-hall-affidavit.pdf
[6]  Id.
[7]  Report at note 1, page 2, last full paragraph.
[8]  Id..As a further explanation, the report page 1 says that Oregon's Act (DWDA) "allows" terminally ill Oregonians to self-administer the lethal dose.  Nothing says that administration "must" be by self-administration.  Self-administration can also be non-voluntary, for example, if the patient was under a threat of harm to a pet, or incapacitated, say due to alcohol. The rest of the report, pages 2-7 talks about the patient's "ingestion" of the lethal dose, which could also be voluntary, non-voluntary or involuntary. For more information about the term "ingestion," see Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009, at https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm. See also Margaret Dore, "'Death with Dignity': A Recipe for Elder Abuse and Homicide (Albeit not by Name)," Marquette Elder's Advisor, Vol. 11, No. 2, Spring 2010, pp. 391-2, available at http://choiceisanillusion.files.wordpress.com/2014/01/dore-marquette-law-review-article.pdf
[9]  MetLife, "Broken Trust: Elders, Family and Finances," 2009, at https://www.metlife.com/mmi/research/broken-trust-elder-abuse.html#findings
[10]  Oregon's Death with Dignity Act Report at note 1, supra, page 2, paragraph 2.
[11]  News Release, "Rising suicide rate in Oregon reaches higher than national average," Christine Stone, Oregon Public Health Information Officer, Oregon Health Authority, September 9, 2010.
http://choiceisanillusion.files.wordpress.com/2014/01/rising-suicide-rate-in-oregon.pdf
[12]  David Stabler, "Why Oregon's suicide rate is among highest in the country, " The Oregonian, May 15, 2013, at http://blog.oregonlive.com/living_impact/print.html?entry=/2013/05/why_oregons_suicide_rate_is_am.html
[13]  http://en.wikipedia.org/wiki/Suicide_contagion
[14]  Report at note 1, page 6 (middle of page)
[15]  The check-the-box form is Question 15 of the Oregon Death with Dignity Act Attending Physician Follow-up Form, page 5, available at http://choiceisanillusion.files.wordpress.com/2014/01/attending-physician-follow-up-form.pdf
[16]  Report at note 1, page 6 (middle of page).
[17]  Id, entire report.

A Legislator's Question

By Margaret Dore, Esq.
Updated February 5, 2014

A legislator considering an assisted suicide law asked me this question:  "Is there a way to allow a person to end his life without making someone else a criminal?"

This was my (slightly edited) response:

People take their lives all the time.  One of my cousins shot himself and another threw himself in front of a train.  There was no criminality involved.  Also, if people are in pain, palliative care laws allow medical personnel to give patients copious amounts of drugs, including up to sedation, which can hasten the patient's death. This is the principal of double effect.  This is legal.  For more information, read the Affidavit of Kenneth Stevens, MD, page 3, paragraph 13.

There is also palliative care abuse in which no one seems to be held accountable, except for maybe one case in California where doctors relied on a wealthy patient's daughters, who said that their father was really bad off and didn't want treatment, which was not the case.  At least, that's what's claimed by the man's son. See William Dotinga, "Grim Complaint Against Kaiser Hospital," Court House News Service, February 6, 2012.

I've had like 15-20 contacts in the past year by people upset about their family member being suddenly off'd by medical personnel and/or having DNR's put on family members/friends without the patient's consent.  My caregiver friends also talk about guarding their patients in the hospital.  Here are some letters from Montana.  http://www.montanansagainstassistedsuicide.org/2013/04/dont-give-doctors-more-power-to-abuse.html

Here's a letter from Washington State where assisted suicide is legal. The letter talks about doctors being quick with the morphine and also regarding the conduct of an adult son shortly after our assisted suicide law was passed ("an adult child of one of our clients asked about getting the pills [to kill the father].  It wasn't the father saying that he wanted to die").  http://www.montanansagainstassistedsuicide.org/2012/07/dear-montana-board-of-medical-examiners.html  Here's a letter from a wife about how she was afraid to leave her husband alone after a doctor pitched assisted suicide to her husband. http://www.montanansagainstassistedsuicide.org/2013/01/i-was-afraid-to-leave-my-husband-alone.html

There is also the issue that people who say they want to die don't mean it, as with any suicide.  See http://www.montanansagainstassistedsuicide.org/p/what-people-mean-when-they-say-they.html

I've had two clients whose fathers signed up for the Oregon/Washington assisted suicide acts.  With the first case, one side of the family wanted the father to use the act and the other side didn't.  He spent the last months of his life torn over whether of not he should kill himself.  His daughter was also traumatized.  He died a natural death.  There is a Swiss study that you might be interested in, that 1 out of 5 family members were traumatized by witnessing the legal assisted suicide of a family member.  See http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf

In my other case, the father had two suicide parties and it's not clear that it was voluntary.  My client, his son, was told that his dad had said "You're not killing me, I'm going to bed").  Regarding the next day, my client was told that his dad was already high on alcohol when he drank the lethal dose.  But then the person telling him this changed his story.  In Montana, Senator Jeff Essman, made a relevant observation regarding this point:

"[All] the protections [in Oregon's law] 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."

Senate Judiciary Hearing on SB 167 on February 10, 2011

I, however, doubt that a person in Oregon could be prosecuted.  If you read the act carefully, there is no requirement of patient consent to administration of the lethal dose, and to the extent that's ambiguous, there's the rule of lenity.  In Washington State, prosecutors are required to report assisted suicide deaths as "Natural" - no matter what - at least, that's what the regulation says:  http://www.doh.wa.gov/portals/1/Documents/5300/DWDAMedCoroner.pdf   How can you prosecute someone for homicide if the death is required to be reported as "Natural?"

Here in Washington, we have already had some informal proposals to expand the scope of our assisted suicide act.  One in particular disturbed me.  A Seattle Times column suggested euthanasia as a solution for people unable to support themselves, which would be involuntary euthanasia.  See Jerry Large, "Planning for old age at a premium," March 8, 2012, which states:

"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)

So, if you worked hard and paid taxes all your life and then your company pension plan goes belly up, this is how you want society to pay you back?

As a Democrat, I see us as looking out for the little guy, not passing laws to protect perpetrators, healthcare systems, etc. from legitimate claims.  I hope that you will vote against any effort to legalize assisted suicide/euthanasia.

Thank you for writing me back.

Margaret Dore

A response to the press: The wife would still be a victim. In Oregon, murder-suicide follows "the national pattern."

I am an attorney in Washington State where physician-assisted suicide is legal.  I was disturbed by your article suggesting that legal assisted suicide would somehow prevent murder-suicides.

According to Donna Cohen, a professor of psychiatry and behavioral sciences, the typical murder-suicide case involves a depressed controlling husband who shoots his ill wife.  "The wife does not want to die and is often shot in her sleep.  If she was awake at the time, there are usually signs that she tried to defend herself." 
 
The typical wife in these cases does not "choose" her death.  She is a victim of spousal abuse.  Legal assisted suicide, regardless, fails to guarantee "choice."  These laws instead empower doctors, family members and new "best friends" to legally pressure people to take their lives.  See Margaret K. Dore, "'Death with Dignity,' What Do we Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009.

 In Oregon where assisted-suicide has been legal since 1997, murder-suicide has not been eliminated.[1]  Indeed, murder-suicide follows "the national pattern."^[2]  The suggestion that legal assisted suicide prevents murder-suicide is without factual support. 

 For information about problems with legalization, please see this link: http://www.choiceillusion.org/2013/11/quick-facts-about-assisted-suicide_11.html        

Thank you for your consideration.  (the cited footnotes are below my signature block)

Margaret Dore, Esq. and President
Law Offices of Margaret K. Dore, P.S.
Choice is an Illusion
www.margaretdore.com
www.choiceillusion.org
1001 4th Avenue, 44th Floor
Seattle, WA  98154

***

[1]  See Don Colburn, "Recent murder-suicides follow the national pattern," The Oregonian, November 17, 2009 ("In the span of one week this month in the Portland area, three murder-suicides resulted in the deaths of six adults and two children"), available at  http://www.oregonlive.com/health/index.ssf/2009/11/recent_murder-suicides_follow.html ; "Murder-suicide suspected in deaths of Grants Pass [Oregon] couple," Mail Tribune News, July 2, 2000 (regarding husband, age 77, and wife, age 76) at http://archive.mailtribune.com/archive/2000/july/070200n6.htm; and Colleen Stewart, "Hillsboro [Oregon] police investigating couple's homicide and suicide," The Oregonian, July 23, 2010 ("Wayne Eugene Coghill, 67, shot and killed his wife, Nyla Jean Coghill, 65, before taking his own life in their apartment"), at http://www.oregonlive.com/hillsboro/index.ssf/2010/07/hillsboro_police_investigating_homicide_and_suicide.html.
[2]  See Don Colburn above.

Montana board forced to remove position statement. Help us make it permanent & overturn Baxter

For the last three years, Montanans Against Assisted Suicide (MAAS) has been an integral player in keeping assisted suicide from becoming legal in Montana.  Most recently, MAAS has been prosecuting a lawsuit against the Montana Board of Medical Examiners.  The suit has already caused the Board to remove a position statement implying that assisted suicide "may" be legal in Montana.

The lawsuit, however, has also been dismissed due to the Board's removal of the position statement.  See court order here.  If MAAS does not appeal by February 11, 2014 , there will be nothing to stop the Board from re-issuing its statement, or a worse statement, the very next day.  Appeal will also allow MAAS to challenge the Baxter decision, which proponents claim legalized assisted suicide in Montana.  A MTN News article describes the situation, as follows:

 [The] position paper - in response to the lawsuit - has since been rescinded by the Board and scrubbed from its website. But [MAAS's attorney, Margaret] Dore said court action was still needed to prevent the Board from reinstating such a position.

She repeatedly asked District Judge Mike Menahan to weigh in on a Montana Supreme Court ruling known as Baxter, that envisions potential defenses to doctors charged with homicide for assisting with suicide.

Sanjay Talwani, "Montana judge hears assisted suicide arguments," MTN News, December 11, 2013.

Problems with legal assisted suicide include that it encourages people with years to live, to throw away their lives.  Legalization also creates new opportunities for elder abuse, for example, when there is an inheritance involved.  In Oregon, legalization has enabled Oregon's Medicaid program to offer the "treatment" of suicide in lieu of desired treatments (to improve the quality of life, to extend life or to cure). 

For more information, please click here.

MAAS's attorney, Margaret Dore, who is also President of Choice is an Illusion, is donating her time. Choice is an Illusion has also provided financial support for the MAAS lawsuit.  Ongoing funds are, however, needed to pay for the rest of MAAS's legal team including the Charlton Law Firm and for out of pocket expenses such as transcripts, computer research and court fees.   We are asking for your support as your finances allow.  Any amount is appreciated.
                                                                                
Choice is an Illusion is proud to have been part of MAAS' victory to force this action by the Board.  Please donate directly to MAAS, or to Choice is an Illusion as set forth below:

Please make checks payable to: MAAS, 610 North 1st St. Suite 5-285, Hamilton, MT  59840, or to Choice is an Illusion, 1001 4^th Avenue, 44^th Floor, Seattle, WA 98154

Please donate online by clicking here or here.

Thank you for your support.

New Board Member Kate Kelly!

Welcome to our newest Board member, Kate Kelly!

Kate Kelly, B.Ed., B.A.

Kate Kelly grew up in Halifax Nova Scotia, Canada.  She is the daughter of self-educated working-class parents, who instilled in her a love of books, music, nature, old movies, and compassion for "the average Joe" and all vulnerable creatures. Kate dropped out of high-school, becoming well-acquainted with minimum-wage jobs. She eventually attended university as a mature student, graduating with a B.Ed. in English and a B.A. in Drama.  

Kate has been a travel  agent, salesclerk, child care worker, actress, cab driver, art model, gas jockey, reporter, cleaning woman, teacher, jazz singer and office clerk. She has lived and worked in 6 Canadian provinces and 1 territory, and travels extensively. Kate is passionate about seniors' rights, rescuing dogs, and singing. She hopes to live to at least 100, and die without being "pushed along."  

Kate's publications include "Mild Stroke Led to Mother's Forced Starvation."

Board Member William Reichel, M.D.

Below is an updated biography for Choice is an Illusion Board Member, William Reichel MD.

As noted below, he was recently named as one of five Pioneers in Geriatric Medicine.  Thank you for your work Dr. Reichel!


William Reichel, M.D.

William Reichel, M.D. is Vice President and a Board member of Choice is an Illusion.  He is also an Affiliated Scholar with the Center for Clinical Bioethics, Georgetown University School of Medicine. Dr. Reichel received his M.D. from Columbia University College of Physicians and Surgeons in 1961. His residency in Internal Medicine was at Stanford Medical Center. He provided leadership in Geriatrics, serving 13 years on the Board of Directors of the American Geriatrics Society, including serving as its President. He was recently named as one of five Pioneers in Geriatric Medicine.  The 6th Edition of a Cambridge University Press text, "Reichel's Care of the Elderly: Clinical Aspects of Aging," was released in February 2009, and the 7th Edition is in preparation.

In his practice, Dr. Reichel saw the many ethical dilemmas that occur in patient care. He thus pursued a study of ethics, at first at Georgetown in 1984, and then as a Visiting Scholar in Medical Ethics at Harvard Divinity School, 1988-1990. At Harvard Divinity School, he concentrated on euthanasia, both in Germany before and during World War II, and in the Netherlands, publishing on assisted suicide and euthanasia. In 1998, Dr. Reichel was appointed to the Center for Clinical Bioethics at Georgetown where he continued his scholarly work that included the study of assisted suicide and euthanasia. Now retired from practice, Dr. Reichel continues as an Affiliated Scholar at the Center for Clinical Bioethics and he continues to participate in the public debate against legalization of assisted suicide and euthanasia. His commentaries in letters to the editor have been published throughout the United States, in Canada, the UK and New Zealand. For example, click here.

William Reichel MD: Dutch law allows euthanasia

Originally published in The Advocate, the Official Publication of the Idaho State Bar, October 2010.
http://www.margaretdore.com/info/October_Letters.pdf
        
I am a physician who has studied assisted-suicide and euthanasia since 1988, especially in the Netherlands.  I respond to Margaret Dore's article, which quotes me for the proposition that those who believe that legal euthanasia and/or assisted suicide will assure their "choice," are naive.  ("Aid in Dying: Not Legal in Idaho; Not About Choice").  The quote is accurate....

In the Netherlands, Dutch law calls for performing euthanasia and assisted suicide with the patient's consent.  This is not, however, always done.  Indeed, over time, assisted-suicide on a strictly voluntary basis evolved into allowing euthanasia on an involuntary basis.  Euthanasia is also performed on infants and children, who are not capable of giving consent.

2005 is the most recent year for which we have an official report from the Dutch government.  The report is "spun" to defend its law, but nonetheless concedes that 550 patients (an average of 1.5 per day) were actively killed by Dutch doctors "without an explicit request."  The report also concedes that an additional 20% of deaths were not reported to the authorities as required by Dutch law.
        
 [Proponents of assisted suicide and euthanasia] hold . . . out the carrot of  "choice" to induce the public into believing that [these practices] are somehow benign.  Do not be misled.

William Reichel, M.D.
Affiliated Scholar
Center for Clinical Bioethics
Georgetown University School of Medicine
Washington DC

Mild stroke led to mother's forced starvation

By Kate Kelly

I watched an old woman die of hunger and thirst.  She had Alzheimer's, this old woman, and was child-like, trusting, vulnerable, with a child's delight at treats of chocolate and ice cream, and a child's fear and frustration when tired or ill.

Kate Kelly with a
photo of her mother.

I watched her die for six days and nights.

I watched her suffer, and I listened to the medical practitioners, to a son who legally decided her fate, and to an eldest daughter who advised him and told me that the old woman, my mother, was "comfortable," except when she was "in distress," at which times the nurses medicated her to make her "comfortable" again.

I watched the old woman develop ulcerations inside her mouth as she became more and more dehydrated; the caregivers assured me these were not painful.

I listened to her breathing become more and more laboured, as her lungs became congested from the morphine administered every three to four hours, and later every hour.

That is what morphine does, you see.  It relieves pain, but its cumulative effect is that eventually it shuts down the respiratory system.

No one explained why the old woman was given morphine in the first place, since she was conscious and trying to speak.  It is normal that a mild stroke causes temporary inability to swallow, slurred speech, and a severe headache, but all of these are often reversed when the stroke victim is treated and the treatment includes nourishment and water.

The explanation for not giving nourishment and water - a feeding tube and IV (intravenous) - is that these were "extraordinary measures" for keeping someone alive.

I watched the old woman day and night for six days.  The first night, after the first shot of morphine, her mouth hung open and her tongue started to roll and flutter.  At the same time, her jaw trembled continuously.

This went on all night and into the early hours of the morning.  Her mouth never closed again, except to clamp tightly on wet cloths placed on her lips.  Her eyes were partially closed, but they moved back and forth, back and forth, becoming small slits after seven or eight hours, not closing fully until that long first night was over.

She opened her eyes only once after that, when the nurse was late with the morphine, on the third, or maybe the fourth, day.

The old woman started to moan.

Not moaning, said the nurses and the old woman's eldest daughter.  Just air escaping from the lungs.  Not moaning at all.

The old woman's eyes started to open, and the air escaping from the lungs sounded exactly like a moan of agony, as the old woman's face twisted in horrible contortions.  I screamed, "Her eyes are opening! Oh, God. Oh, God!"

Even as the morphine, quickly injected by a disconcerted nurse, caused the old woman's eyes to close and her face to relax, I doubted its efficacy.  I thought back to the night before, when I, in tears at the old woman's slow dying, had been confronted by a delegation of four of the nursing staff, each of them in turn trying to convince me that the old woman was not suffering in any way at all.  The morphine, they said, takes away all pain.

But, I answered them, she can feel: she's squeezing my hand, and if I try to take my hand out of hers, she squeezes tighter, and when I hold a little piece of gauze to her lips, she tries to suck the water out of it.  She's thirsty!  This is a horror; this is cruelty!

No, they said.  She's not thirsty.  It's just reflex.  But, I tell them, I watched her clamp her lips on the gauze so tightly that I had to pull to get it out of her mouth.

She reacts when you touch her feet, her legs, and her hair. If she can feel that she can feel thirst, I plead with them.

It's not the same, they tell me.  She's not in pain.

I look at her.  But what if you're wrong? I say.  What if you're wrong?

They stand there, saying nothing.  Then one looks at the old woman and says, we'd better turn her now.  She and another care worker go about the business of repositioning the old woman, to keep her “comfortable" and the other two leave.

The days and nights went in and out of focus.  I sat in a chair at the side of the old woman's bed, one hand grasped tightly by her hand.  I slept an hour or two, here and there, waking always with a start.

"I'm here," I murmured, so the old woman would know I was keeping the promise I made to her on the first night, after her son and eldest daughter left to get some food, drink, and rest.  I promised her then, "I will not leave here until you do.

The old woman was fading by the fourth day.  Her eldest daughter had been visiting for an hour or so each day, usually mid-morning.  This daughter, a former hospital worker, lightly stroked her mother's face and hair and timed the length of her mother's "breath apnea," the length of time her mother

stopped breathing.

She announced the number of seconds, and then counted the number of breaths between each stopped breath.  Seven breaths, she said, 11 breaths.

Sometimes she described the progress of her mother's death, She's probably down to about 60 pounds now, she pronounced.

Sometimes - I'm not sure when I noticed it first - the nurses asked us to leave while they attended to the old woman.  Other times they didn't.  Once, perhaps on the fourth day, I told them I didn't have to leave: I had watched them turn her, I had seen her tiny naked body as they gently washed her.  I didn't even flinch anymore when they injected the syringe of morphine.

We have to give her a suppository, they said.

A suppository?  Why?

For anxiety, they said.

Anxiety.  So that she would appear to die with dignity.  The morphine was no longer enough.  This courageous old woman, who could face, who had faced, unimaginable hardships with nothing but her faith and her dignity, she could teach you about dignity, I thought to myself.

On the fifth day the eldest daughter visited twice.  On her second visit, several staff members entered the room with her.   They were all talking loudly, about nothing in particular, except for one care worker, fond of the old woman, who walked over to the bed and called the old woman's name loudly enough to interrupt the others' light conversation.  She examined the old woman's hands, lifted the sheet covering her and looked at her legs and feet.  She called the old woman's name again, and the care worker's face showed alarm.

How long has it been? she asked.  She's not even mottling! (Mottling is the term given to describe the blackening of the feet and hands as the body, dehydrating, tries to preserve the vital organs by stopping the flow of blood to the limbs).

You know, continued the care worker, I don't think it's her time.  It's been, what, five days?  If she had been ready to go, she'd have gone in 24 hours.

The room went quiet.  The care worker and I looked at each other.  You're right, I said.  The eldest daughter and one of the nurses began to tell her she was wrong, and a nurse hustled her out of the room.

By the sixth night I was not sure I could go on.  I slept for an hour or so every four or five hours. I still sat in the chair by her bed, but now I slept with my head on bed, near her stomach.

The old woman's breathing was laboured, her will to live defying the system and the foolish young doctor who, on that first night, gave her 24 hours to live, as though he were God Himself.

My heart was breaking for her.  I could do nothing to save her, could do nothing but suffer with her.  I cried much of the time, but softly, so she would not know.  I didn't want to add to her agony.

I had been there six days.  She could no longer hold my hand, so I slipped my hand gently under hers.  I felt an anguish so profound that I began to wonder if I could survive it.

The old woman's breathing was suddenly no longer laboured.  Her breath eased from her, and her face - oh, her face had become the colour of pearls.

In a split second, the frown that had creased the line between her brows was smoothed away.  Her head rested gently to one side.  Two care workers entered the room.  I saw them in my peripheral vision, but I kept my gaze on the old woman.

We're just going to turn her, one of the workers said.

No, I said, my mother is dying.

One of them left to get a nurse, and then the old woman - my dear mother, my little, child-like, beautiful mother - died.

I put my arms round her, kissed her poor, closed eyes and her now relaxed mouth, and held her limp, tiny body, no more struggling for breath.

I watched an old woman die of hunger and thirst.  I watched her die for six days and nights.  I watched her suffer, and struggle, and hold onto life.

She had not often found life easy, but she had always found it worthwhile.  She was 94 years old.  She had been born and had lived all her life in Canada.  She had worked hard all her life, married, raised three children, voted, paid taxes, saved enough money to buy her own home, obeyed the laws, donated to charity, done volunteer work, paid her bills, and given much love and brought much joy to many, many people in her 94 years.

In return, in the spring of 2009, her son and her eldest daughter, with the permission and assistance of the law, because this old woman had had a mild stroke, refused her food and water.  She could not swallow, so she would have needed the food and water administered artificially.

And the youngest daughter could do nothing except watch her mother die slowly, and write this, in the hope that my mother's death, like her life, will have made a difference.

* * *

Kate Kelly is a member of the Board of Choice is an Illusion.  She is also a teacher, a jazz singer and a former newspaper reporter.  To read more about Kate, click here.