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Thursday, March 1, 2012

The Massachusetts Assisted-Suicide Initiative Fact Check: The Baloney Meter is Running High


Margaret Dore
March 1, 2012
1.  Legalization will Empower the Government

Proponents claim that legalizing assisted suicide will keep the government out of people's lives.  The opposite is true.

Fact check:  In Oregon, where assisted suicide is legal, legalization has allowed the Oregon Health Plan, a government entity, to steer people to suicide.  The most well known cases involve Barbara Wagner and Randy Stroup.  Each wanted treatment.  The Plan denied coverage and steered them to suicide by offering to cover the cost of their suicides instead.  See  See Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, August 6, 2008; and "Letter noting assisted suicide raises questions," KATU TV, July 30, 2008.


2.  The Initiative Allows Someone Else to Administer the Lethal Dose

Proponents claim that only the patient may administer the lethal dose.  This is not true.

Fact check:  The initiative, H.3884, states that patients "may" self-administer the lethal dose. There is no language stating that administration “must” be by self-administration.  "Self-administer" is also a specially defined term that allows someone else to administer the lethal dose to the patient.  See here.

3.  An Heir is Allowed to Witness the Lethal Dose Request

Proponents claim that the lethal dose request form must be "independently witnessed" by two people.  This is not true. 

Fact check:  The initiative, Sections 3 and 21, provides that one of two witnesses on the lethal dose request form cannot be a patient’s heir or other person who will benefit financially from the patient's death; the other witness can be an heir or other person who will benefit financially from the death.


4.  Substantial Compliance

Proponents claim that the initiative has "strict safeguards" to protect patients.  The initiative, however, only requires "substantial compliance" with its provisions.  Section 18(1)(a) states:  "A person who substantially complies in good faith with provisions of this chapter shall be deemed to be in compliance with this chapter."

5.  Assisted Suicide is a Recipe for Elder Abuse

Proponents claim that the initiative is safe, which is not true.

Fact check:  The initiative does not require witnesses at the death.  Without disinterested witnesses, the opportunity is created for an heir, or someone else who will benefit financially from the death, to administer the lethal dose to the patient without the patient's consent.  Even if he struggled, who would know?


6.  Patients are not Necessarily Dying

Proponents imply that the initiative only applies to people in their "final days." This is untrue.

Fact check:  See Nina Shapiro, "Terminal Uncertainty — Washington's new 'Death with Dignity' law allows doctors to help people commit suicide — once they've determined that the patient has only six months to live. But what if they're wrong?," Seattle Weekly, January 14, 2009; and Jeanette Hall, "She pushed for legal right to die, and - thankfully - was rebuffed," Boston Globe, October 4, 2011.

7.  Assisted Suicide is a Wedge Issue
 
Proponents deny that assisted suicide is a "wedge issue" to legalize direct euthanasia of non-terminal people.

Fact check:  In Washington state, where assisted suicide has been legal since 2009, there has been a proposal to expand Washington's law to direct euthanasia for non-terminal people.  See Brian Faller, "Perhaps it's time to expand Washington's Death with Dignity Act," The Olympian, November 16, 2011.


8.  Legal Assisted Suicide Threatens People with Disabilities

Proponents claim that people with disabilities are not at risk from legalization of assisted suicide, which is untrue.

Fact check:  Disability rights groups such as Not Dead Yet oppose assisted suicide as a threat to their lives.  In Oregon and Washington, official government forms for assisted suicide acts in those states promote disability as a reason to commit suicide.[1]  People with disabilities are thereby devalued.  In 2009, there was a proposed assisted suicide bill in New Hampshire that squarely applied to people with disabilities.[2]  If the initiative were to be passed now, people with disabilities see themselves as potentially next in line under a future expansion of that law.  As noted above, there has already been a proposal in Washington state to expand its law to direct euthanasia for non-terminal people.
 

* * * 


[1]  See e.g. "Oregon Death with Dignity Act Attending Physician Follow-up Form," question 15, providing seven suggested answers as to why there was a lethal dose request.  Some of the answers are written in terms of disability being an acceptable reason to kill yourself.  These answers include:  "[A] concern about . . . the loss of control of bodily functions."
[2]  Stephen Drake and Not Dead Yet, "New Hampshire Poised to Redefine "Terminally Ill" - to PWDs and others for Assisted Suicide Eligibility," January 30, 2009 (regarding New Hampshire's 2009 assisted suicide bill, HB 304, which applied to people with disabilities, people with HIV/AIDS and other non-dying people).

Saturday, November 19, 2011

A Better Response Would be to Repeal Washington's Act as a Fraud on the Voters

On November 16, 2011, an article appeared in a Washington State newspaper arguing for expansion of Washington's physician-assisted suicide act to direct euthanasia and to persons without a terminal disease.[1]  The author, Brian Faller, candidly admitted:  "To improve the chances of passage, the Death with Dignity Act was written to apply only to the choices of the terminally ill who are competent at the time of their death."[2]  Now, he shows the other side's true colors.

In any case, this is my response:

Dear Editor:

I am an attorney who has written multiple articles about our physician-assisted suicide act. I am also President of Choice is an Illusion, a non-profit corporation opposed to assisted-suicide. I disagree with Brian Faller that our physician-assisted act should be expanded to include direct euthanasia. A better course would be to repeal that act as a fraud on the voters.

Our assisted-suicide act was enacted as Initiative 1000 in 2008 and went into effect in 2009. During the election, proponents claimed that its passage would assure individuals control over their deaths. The act is instead a recipe for elder abuse. Key provisions include that a patient’s heir, who will benefit financially from his death, is allowed to actively assist him to sign up for the lethal dose. Specifically, an heir is allowed to be one of two witnesses on the lethal dose request form. In the context of a will, the same situation would create a presumption "duress, menace, fraud, or undue influence." (RCW 11.12.160(2)).

There are also no witnesses required at the death. Without disinterested witnesses, the opportunity is created for someone else, including an heir, to administer the lethal dose to the patient without his consent. Even if he struggled, who would know?

The idea that our act promotes patient control or individual liberty is untrue. Our act instead puts older people and others in the cross-hairs of abuse. For more information, please see www.choiceillusion.org and click on the page for Washington State.

* * *
[1]  Brian Faller, "Perhaps it's time to expand Washington's Death with Dignity Act, The Olympian, November 16, 2011, available at http://www.theolympian.com/2011/11/16/1878667/perhaps-its-time-to-expand-washingtons.html
[2]  Id.

Wednesday, November 9, 2011

"No, physician-assisted suicide is not legal in Montana: It's a recipe for elder abuse and more"

By State Senator Jim Shockley and Margaret Dore
Published in The Montana Lawyer
The State Bar of Montana[1]

Introduction

There are two states where physician-assisted suicide is legal: Oregon and Washington.  These states have statutes that  give doctors and others who participate in a qualified patient’s suicide immunity from criminal and civil liability.  (ORS 127.800-995 and RCW 70.245). 

In Montana, by contrast, the law on assisted suicide is governed by the Montana Supreme Court decision, Baxter v. State, 354 Mont. 234 (2009).  Baxter gives doctors who assist a patient’s suicide a potential defense to criminal prosecution.  Baxter does not legalize assisted suicide by giving doctors or anyone else immunity from criminal and civil liability.  Under Baxter, a doctor cannot be assured that a suicide will qualify for the defense.  Some assisted suicide proponents nonetheless claim that Baxter has legalized assisted suicide in Montana.

Legalizing assisted suicide in Montana would be a recipe for elder abuse.  The practice has multiple other problems.

What is physician-assisted suicide?

The American Medical Association (AMA) states: “Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act.”  (Code of Medical Ethics Opinion 2.211).  For example, a “physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide.”  (Id.)

The Baxter decision

Baxter found that there was no indication in Montana law that physician-assisted suicide, which the Court termed “aid in dying,” is against public policy.  (354 Mont. at 240, ¶¶ 13, 49-50).  Based on this finding, the Court held that a patient’s consent to aid in dying “constitutes a statutory defense to a charge of homicide against the aiding physician.”  (Id. at 251, ¶ 50).

Baxter, however, overlooked elder abuse.  The Court stated that the only person “who might conceivably be prosecuted for criminal behavior is the physician who prescribes a lethal dose of medication.”  (354 Mont. at 239, ¶ 11).  The Court thereby overlooked criminal behavior by family members and others who benefit from a patient’s death, for example, due to an inheritance.

Baxter also overlooked caselaw imposing civil liability on persons who cause or fail to prevent a suicide.  See Krieg v. Massey, 239 Mont. 469, 472-3 (1989) and Nelson v. Driscoll, 295 Mont. 363, ¶¶ 32-33 (1999).  Baxter is, regardless, a narrow decision in which doctors cannot be assured that a suicide will qualify for the defense.  Attorneys Greg Jackson and Matt Bowman provide this analysis:

If the idea of suicide itself is suggested to the patient first by the doctor or even by the family, instead of being on the patient's sole initiative, the situation exceeds "aid in dying" as conceived by the Court.  If a particular suicide decision process is anything but "private, civil, and compassionate," . . . , the Court's decision wouldn't guarantee a consent defense.  If the patient is less than "conscious," is unable to "vocalize" his decision, or gets help because he is unable to "self-administer," or the drug fails and someone helps complete the killing, Baxter would not apply. . . .
No doctor can prevent these human contingencies from occurring in a given case . . . in order to make sure that he can later use the consent defense if he is charged with murder.
“Analysis of Implications of the Baxter Case on Potential Criminal Liability,” Spring 2010, at  http://www.montanansagainstassistedsuicide.org/p/baxter-case-analysis.html


The 2011 Legislative Session

The 2011 legislative session featured two bills in response to Baxter, both of which failed: SB 116, which would have eliminated Baxter’s potential defense; and SB 167, which would have legalized assisted suicide by providing doctors and others with immunity from criminal and civil liability.

During a hearing on SB 167, the bill's sponsor, Senator Anders Blewett, said:  “[U]nder current law, ... there’s nothing to protect the doctor from prosecution.”  ( http://maasdocuments.files.wordpress.com/2011/07/blewett_speckhart_trans_001.pdf ).  Dr. Stephen Speckart made a similar statement: "[M]ost physicians feel significant dis-ease with the limited safeguards and possible risk of criminal prosecution after the Baxter decision."  (Id. at p.2)

Legalization would create new paths of abuse

In Montana, there has been a rapid growth of elder abuse.  Elders' vulnerabilities and larger net worth make them a target for financial abuse.  The perpetrators are often family members motivated by an inheritance.  See e.g.  www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf .

Preventing elder abuse is official Montana state policy.  See e.g., 52-3-801, MCA.  If Montana would legalize physician-assisted suicide, a new path of abuse would be created against the elderly, which would be contrary to that policy.  Alex Schadenberg, Chair of the Euthanasia Prevention Coalition, International, states:
With assisted suicide laws in Washington and Oregon, perpetrators can . . . take a 'legal' route, by getting an elder to sign a lethal dose request.  Once the prescription is filled, there is no supervision over the administration. . . . [E]ven if a patient struggled, “who would know?
http://www.isb.idaho.gov/pdf/advocate/issues/adv10oct.pdf, p. 14.

“Terminally Ill” Does Not Mean Dying

Baxter’s potential defense applies when patients are "terminally ill," which Baxter does not define.  In Oregon, “terminal” patients are defined as those having less than six months to live.  Such persons are not necessarily dying.  Doctors can be wrong.  Moreover, treatment can lead to recovery.  Oregon resident, Jeanette Hall, who was diagnosed with cancer and told that she had six months to a year to live, said:


I wanted to do our [assisted suicide] law and I wanted my doctor to help me.  Instead, he encouraged me to not give up . . .  I had both chemotherapy and radiation. . . .
It is now 10 years later.  If my doctor had believed in assisted suicide, I would be dead. 
http://mtstandard.com/news/opinion/mailbag/article_aeef3982-9a98-11df-8db2-001cc4c002e0.html 
Legal physician-assisted suicide empowered the Oregon Health Plan, not individual patients 

Once a patient is labeled “terminal,” an easy argument can be made that his or her treatment should be denied.  This has happened in Oregon where patients labeled “terminal” have not only been denied coverage for treatment, they have been offered assisted-suicide instead.

The most well known cases involve Barbara Wagner and Randy Stroup.  (KATU TV, at http://www.katu.com/news/26119539.html , ABC News, at http://www.abcnews.go.com/Health/Story?id=5517492  Ken Stevens, MD, at pp. 16-17, at http://choiceillusionoregon.blogspot.com/p/oregons-mistake-costs-lives.html).  The Oregon Health Plan refused to pay for their desired treatments and offered to pay for their suicides instead.  Neither Wagner nor Stroup saw this as a celebration of their “choice.”  Wagner said: “I’m not ready to die.”  Stroup said: “This is my life they’re playing with.”
            
Stroup and Wagner were steered to suicide and it was the Oregon Health Plan doing the steering.  Oregon’s law empowered the Oregon Health Plan, not individual patients.

Oregon’s studies are invalid

Oregon’s statute does not require a doctor to be present when the lethal dose is administered.  (ORS 127.800-995).  During a hearing on SB 167, Senator Jeff Essmann made a related point, as follows:
[A]ll 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 Transcript, February 10, 2011, p.15, at http://www.margaretdore.com/pdf/senator_essmann_sb_167_001.pdf

Public confusion

In Montana, the moving force behind legalizing assisted suicide is Denver-based Compassion & Choices.  On September 15, 2011, that organization’s president published an article on Huffington Post claiming that under Baxter physicians in Montana are “safe from prosecution.”  ( http://www.huffingtonpost.com/barbara-coombs-lee/aid-in-dying-montana_b_960555.html )  This is clearly not the case and  propaganda.  A physician relying on her advice could be charged with homicide.

Conclusion  

Baxter is a flawed decision that overlooked elder abuse.  Baxter has created confusion in the law, which has put Montana citizens at risk.  Neither the legal profession nor the medical profession has the necessary guidance to know what is lawful. 


Legalizing assisted suicide is bad public policy.  Doctors’ diagnoses can be wrong and legalization is a recipe for abuse.  Legalization would also allow the state government to encourage citizens to kill themselves.  This is an area where the government does not belong.  Montana consistently has one of the highest suicide rates in the nation.   Montana doesn’t need the “Oregon Experience.”


Legislation should be enacted to overrule Baxter and clearly declare that assisted suicide is not legal in Montana.  
      
* * *

Senator Jim Shockley, of Victor, is a Republican State Senator, probate lawyer, and an adjunct instructor at the University of Montana School of Law. 

Margaret Dore is an attorney in Washington State where assisted suicide is legal.  She is also President of Choice is an Illusion, a nonprofit corporation opposed to assisted-suicide.  (www.choiceillusion.org)  She is a Democrat.  

* * *

[1] To read this article as published in The Montana Lawyer and the opposing article by Senator Anders Blewett, go here:

Wednesday, October 19, 2011

Don't be fooled by assisted-suicide bill

http://www.lowellsun.com/editorials/ci_19137188
The Lowell Sun
Updated: 10/18/2011 09:27:53 AM EDT

This letter responds to Marie Donovan's article about the proposed Massachusetts death-with-dignity act, which seeks to legalize assisted suicide in your state (" 'Death with Dignity Act' renews end-of-life debate"). I am an attorney in Washington state, one of just two states where physician-assisted suicide is legal. The other state is Oregon. I am also president of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide as an issue of public safety (
www.choiceillusion.org).

In both Washington and Oregon, assisted-suicide laws were passed via highly financed sound-bite, ballot-initiative campaigns. No such law has made it through the scrutiny of a legislature -- despite more than 100 attempts. This year, a bill was defeated in the New Hampshire House, 234 to 99.

The proposed Massachusetts act is a recipe for elder abuse. Key provisions include that an heir, who will benefit financially from a patient's death, is allowed to actively help sign the patient up for the lethal dose. See e.g., Section 21 allowing one of two witnesses on the lethal-dose request form to be an heir (
http://www.mass.gov/Cago/docs/Government/2011-Petitions  ).

Once the lethal dose is issued by the pharmacy, there is no oversight over administration. The proposed act does not require that a doctor or anyone else be present at the time of death. This creates the opportunity for an heir, or another person who will benefit from the death, to administer the lethal dose to the patient without the patient's consent. Even if he struggled, who would know?

Donovan's article prominently features a discussion of religion. In Washington state, proponents used similar discussions and even religious slurs to distract voters from the pitfalls of legalization. What the proposed law said and did was all but forgotten.

Do not be deceived.
/11-12.pdf
MARGARET DORE
Choice is an Illusion
Seattle, Wash.

Thursday, October 6, 2011

Hawaii: An Odd Claim of Legality

Barbara Coombs Lee has a new article on Huffington Post, claiming that physician-assisted suicide ("aid in dying") is legal in Hawaii.  This is an odd claim given that bills to legalize assisted suicide in Hawaii have repeatedly failed, most recently this year.[1]

Coombs Lee's article begins with a discussion of melting snow, moves on to a panel of experts, focuses on Montana and then finally discusses the law of Hawaii.[2]  With regard to Hawaii, her arguments are similar to those presented in a brief drafted by Kathryn Tucker.[3]  My prior critique of that brief states in part:

"In Hawaii, bills to enact physician-assisted suicide have repeatedly failed and/or been defeated in the Legislature since at least 2002.[7] This fact alone is sufficient to defeat Tucker's claim that [a 1909] statute has somehow already legalized assisted suicide.  Consider for example, Lawrence v. Lawrence, 105 Wn.App. 683, 687-8, 20 P.3d 972 (2001).  The Washington State Court of Appeals held that the "friendly parent concept" was not the law because bills to enact it had been rejected by the legislature.  In Hawaii, bills to enact physician-assisted suicide have repeatedly failed and/or been rejected in the legislature.  For this reason alone, physician-assisted suicide is not the law of Hawaii."

http://www.choiceillusion.org/2011/09/hawaii-assisted-suicide-is-not-already.html

* * *

1.  On February 7, 2011, SB 803 was defeated in Committee 4 to 0.  See Hawaii Legislative website at http://www.capitol.hawaii.gov/session2011/lists/measure_indiv.aspx?billtype=SB&billnumber=803
2.  http://www.huffingtonpost.com/barbara-coombs-lee/hawaii-aid-in-dying_b_995217.html.
3.  Kathryn Tucker, "End-of-life Law and Policy in Hawaii Aid in Dying," as of September 20, 2011, available at http://choiceisanillusion.files.wordpress.com/2011/10/tucker-brief_0011.pdf

Wednesday, September 21, 2011

Montana Propaganda: Baxter & Assisted Suicide

By Margaret Dore, Esq.

Barbara Coombs Lee, President of Compassion & Choices, has posted a propaganda piece on Huffington Post falsely claiming that a physician who assists a suicide in Montana is "safe" from prosecution.  My request for equal time to correct the record on Huffington Post has been ignored.  A discussion of the actual law of Montana is set forth below. 

A.  Assisted Suicide

There are just two states where physician-assisted suicide is legal: Oregon and Washington.  These states have statutes that give doctors and others who participate in a qualified patient’s suicide, immunity from criminal and civil liability.  (ORS 127.800-995 and RCW 70.245). 

In Montana, by contrast, the law on assisted suicide is governed by the Montana Supreme Court decision, Baxter v. State, 354 Mont. 234 (2009).  Baxter gives doctors who assist a suicide a potential defense to criminal prosecution.  Baxter does not legalize assisted suicide by giving doctors or anyone else immunity from criminal and civil liability.  Under Baxter, a doctor cannot be assured that a particular suicide will qualify for the defense. 

B.  The Baxter Decision is Wrong

Baxter found that there was no indication in Montana law that physician-assisted suicide, which the Court termed “aid in dying,” is against public policy.  (354 Mont. at 240, ¶¶ 13, 49-50).  Based on this finding, the Court held that a patient’s consent to assisted suicide “constitutes a statutory defense to a charge of homicide against the aiding physician.”  (Id. at 251, ¶ 50).

Baxter, however, overlooked caselaw imposing civil liability on persons who cause or fail to prevent a suicide.  See e.g., Krieg v. Massey, 239 Mont. 469, 472-3 (1989) and Nelson v. Driscoll, 295 Mont. 363, ¶¶ 32-33 (1999).  Baxter also overlooked elder abuse.  The Court stated that the only person “who might conceivably be prosecuted for criminal behavior is the physician who prescribes a lethal dose of medication.”  (354 Mont. at 239, ¶ 11).  The Court thereby overlooked criminal behavior by family members and others who benefit from a patient’s death, for example, due to an inheritance.

The Baxter decision is fundamentally flawed and wrong.

C.  Doctors are not "Safe" Under Baxter

Baxter is a narrow decision via which doctors cannot be assured that a particular suicide will qualify for the defense. Attorneys Greg Jackson and Matt Bowman provide this analysis:

"If the patient is less than 'conscious,' is unable to 'vocalize' his decision, or gets help because he is unable to 'self-administer,' or the drug fails and someone helps complete the killing, Baxter would not apply. . . .

http://www.montanansagainstassistedsuicide.org/p/baxter-case-analysis.html

Even if a doctor "beats the rap" on prosecution, there is the issue of civil liability.  See Krieg and Nelson, supra.  Like O.J. Simpson, a doctor who escapes criminal liability could find himself sued by a family member upset that he "killed mom."  The doctor could be held liable for civil damages.

* * *

Margaret Dore is President of Choice is an Illusion, a nonprofit corporation opposed to assisted-suicide. (www.choiceillusion.org She is also an attorney in Washington State where assisted suicide is legal.

* * *

[1] http://www.huffingtonpost.com/barbara-coombs-lee/aid-in-dying-montana_b_960555.html 

Saturday, September 10, 2011

Barbara Coombs Lee Renews Plea to Eliminate Oregon Reporting Consistent with Elder Abuse

Today, Barbara Coombs Lee, President of Compassion & Choices, published a blog on Huffington Post arguing that reporting for Oregon's assisted suicide act is no longer needed.[1]  This is the same claim that Compassion & Choices made in Montana before its proposed bill to legalize assisted suicide was defeated last February.

The reporting in question is consistent with elder abuse, i.e., of people with money.  This quote is from my memo against Compassion & Choices' bill, SB 167:

"Doctor reporting is . . . eliminated.1  The former Hemlock Society, Compassion & Choices, claims that this is because Oregon’s reporting system has “demonstrated the safety of the practice.”2  To the contrary, Oregon’s reports support that the claimed safety is speculative.  The reported statistics are also consistent with elder abuse.  No wonder Compassion & Choices wants the reporting system gone."

To view the entire memo, click here. 

* * *

[1]  Barbara Coombs Lee, "What We Know From Oregon's 'Death with Dignity' Experiment," Huffington Post, September 10, 2011 ("Bureaucratic paperwork has provided important data demonstrating the safety of aid in dying [assisted suicide] . . .").  To view her post, click here.