Tuesday, October 21, 2014

The Brittany Maynard Case Illustrates Problems With Legal Assisted Suicide.

By Margaret Dore, Esq., MBA

Brittany Maynard is a beautiful young woman with a brain tumor.  For the last two weeks, her story has been promoted by the former Hemlock Society, now known as Compassion & Choices, in an aggressive multi-media campaign.

1. There is a Risk of Suicide Contagion.

It is well known that media reporting of suicide can encourage other suicides, for example, a "copycat suicide" or a "suicide contagion." A famous example is Marilyn Monroe.  Her widely reported suicide was followed by a increase in other suicides.

This encouragement phenomenon can also occur when the inspiring death is not a suicide.  An example is the televised hanging of Saddam Hussein, which led to suicide deaths of children worldwide.  An NBC News article begins:
The boys' deaths - scattered in the United States, in Yemen, in Turkey and elsewhere in seemingly isolated horror - had one thing in common:  They hanged themselves after watching televised images of Saddam Husseins' execution.
http://www.nbcnews.com/id/16624940/ns/world_news-mideast_n_africa/t/copycat-hangings-follow-saddam-execution/#.VDr5AfldWSo

Groups such as the National Institute of Health and the World Health Organization have developed guidelines for reporting suicide. Important points include that the risk of additional suicides increases "when the story explicitly describes the suicide method, uses dramatic/graphic headlines or images, and repeated/extensive coverage."  http://www.nimh.nih.gov/health/topics/suicide-prevention/recommendations-for-reporting-on-suicide.shtml See also: http://www.who.int/mental_health/prevention/suicide/resource_media.pdf

The media campaign by the suicide advocacy group, Compassion & Choices, to promote the death of Ms. Maynard, by "aid in dying," a euphemism for legal assisted suicide in Oregon, violates all of these guidelines.  We are told of the planned method, when and where it will take place and who will be there.  There is repeated extensive coverage in multiple media.

With this situation, the risk of suicide contagion associated with Compassion & Choices' media campaign is real.  The persons at risk include children.

2. Family Members who Witness an Assisted Suicide Can be Traumatized.

According to media reports, Ms. Maynard's plan is to have her family present when she goes, and that with this situation, she hopes to spare them emotional pain.[1]  If so, she may want to reconsider her plan.  A Swiss study of family members and friends who witnessed legal assisted-suicides in Switzerland found that 20% had “severe mental health problems at 14 to 24 months post-loss.”

Here's a link to an article about the study: http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf  Here's the conclusion:
[T]he findings suggest that witnessing death by assisted-suicide impacts the mental health of family members and friends.  About 20% of our respondents had full or partial PTSD and 16% had symptoms of depression after about 19 months after the death. Witnessing the unnatural death of a significant person thus seems to have a strong impact on the bereaved, which may lead to severe mental health problems at 14 to 24 months post-loss.  Id.
3.  Legal Assisted Suicide Encourages People with Years to Live, to Throw Away Their Lives.

In Oregon, assisted suicide is legal for persons with a “terminal disease,” which is defined in terms of a prediction of less than six months to live.[2]

According to media reports, Ms. Maynard has a brain tumor, which is end stage and death is “certain.”  On the other hand, doctors can be wrong.  Consider this article from Washington State, describing the case of Maryanne Clayton:
She . . . had Stage IV lung cancer, the most advanced form there is. Her tumor had metastasized up her spine. . . . The doctor gave [her] two to four months to live. . . . 
That was almost four years ago.[3]
Legal assisted suicide encourages people with years to live, to throw away their lives.

4. Assisting Persons, including Institutions and Organizations, can have their own Agendas.

The recent Melchert-Dinkel case shows a reality that people tend to forget, that with legal or illegal assisted suicide, the assisting person can have an agenda.  For Melchert-Dinkel, his agenda was to get other people to hang themselves in front of his webcam.  He told police that he did it for the "thrill of the chase"  See http://www.independent.co.uk/news/world/americas/suicideobsessed-us-nurse-convicted-of-helping-coventry-man-kill-himself-9722534.html

Meanwhile, in Oregon, that state's Medicaid program has a well-documented agenda to steer patients to suicide via coverage incentives.  See https://maasdocuments.files.wordpress.com/2014/08/bradley-c-c-missoulian-as-published.pdf  Similarly, the former Hemlock Society, Compassion & Choices, has an agenda for a public policy change, to reduce patient access to cures.  Id.

Compassion & Choices also has an agenda to ensure that its assisted suicides succeed.  They are nearly always present during Oregon assisted suicides.  They also encourage family members to be present, which as noted above, is reportedly contemplated by Ms. Maynard.  With this situation, the event is similar to a wedding, in which everyone is there and watching. There can be social pressure to go forward.

* * *
Margaret Dore is an attorney in Washington State where assisted suicide is legal.  She is a former Law Clerk to the Washington State Supreme Court.  She is President of Choice is an Illusion, a 501(c)(4) nonprofit corporation.  Choice is an Illusion welcomes everyone opposed to assisted suicide and euthanasia regardless of your views on other issues.  See www.margaretdore.com  www.choiceillusion.org 

[1] See https://choiceisanillusion.files.wordpress.com/2014/10/29-year-old-woman_-why-im-taking-my-own-life.pdf (regarding Ms. Maynard's intention to have her family present, with one of her goals being “to put myself through less physical and emotional pain and my family as well”). (Emphasis added).  
[2] ORS 127.800 s.1.01(12).
[3]Nina Shapiro, "Terminal Uncertainty," Washington's new "Death with Dignity" law allows doctors to help people commit suicide - once they've determined that the patient has only six months to live. But what if they're wrong? The Seattle Weekly, January 14, 2009. For un-formatted online version, go here: http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty  For pdf, go here:  https://choiceisanillusion.files.wordpress.com/2013/10/terminal-uncertainty.pdf

Thursday, October 16, 2014

Three Reasons that Assisted-Suicide Should not be Legalized.

1.  Legal Assisted Suicide Encourages People with Years to Live to Throw Away Their Lives.

In the US, assisted suicide is generally being proposed for terminally ill people.  In this context, the phrase, "terminally ill," includes many people who aren't dying or even close to death. Examples include a healthy 18 year old diabetic, who is dependent on insulin, and my friend, Jeanette Hall, who was talked out of assisted suicide fourteen years ago. See http://choiceisanillusion.files.wordpress.com/2012/07/schrempp_wonderly_opn_ltr1.pdf and http://choiceisanillusion.files.wordpress.com/2014/06/nj-a2270-legal-analysis_001.pdf

Consider also, John Norton, who was diagnosed with ALS. He was told that he would get progressively worse (be paralyzed) and die in three to five years.  Instead, the disease progression stopped on its own.  In a 20l2 affidavit, at age 74, he states:
If assisted suicide or euthanasia had been available to me in the 1950's, I would have missed the bulk of my life and my life yet to come.
http://www.massagainstassistedsuicide.org/2012/09/john-norton-cautionary-tale.html

2.  Assisted Suicide Laws are Stacked Against the Patient.

Assisted suicide laws, for example, in Oregon and Washington, are stacked against the patient  This is because their ultimate purpose is to allow other people to encourage a patient towards suicide, or to kill the patient, i.e., without their getting into trouble.

In Oregon and Washington, the most obvious problem for the patient, is a complete lack of oversight when the lethal dose is administered. Not even a witness is required.  Even if the patient struggled, who would know?  See e.g., https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm

As for Montana, assisted suicide is not legal and subject to ongoing litigation in that state's Supreme Court.  See e.g. https://maasdocuments.files.wordpress.com/2014/08/bradley-c-c-missoulian-as-published.pdf and http://www.montanansagainstassistedsuicide.org/2014/02/maas-appeals-medical-examiner-board.html

3.  Assisting Persons, including Institutions, can have their own Agendas.

The recent Melchert-Dinkel case shows a reality that people tend to forget, that with legal or illegal assisted suicide, the assisting person can have an  agenda.  For Melchert-Dinkel, his agenda was the "thrill of the chase."

In a recent Montana case, the defendant's agenda was to prevent a 15 year old girl from testifying against him.  Similar to Melchert-Dinkel, he allegedly got her on a webcam.  But, instead of talking about hanging, he allegedly pushed her to slash her wrists and take prescription pills instead.  Fortunately, according to charging documents, she got scared and sought help from her parents.  See http://billingsgazette.com/news/local/crime-and-courts/convicted-rapist-charged-with-aiding-or-soliciting-suicide-of-victim/article_65c2f39c-ae01-5104-a279-da45b352ef42.html

Meanwhile, in Oregon, that state's Medicaid program has a well-documented agenda to steer patients to suicide via coverage incentives.  Similarly, the former Hemlock Society, Compassion & Choices, has an agenda for a public policy change, to reduce patient access to cures.  See http://www.montanansagainstassistedsuicide.org/2014/08/bradley-williams-takes-on-compassion.html and http://www.choiceillusion.org/2014/09/bradley-williams-uses-coombs-lees-own.html

Family members and other people can have an agenda in the inheritance context, for example, to get rid of mom before she changes her will.  See http://www.choiceillusion.org/2014/02/preventing-abuse-and-exploitation.html and http://www.montanansagainstassistedsuicide.org/2013/03/physician-assisted-suicide-part-of.html

Don't be fooled.

Margaret Dore, Esq., MBA
Law Offices of Margaret K. Dore, P.S.
Choice is an Illusion, a non-profit 501(c)(4) corporation
www.margaretdore.com
www.choiceillusion.org
1001 4th Avenue, 44th Floor
Seattle, WA  98154
206 389 1754

Friday, February 21, 2014

Not Dead Yet: "American Bar Association Newsletter Features Margaret Dore Article on Elder Financial Abuse and Assisted Suicide"

http://www.notdeadyet.org/2014/02/american-bar-association-newsletter-features-margaret-dore-article-on-elder-financial-abuse-and-assisted-suicide.html 

In a new article that appeared in The Voice of Experience newsletter of the American Bar Association, Washington State elder law attorney Margaret Dore explained how she got involved in the fight against [the] legalization of assisted suicide.  The ABA newsletter is only available to subscribers, but the article, Preventing Abuse and Exploitation: A Personal Shift in Focus. An article about guardianship, elder abuse and assisted suicide, also appears on Dore's Choice Is An Illusion website.

Dore recounted some early experiences in handling guardianship cases involving elders.  Initially, she worked within the system, but then things changed:

. . . 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. . . .

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 http://www.margaretdore.com/pdf/Dore_AJFL_Winter08.pdf
Dore's career as an elder law attorney brought new elements to the discussion of potential issues affecting elders who might be victimized.  As Dore noted in her ABA article:

In 2011, Met Life released [a . . ] study . . . , 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."   [The study is available at www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf.]
Dore went on to connect the dots between elder financial abuse and assisted suicide:

In the United States, physician-assisted suicide is legal in three states:  Oregon, Washington and Vermont. . . .

All three laws are a recipe for abuse.  One 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?
In this and other legal articles, Dore has brought new analysis and valuable insights to the public debate over legalization of assisted suicide.  The majority of reported cases in Oregon and Washington involved people with education and resources.  Unfortunately, an elder's resources are no safeguard against abuse.  In fact, Dore's voice of experience would suggest that resources may instead be a motivation for it. -  Diane Coleman

Wednesday, February 5, 2014

Preventing Abuse and Exploitation: A Personal Shift in Focus

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 atwww.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 athttp://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.  Seewww.metlife.com/assets/cao/mmi/publications/studies/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 atwww.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.