Tuesday, November 4, 2014

Euthanasia without patient consent and over the family's objection

This last August, the Washington Post did a feature article on how non-dying people are being killed in hospices. See http://www.washingtonpost.com/news/storyline/wp/2014/08/21/as-more-hospices-enroll-patients-who-arent-dying-questions-about-lethal-doses-arise/?   

I have had many people contact me with similar stories.  Below, please find the latest one by a Romanian immigrant.  I hope that more doctors, nurses and other healthcare professionals can speak out about these cases, before it's too late.

Margaret Dore, Esq., MBA, President
Choice is an Illusion, a 501(c)4 nonprofit corporation


Case in Point: 


My name is Daniela. I am 46 years old and live in Oregon. I believe my grandmother was killed in a hospital on June 24, 2014. She was in the emergency room for three hours and was given morphine after we had refused it and clearly asked for her right to die naturally. The nurse told me that it was time to say goodbye and she died almost immediately upon receiving that shot. I have the medical records, but there is no notation of the morphine she was given, which makes me believe the records were falsified. 

Elisabeta KoczurThe photograph to the left is of Elisabeth Koczur.

The last wish my grandma had was for a drink of water. I don't think I will ever forget how she looked at me expecting help. Four nurses in the room imprisoned me and I could not move. I was forced to keep looking in her eyes as she pleaded for water. Why was I not allowed to grant her last wish?

Our family is in shock and is having emotional problems because of what we witnessed. My grandma went to the hospital with abdominal pain and shortness of breath. There, according to the medical records, she was diagnosed to have congestive heart failure, but, when she went into cardiac arrest, they did not attempt to resuscitate her. If she had received proper treatment, she might be here with us today. Grana, as I called her, was 99 years old. I think they decided that she had lived too long, but they did not know this beautiful soul.

Grana was from Romania and had suffered many horrible things in her life. She was a war orphan and spent her life helping other Romanian orphans, myself included. Like so many immigrants, we left our homes and land searching for freedom which turned out to be an illusion. We arrived in the West where we worked hard and were looked down upon. Our hearts cried so many times because of how we were treated in this foreign land, but it was too late to return home. My sons were born and we had to look ahead.
Elisabeth Koczur as she aged.Photograph is of Elisabeth Koczur in middle age.

Grana didn't speak English. She was old and partially deaf, but everyday she would learn a new word and was proud of her achievements. She taught my sons to speak, read and write our Romanian language. They read the Bible to her because her eyes were damaged in the German factory where she worked during World War II. The Germans were testing gas masks on the employees. Every day she had to stay in a room with a mask on until tears would come from her eyes. When the Germans would see that through the glass panel behind which they stood, they would let her out. That is how she lost her vision. Grana endured more than I could ever write about. She was raped by Russians recruited to work for the Germans. She was orphaned during World War I and never knew her father who died before she was born. Being poor she had to work hard to earn a living. I don't know anyone who was persecuted and endured as many hardships as my grandma, and all with great hope in her heart.   

I was an unwanted pregnancy. Grana gave me the chance to see the light. We lived together for 46 years. When I was an infant, God partnered me with my grandma, placing me in her loving and caring hands. When she was elderly and infirm I prayed everyday that I would be able to give her the same tender loving care. God granted my prayer until that night when the hospital separated us. Now I cannot sleep because I have nightmares. In our culture the last wish is greatly respected and now I hear my grandma cry for water every night. I was left alone in the exam room for hours with her dead body in my arms kissing her and praying for her. A hospital chaplain stopped by for a few minutes and told me that I am selfish not to let God enjoy my grandma. I felt that something broke in my head when I heard that. 
   
Elisabeta Koczur, age 99, three weeks before she was morphined to death at Kaiser ClackamasPhotograph to the left is of Elisabeth Koczur three weeks before her death at the age of 99 years.

I'm alone and afraid. I saw how the crooked* sentenced Grana to die and I know my life is in their hands as well. When I no longer produce, I will be removed. Pray, you who read, that the souls of the departed in the hospitals of this country find peace! And pray for our souls, the souls of those who still live. We should not rest until justice is done. Otherwise we will die, one by one, defeated by the darkness.

I enjoyed listening to my grana's stories about heaven and hell and how the dead people would rise from their graves to be judged when the Angel Gabriel blew his silver trumpet on the Last Day. Oh, and how I wait that day.

*Editor's note: Daniela uses "crooked" to mean healthcare providers who deviate from what is just and good.

Grave Marker for Elisabeth Koczur

Location of Elisabeth Koczur - Her grave is the one with the hanging basket.Elisabeta Koczur's burial location - To view this location full size click on the picture.



Documentation which demonstrates falsified medical records, misdiagnosis and intentional death by morphine which the family and patient begged the Kaiser staff to stop doing.

Koczur Medical Records obtained from Kaiser Permanente, including ambulance records -  This is a large pdf file.

Elisabeth Koczur Certificate of DeathElisabeta Koczur Certificate of Death - http://horror.kaiserpapers.org/images/koczur-certificate-of-death.JPG

Monday, November 3, 2014

Three bullet points against assisted suicide

1.  Legal assisted suicide encourages people with years to live to throw away their lives.  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? The Seattle Weekly, January 14, 2009,   https://choiceisanillusion.files.wordpress.com/2013/10/terminal-uncertainty.pdf

2.  Legal assisted suicide is a recipe for elder abuse, for example, in the inheritance context.  See this short bar article (non-lawyers say they like it):  https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm 

3.  Once assisted suicide is legal, there is pressure to expand to euthanasia for non-terminal people, for example, to you or your family member, who through no fault of their own, falls on hard times:  http://www.montanansagainstassistedsuicide.org/2014/10/this-is-how-society-will-pay-you-back_9.htm

Friday, February 21, 2014

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

Diane Coleman
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.