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1. What does SB 220 do?
SB 220 seeks to legalize physician-assisted suicide in Montana.
2. What is physician-assisted suicide?
The American Medical Association (AMA) defines physician-assisted suicide as occurring "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."[1] An example would be a doctor’s prescription for a lethal drug to facilitate a patient’s suicide.[2]
3. What is the American Medical Association's position on physician-assisted suicide?
The American Medical Association rejects assisted suicide, stating:
"Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks."[3]
4. Is it true that assisted suicide is only legal in two states?
Yes. There are just two states where physician-assisted suicide is legal: Oregon and Washington.[4]
5. Are there also states that have strengthened their laws against assisted suicide?
Yes. In the last two years, three states have strengthened their laws against assisted suicide.[5]. Those states are: Idaho; Georgia; and Louisiana.[6]
6. How does SB 220 work?
SB 220 has an application process to obtain the lethal dose, which includes a written lethal dose request form.[7]
Once the lethal dose is issued by the pharmacy, there is no oversight.[8] The death is not required to be witnessed by disinterested persons.[9] Indeed, no one is required to be present.[10]
7. To whom does SB 220 apply?
SB 220 applies to patients with a "terminal" disease, which is defined in terms of a prediction of less that six months to live.[11]
8. Can such patients have years to live?
Yes. Such persons are not necessarily dying and may have years to live. This is because doctor predictions of life expectancy can be wrong[12].
This is also because the "six months to live" is based on the patient's not being treated. Consider, for example, Oregon resident, Jeanette Hall. She was diagnosed with cancer in 2000 and wanted to do assisted suicide.[13] Her doctor convinced her to be treated instead.[14] In a recent affidavit, she states:
"This July, it was 12 years since my diagnosis. If [my doctor] had believed in assisted suicide, I would be dead."[15]
9. Why is SB 220 a recipe for elder abuse?
SB 220 has significant gaps that put elders at risk. The most obvious gap is a lack of witnesses when the lethal dose is administered.[16] Without disinterested witnesses, the opportunity is created for an heir, or another person who will benefit from the death, to administer the lethal dose to the patient against his will and without anyone knowing. Even if he struggled, who would know?
10. Does the term, "self-administer," require the patient to administer the lethal dose to himself or herself?
No.
SB 220 states that patients "may" self-administer the lethal dose.[17] There is no provision in SB 220 that administration of the dose "must" be by self-administration.[18]
11. Does the term, "self administer" allow someone else to administer the lethal dose to the patient?
Yes. SB 220 defines "self-administer" as the patient’s "act of ingesting."[19] SB 220 does not define "ingest." Dictionary definitions include:
"[T]o take (food, drugs, etc.) into the body, as by swallowing, inhaling, or absorbing." (Emphasis added).[20]
With these definitions, someone else putting the lethal dose in the patient’s mouth qualifies as proper administration because the patient will thereby be "swallowing" the lethal dose, i.e., "ingesting" it. Someone else placing a medication patch on the patient’s arm will also qualify because the patient will thereby be "absorbing" the dose, i.e., "ingesting" it. Gas administration, similarly, qualifies because the patient will thereby be "inhaling" the dose, i.e., "ingesting" it. With self-administer defined as mere ingesting, someone else is allowed to administer the lethal dose to the patient.
12. Is Oregon's most recent annual report consistent with elder abuse?
Yes.
The preamble to Oregon’s most recent annual statistical report implies that all of the deaths under the act were voluntary (self-administered).[21] The information provided in the report does not, however, address whether the deaths were voluntary.[22] For example, there is no information provided as to whether the patients consented to administration of the lethal dose.[23]
The report does, however, provide the following demographics. Most of the persons who died under Oregon’s act were age 65 and older.[24] They were also white and well-educated; many had private insurance.[25]
Typically, persons with these attributes would be seniors with money, which would be the middle class and above, a group disproportionately at risk of financial abuse and exploitation.[26] Oregon's recent report is thereby statistically consistent with elder financial abuse.
13. Why is any report claiming that Oregon's law is safe, invalid?
Last session, Senator Jeff Essmann provided this common sense explanation:
"[All] the protections 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."[27]
14. If SB 220 is enacted, will patients in Montana be steered to suicide?
If Montana follows Oregon's example, yes.
In Oregon, legalization of physician-assisted suicide has also empowered the Oregon Health Plan (Medicaid) to steer patients to suicide. The most well known cases are Barbara Wagner and Randy Stroup.[28] Each wanted treatment.[29] The Plan denied coverage for treatment and offered to pay for their suicides instead.[30] Wagner was devastated.[31] She said "I’m not ready to die."[32] Stroup said "This is my life they’re playing with."[33]
Today, the Oregon Health Plan continues to steer patients to suicide. Oregon doctor, Ken Stevens, explains:
"8. . . . The Plan covers the cost [of the suicide]. . . .
9. Under the . . . Plan, there is also a financial incentive towards suicide because the Plan will not necessarily pay for a patient’s treatment. For example, patients with cancer are denied treatment if [they fit within] 'Guideline Note 12.' . . .
11. Some of [these patients, if treated,] will likely live . . . as much as five, ten or twenty years depending on the type of cancer. This is because there are always some people who beat the odds.
12. All such persons who fit within 'Guideline Note 12' will nonetheless be denied treatment. Their suicides under Oregon’s assisted suicide act will be covered."[34]
Footnotes:
[1] AMA Code of Medical Ethics, Opinion 2.211, available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page
[2] Id.
[3] Id.
[4] Oregon’s physician-assisted suicide act was passed as Ballot Measure 16 in 1994 and went into effect after a referendum in 1997; Washington’s act was passed as Initiative 1000 on November 4, 2008 and went into effect on March 5, 2009. See http://www.doh.wa.gov/dwda/default.htm
[5] See Margaret Dore, "US Overview," updated July 30, 2012, at http://www.choiceillusion.org/p/us-overview.html
[6] Id.
[7] The form can be viewed at SB 220, § 11. (To view, click here and go to pp. A-6 through A-8). If the link doesn't work, go here: http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf
[8] See SB 220 in its entirety, at A-1 through A-13, at this link: http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf
[9] Id.
[10] Id.
[11] See SB 220, § 2(15), at A-2 at this link: http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf
[12] 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, available at www.seattleweekly.com/2009-01-14/news/terminal-uncertainty
See also: Affidavit of John Norton (when he was eighteen years old, he was told that he would die of ALS and paralysis in three to five years, but the disease progression stopped; he is now 75 years old); and Affidavit of Kenneth Stevens, MD, September 18, 2012. Attached at A-24 to A-31, at this link: http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf
[13] See Affidavit of Kenneth Stevens, ¶¶ 3-7, described above at note 14 and Affidavit of Jeanette Hall Opposing Assisted Suicide, August 17, 2012, attached at A-14, at this link: http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf
[14] Id.
[15] Jeanette Hall Affidavit ¶4, described above at note 15.
[16] See SB 220 in its entirety (there are no witnesses required at the death). (Attached at A-1 through A-13 at this link: http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf ) For other gaps in the SB 220, read the legal analysis at this same link, pp. 5-10).
[17] See SB 220 §2(8) & (12)
[18] See SB 220 in its entirety (there is no requirement that the lethal dose be self-administered). (Attached at A-1 through A-13 at this link: http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf )
[19] SB 220 §2(14), states: "Self-administer" means a qualified patient’s act of ingesting medication to end the qualified patient’s life . . ." (Emphasis added).
[20] Webster’s New World College Dictionary, ingest. (Attached at A-42, at this link: http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf ).
[21] Oregon's most recent annual report is attached hereto at A-36, at this link: http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf
[22] The report (at A-36 though A-41) instead focuses on the patient’s "ingestion" of the lethal dose, i.e., whether the patient swallowed, inhaled or absorbed the dose, which as described above, would not necessarily require a volitional act by the patient. A patient could also voluntarily swallow the lethal dose, but not know what it was, or be drunk, or be otherwise incapacitated so as to "ingest" the lethal dose, but not give consent.
[23] Id.
[24] Oregon’s report for 2012 states: ""Of the 77 DWDA deaths during 2012, most (67.5%) were aged 65 years or older." (Attached at A-37, at this link, http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf)
[25] Oregon’s report states: "As in previous years, most were white (97.4%), [and] well-educated (42.9% had at least a baccalaureate degree)." (Attached at A-37, http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf). The report also states: "Excluding unknown cases, all (100.0%) had some form of health insurance, although the number of patients who had private insurance (51.4%) was lower than in previous years(66.2%) . . ." Id.
[26] See "Broken Trust: Elders, Family, and Finances, a Study on Elder Financial Abuse Prevention, by the MetLife Mature Market Institute, page 4 ("Elders’ vulnerabilities and larger net worth make them a prime target for financial abuse"), available at http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf
[27] Senator Essmann's testimony can also be viewed on this hearing transcript for SB 167, February 10, 2011,
http://www.margaretdore.com/pdf/senator_essmann_sb_167_001.pdf
[28] See Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, August 6, 2008, available at http://abcnews.go.com/Health/story?id=5517492&page=1
and KATU TV, "Letter noting assisted suicide raises questions," KATU TV, July 30, 2008, at http://www.katu.com/news/specialreports/26119539.html [29] Id.
[30] Id.
[31] Id.
[32] KATU TV at note 28
[33] ABC News s at note 28
[34] Affidavit of Kenneth Stevens, MD, attached at A-24 to A-31, at this link: http://maasdocuments.files.wordpress.com/2013/02/no-on-sb-220attachments_001.pdf
