Wednesday, December 12, 2018

Dore Memo to Justice Committee: Reject End of Life Choice Bill

Margaret Dore, Esq.
Click here to view a pdf version, including supporting documentation.

I.  INTRODUCTION

I am president of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia.[1] I am also an attorney in Washington State USA where these practices are legal.[2] Our law is based on a similar law in Oregon.[3]

My background includes providing legal analysis and/or testimony against assisted suicide and euthanasia, in 22 US states, South Africa and Australia. I have participated in public debates as well as public interest litigation.

The “End of Life Choice Bill” seeks to legalize assisted dying, which means assisted suicide and euthanasia.[4] If enacted, the bill will apply to people with years or decades to live, and provide cover for murder. I urge you to recommend to Parliament to reject this bill.

II.  DEFINITIONS (TRADITIONAL)

“Assisted suicide” occurs when a person provides the means or information for another person to commit suicide, for example, by providing a rope or lethal drug.[5] If the assisting person is a physician, a more precise term is “physician-assisted suicide.”[6]

“Euthanasia” is the administration of a lethal agent to cause another person’s death.[7] Euthanasia is also known as “mercy killing.”[8]

III.  ASSISTING PERSONS CAN HAVE AN AGENDA

Persons assisting a suicide or euthanasia can have an agenda.  Consider Graham Morant, recently convicted of counseling his wife to kill herself in Australia.  Per the court, his motive was life insurance.[9] Consider also Tammy Sawyer, trustee for Thomas Middleton in Oregon.  Two days after his death by legal assisted suicide, she sold his home and deposited the proceeds into bank accounts for her own benefit.[10]

Medical professionals too can have an agenda. Michael Swango, MD, now incarcerated, got a thrill from killing his patients.[11] Consider also Harold Shipman, a doctor in the UK, who not only killed his patients, but stole from them and in one case made himself a beneficiary of the patient’s will.[12]

IV.  PUSHBACK AGAINST ASSISTED SUICIDE IN THE US

US territory includes 50 states, the District of Columbia, five major territories and various minor islands.[13] There are 5 states and the District of Columbia where assisted suicide/euthanasia is legal.[14] Other states have defeated laws seeking to legalize these practices and/or have affirmatively strengthened their laws against these practices. One state, New Mexico, overturned prior legality.  Please find more information below.
A.  This Year, the State of Utah Passed a Law Making Assisted Suicide a Felony 
This year, the state of Utah amended its manslaughter statute to clarify that aiding suicide is a felony.[15] The bill passed the legislature by a 2 to 1 margin.[16]
B.  Last Year, the State of Alabama Passed an Act Banning Assisted Suicide
Last year, Alabama enacted an “Assisted Suicide Ban Act,” which renders any person who deliberately assists a suicide, guilty of a felony.[17] The vote was nearly unanimous.[18]
C.  Two Years Ago, the New Mexico Supreme Court  Overturned Assisted Suicide
Two years ago, the New Mexico Supreme Court overturned a lower court decision recognizing a right to “physician aid in dying,” meaning physician-assisted suicide.[19] Physician-assisted suicide is no longer legal in New Mexico. 

V.  “ELIGIBLE” PERSONS WILL HAVE YEARS OR DECADES TO          LIVE
A.  If New Zealand Follows Oregon, the Bill Will Apply to People With Chronic Conditions, Such as Diabetes
Oregon’s law applies to people with a terminal disease who are predicted to have less than six months to live.  The law states:
“Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.[20]
In Oregon, this definition is interpreted to include chronic conditions such as diabetes mellitus, better known as “diabetes.”[21] Oregon doctor, William Toffler, explains:
Chronic conditions such as diabetes are a “terminal disease” sufficient for assisted suicide, if, without treatment such as insulin, the person has less than six months to live.
This is significant when you consider that without insulin, a typical insulin-dependent 20 year old will live less than a month.
Such persons, with insulin, are likely to have decades to live; in fact, most diabetics have a normal life span given appropriate control of their blood sugar. (Spacing changed).[22]
Dr. Toffler also addresses the New Zealand bill:
I have ... been provided with an excerpt of the ... bill, which states:
In this Act, person who is eligible for assisted dying means a person who— ...
(c)  suffers from
(i)  a terminal illness that is likely to end his or her life                             within 6 months; or

(ii) a grievous and irremediable medical condition; and

(d)  is in an advanced state of irreversible decline in capability                .... (Emphasis added).[23]

Dr. Toffler also testifies:
In my professional judgment, this definition will [also] include insulin dependent diabetes if, like Oregon, New Zealand makes the eligibility determination without treatment.
If so, the typical insulin dependent person will have a life expectancy of less than a month due to being in “an advanced state of irreversible decline in capability” to produce insulin. He or she will have a “terminal illness.”
[I]f New Zealand follows Oregon practice to determine eligibility without treatment, the proposed bill will apply to people with chronic conditions such as insulin dependent diabetes. Such persons, with treatment, can have years or decades to live happy, healthy and productive lives.[24]
B.    Predictions of Life Expectancy Can Be Wrong
“Eligible” persons may also have years or decades to live because predictions of life expectancy can be wrong. This is true due to actual mistakes (the test results got switched) and because predicting life expectancy is not an exact science.[25]

Consider John Norton, diagnosed with ALS at age 18.[26] He was told that he would get progressively worse (be paralyzed) and die in three to five years.[27] Instead, the disease progression stopped on its own.[28] In a 2012 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.[29]
C. Treatment Can Lead to Recovery

In 2000, Jeanette Hall was diagnosed with cancer in Oregon and made a settled decision to use Oregon’s law.[30] Her doctor convinced her to be treated instead, which eliminated the cancer.[31]  Her declaration states:
It has now been 18 years since my diagnosis.  If [my doctor] had believed in assisted suicide, I would be dead.[30]
VI.  THE BILL ALLOWS ASSISTED SUICIDE AND EUTHANASIA

Per the bill, the attending medical practitioner must:
(a)    tell the person [patient] about the following                      methods for the administration of a lethal dose of            medication:
(i)  ingestion, triggered by the person:
(ii)  intravenous delivery, triggered by the person:
(iii)    ingestion through a tube: [and]
        (iv)    injection ....  (Emphasis added).[33]

The first two methods, (i) and (ii), describe physician-assisted suicide as traditionally defined in which the person “triggers,” i.e., initiates the life-ending act.[34]

The bill also says that for the purpose of these two methods, the medical practitioner must administer the lethal dose by providing it to the person.[35] This direction too is consistent with physician-assisted suicide in which a physician administers a lethal dose by dispensing it to a patient, who applies it to himself or herself. [36]

With regard to the last two methods, “ingestion through a tube” and “injection,” the bill says that the attending medical practitioner “must administer [the lethal dose] by providing it,” which can be read as euthanasia.[37]

VII. THE BILL WILL CREATE A PERFECT CRIME

A. Even If the Patient Struggled, Who Would Know?

The drugs typically used for assisted suicide and euthanasia are water and/or alcohol soluble, such that they can be injected into a sleeping or restrained person without consent.[38]

In addition, the bill has no prohibition against another person being alone with the patient when the lethal dose is ingested and/or the patient dies.[39] In other words, the bill allows two people to be there, with one leaving alive and the other leaving dead.

The one leaving alive is allowed to be a medical practitioner, who is required to be “available” to the patient until the patient dies, or to arrange for another medical practitioner to be available.[40] Per the bill, this means being in the “same room” with the patient, or in “close proximity” to the patient, which is not defined.[41] In a published discussion paper cited below, the authors define close proximity as “within 30 miles.”[42]

With the medical practitioner thereby allowed, but not required to be present when a patient dies, the opportunity is created for another person, such as the patient’s heir, to administer the lethal dose in private, without consent.  Even if the patient struggled, who would know?

B. Legal Cover Up

Once death via the lethal dose occurs, the death is treated for all purposes as if the lethal dose had not been provided. In other words, there is a required official legal cover up. The bill states:
A person who dies as a result of the provision of assisted dying is taken for all purposes to have died as if assisted dying had not been provided.[43]
In Washington State, we have a similar requirement. The death certificate is required to list a terminal disease as the cause of death, without even a hint as to the actual cause of death (a lethal drug).[44]  The death is reported as “Natural,” which allows perpetrators to inherit, collect the life insurance and/or forgo being charged with murder.[45] The bill, if enacted, will create a perfect crime.

VIII.  DR. SHIPMAN AND THE CALL FOR DEATH CERTIFICATE REFORM

According to a 2005 article in the UK’s Guardian newspaper, there was a public inquiry regarding Dr. Shipman’s conduct, which determined that he had “killed at least 250 of his patients over 23 years.”[46] The inquiry also found:
that by issuing death certificates stating natural causes, the serial killer [Shipman] was able to evade investigation by coroners.[47]
According to a subsequent article in 2015, proposed reforms included having a medical examiner review death certificates, so as to improve patient safety.[48] Instead, the instant bill moves in the opposite direction to require a legal cover up in which doctors and other perpetrators will be able to kill patients with impunity. The death will be “natural” as a matter of law. For this reason alone, the proposed bill must be defeated.

IX. TRAUMA TO FAMILY MEMBERS AND FRIENDS
A. The Swiss Study:  Physician-Assisted Suicide Can Be Traumatic for Family Members and Friends
In 2010, a European research study addressed trauma suffered by persons who witnessed legal physician-assisted suicide in Switzerland.[49] The study found that one out of five family members or friends present was traumatized, with the most severe mental health problems occurring 14 to 24 months post loss.[50] An article describing the study states that these people,
experienced full or sub-threshold PTSD (Post Traumatic Stress Disorder) related to the loss of a close person through assisted suicide.[51]
B. My Clients Suffered Trauma in Oregon and Washington State

In Washington State and Oregon, I have had two cases where my clients and their family member patients suffered severe trauma due to legal assisted suicide. In the first case, one side of the family wanted the father/patient to take the lethal dose, while the other side did not. The father spent the last months of his life caught in the middle and torn over whether or not he should kill himself. My client, his adult daughter, was severely 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 his (my client's) father had refused to take the lethal dose when it was delivered, stating: "You're not killing me. I'm going to bed." The man also said that my client’s father took the lethal dose the next night when he (the father) was already intoxicated on alcohol. The man who told this to my client subsequently changed his story.

My client, although he was not present, was severely traumatized over the incident, and also by the sudden loss of his father. He also followed the pattern of the Swiss cases described above, becoming especially traumatized about a year and a half after the death.

X. CONCLUSION

If enacted, the bill will encourage people with years or decades to live to throw away their lives. The bill will allow doctors and other persons to cut lives short. There will be legal murder and legal cover up, which will allow perpetrators to keep their inheritances and the life insurance. Some patients and their families will be severely traumatized.

Don’t make Washington and Oregon’s mistake. I urge you to recommend to Parliament that the proposed bill be rejected.

Respectfully Submitted

Margaret Dore, Esq., MBA
Law Offices of Margaret K. Dore, P.S.
Choice is an Illusion, a nonprofit corporation
www.choiceillusion.org
www.margaretdore.org
1001 4th Avenue, Suite 4400
Seattle, WA USA 98154
206 697 1217

Endnotes:

[1]  Choice is an Illusion is a nonprofit corporation founded in 2010. For more information, see www.choiceillusion.org and www.margaretdore.org
[2]  My CV can be viewed here
[3]  Oregon’s law, enacted by a ballot measure, went into effect in 1997. Washington's law, passed by another ballot measure, went into effect in 2009.
[4]  The bill can be viewed in the Appendix, at pages 101 to 115.
[5]  Cf. Ben Winslow, “Teen accused of helping friend commit suicide could face trial for murder,” The Salt Lake Tribune, 10/12/17 (The defendant “bought the rope, tied the noose and picked the tree”), in the Appendix, pp. 5 & 6, &  https://www.aol.com/article/news/2017/10/12/teen-accused-of-helping-friend-commit-suicide-could-face-trial-for-murder/23241619
[6]  The American Medical Association Code of Medical Ethics, Opinion 5.7 (defining physician-assisted suicide).  In the Appendix at page 7.
[7]  Id., Opinion 5.8, “Euthanasia,” (lower half of the page)
[8]  “Mercy killing” - The Free Dictionary, in the  Appendix at p. 8.
[9]  R v Morant [2018] QSC 251, Order, 11/02/18, p. 11, paragraph 78, https://archive.sclqld.org.au/qjudgment/2018/QSC18-251.pdf (“you counselled and aided your wife to kill herself because you wanted to get your hands on the 1.4 million [life insurance payout]”)
[10]  KTVZ.com, “Sawyer Arraigned on State Fraud Charges,” 07/14/11, in the Appendix at page 9.
[11]  Charlie Leduff, “Prosecutors Say Doctor Killed to Feel a Thrill,” The New York Times, 09/07/2000 (“Basically, Dr. Swango liked to kill people. By his own admission in his diary, he killed because it thrilled him”), attached in the Appendix at pages 10-12. See also: CBSNEWS.COM STAFF, “Life in Jail for Poison Doctor, July 12, 2000.
[12]  David Batty, “Q & A: Harold Shipman,” The Guardian, 08/25/05, attached in the Appendix at pages 13 through 15. See also Fiona Guy, “Healthcare Serial Killers: Doctors and Nurses Who Kill,” Crime Traveller, (2015, Sept 09), excerpts in the Appendix at pages 16-19.
[13]  https://en.wikipedia.org/wiki/List_of_states_and_territories_of_the_United_States
[14]  Assisted suicide/euthanasia is legal in California, Colorado, Oregon, Washington State and Vermont. Hawaii has enacted a law to legalize, which is not in effect.
[15]  https://le.utah.gov/~2018/bills/static/HB0086.html
[16]  The Utah bill passed the House 51 to 18, and the Senate, 19 to 5.  For more information, see https://le.utah.gov/~2018/bills/static/HB0086.html and click “status.”
[17]  Alabama: Assisted Suicide Ban Act to Go Into Effect,” http://www.choiceillusion.org/2017/07/alabama-assisted-suicide-ban-act-to-go.html 
[18]  Scroll down to view roll calls at https://legiscan.com/AL/bill/HB96/2017
[19]  Morris v. Brandenburg, 376 P.3d 836 (2016).  See also: http://www.choiceillusionnewmexico.org/2016/07/new-mexico-upholds-assisted-suicide.html
[20]  ORS 127.800 s.1.01(12), attached in the Appendix at page 23.
[21]  See Oregon’s most recent report regarding its law, attached to the Declaration of William Toffler MD, in the Appendix, at pages 20-25; the report excerpt is at page 24 (listing “diabetes” as an “underlying illness” sufficient for assisted suicide).
[22]  Toffler Declaration, supra, the quote is in the Appendix at page 21, paragraphs 3 & 4.
[23]  Id., at page 21.
[24]  Id., at page 22.
[25]  See: Jessica Firger, “12 million Americans misdiagnosed each year ,” CBS NEWS, 4/17/14; and 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, 01/14/09. (Excerpts attached in the Appendix at pages 26 to 30).
[26]  Affidavit of John Norton, attached in the Appendix, at pages 31 to 33.
[27]  Id., ¶ 1.
[28]  Id., ¶ 4.
[29]  Id., ¶ 5.
[30]  See:  Affidavit of Kenneth Stevens, MD, in the Appendix at pages 34 & 35; and the Declaration of Jeanette Hall, in the Appendix at page 37.
[31]  Id.
[32]  Declaration of Jeanette Hall, ¶4, attached in the Appendix at page 37.
[33]  The bill, section 15(3)(a), in the  Appendix, at page 109.
[34]  Dictionary definitions for “trigger” include “initiate.” See Dictionary.com excerpt attached hereto in the Appendix, at page 47.
[35]  The bill, section 16(4)(a), states:
If the person [patient] chooses to receive the medication [lethal dose], the attending medical practitioner must administer it by -
(a) providing it to the person, for the methods                      described in section 15(3)(a)(i) and (ii) [assisted              suicide] ....  (Emphasis changed).
Attached hereto, the Appendix page 110.
[36]  Dictionary definitions of “administer” include “dispense” and “apply.”  See definitions in the Appendix at page 48.
[37]  The bill, Section 16(4)(b), states:

If the person chooses to receive the medication [lethal dose],            the attending medical practitioner must administer it by- ...

(b) providing it, for the methods described in section 15(3)(a)                  (iii) [ingestion through a tube] and (iv) [injection].

Attached in the Appendix at page 110.
[38]  The drugs used include Secobarbital, Morphine Sulfate, Pentobarbital and Phenobarbital, which are water and/or alcohol soluble.  See excerpts from Oregon’s and Washington’s most recent annual reports and regarding morphine sulfate, in the Appendix at pages 38 to 42. For more information, see http://www.drugs.com/pr/seconal-sodium.html, http://www.drugs.com/pro/nembutal.html and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2977013
[39]  See the bill in its entirety in the Appendix at pages 101 - 105.
[40]  The bill, section 16, attached in the Appendix at page 110.
[41]  Id. See also the bill in its entirety.
[42]  Compton, Janice & Pollak, Robert, 2013. "Proximity and Coresidence of Adult Children and their Parents in the United States: Description and Correlates," IZA Discussion Papers 7431, Institute for the Study of Labor (IZA). Attached in the Appendix at page 50 (“if the individual coresides with, or lives in close proximity (i.e., withing thirty miles) to, his or her mother.”)  Available at http://ftp.iza.org/dp7431.pdf
[43]  The bill, section 25, attached in the Appendix, at page 114.
[44]  Washington State Death Certificate Instruction, in the Appendix, page 43, which can also be viewed at this link: https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-148-DWDAInstructionsForMedicalExaminers.pdf
[45]  Id.
[46]  David Batty, supra, quote in the Appendix, at page 13.
[47]  Id., page 15, second paragraph, titled "What are its findings?"
[48]  Press Association, “Death certificate reform delays ‘incomprensible,’” The Guardian, January 21, 2015, attached to the Appendix, at pages 44 and 45.
[49]  “Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide,” B. Wagner, J. Muller, A. Maercker; European Psychiatry 27 (2010) 542-546, available at http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf  (Cover page in the Appendix at page 46).
[50]  Id.
[51]  Id.

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