Possible expansion of physician-assisted suicide laws in other states should concern Montana

http://missoulian.com/news/opinion/mailbag/possible-expansion-of-physician-assisted-suicide-laws-in-other-states/article_e29d5322-8b2c-11e2-aba7-001a4bcf887a.html

I am doctor in Washington state where physician-assisted suicide is legal for “terminal patients” predicted to have less than six months to live. I disagree with the letter by Kristen Wood (letter, Feb. 28) that expansion is not a concern in this context.

In Washington state, our assisted suicide law has only been in effect for four years. We have, however, already had proposals to expand that law to direct euthanasia of non-terminal people. See e.g., Brian Faller, “Perhaps it’s time to expand Washington’s Death with Dignity Act,” Nov. 16, 2011. Last year, there was also this article in the Seattle Times, suggesting euthanasia for people who cannot afford their own care, which would be involuntary euthanasia: Jerry Large, “Planning for old age at a premium,” March 8, 2012 at http://seattletimes.nwsource.com/text/2017693023.html (“After Monday’s column, . . . a few (readers) suggested that if you couldn’t save enough money to see you through your old age, you shouldn’t expect society to bail you out. At least a couple mentioned euthanasia as a solution.“)

I am very concerned with where this is all going. I hope that Montana does not follow our lead to legalize assisted suicide.

Richard Wonderly,
Seattle, Washington

"He made the mistake of asking for information about assisted suicide"

http://missoulian.com/news/opinion/mailbag/legalizing-assisted-suicide-allows-physicians-to-pressure-patients/article_5726f258-84fb-11e2-9707-001a4bcf887a.html

Last year, my brother, Wes Olfert, died in Washington state, where assisted suicide is legal.

When he was first admitted to the hospital, he made the mistake of asking for information about assisted suicide. I say a mistake, because this set off a chain of events that interfered with his care and caused him unnecessary stress in what turned out to be the last months of his life.

By asking the question, he was given a “palliative care” consult by a doctor who heavily and continually pressured him to give up on treatment before he was ready to do so. It got so bad that Wes actually became fearful of this doctor and asked me and a friend to not leave him alone with her. Justified or not, Wes was afraid that the doctor would do something to him or have him sign something if she would find him alone.

In fact, even though he was on heavy doses of narcotic pain medications and not in a clear state of mind to sign documents without someone to advocate for him, this palliative care MD actually did try to get him to sign a DNR or “Do Not Resuscitate” form without his Durable POA or any family member present. Fortunately, his close friend/POA arrived at that moment to stop this from happening. Some of the other doctors and staff members seemed to also write Wes off once they learned that he had asked about assisted suicide.

I am writing to urge your readers to prevent assisted suicide in Montana. I do this on behalf of myself and my other brother, Ron Olfert, of Sanders County, who also died last year. He was strongly opposed to assisted suicide.

Please contact your legislators and ask them to vote “yes” on House Bill 505.

Marlene Deakins, RN
Tuscon, Arizona

Assisted Suicide: Stress, Trauma and Fear

By Margaret Dore, Esq.

In 2012, a study was released in Switzerland, addressing trauma suffered by persons who witnessed an assisted suicide.[1]  The study found that 1 out of 5 family members or friends present at an assisted suicide were traumatized.[2]  These persons "experienced full or sub-threshold PTSD [Post Traumatic Stress Disorder] related to the loss of a close person through assisted suicide."[3]

Consider also the letter below by nurse Marlene Deakins, and her brother, Ron Olfert, now deceased from Sanders County.  Their letter describes the "unnecessary stress" and "fear" of their brother, Wes Olfert, after he asked a question about assisted suicide in Washington State.  Their letter states:

"Our brother, Wes Olfert, . . . died in Washington State where assisted suicide is legal. When he was first admitted to the hospital, he made the mistake of asking for information about assisted suicide.  We say a mistake, because this set off a chain of events that interfered with his care and caused him unnecessary stress in what turned out to be the last months of his life.

By asking the question, he was given a 'palliative care' consult by a doctor who heavily and continually pressured him to give up on treatment before he was ready to do so. It got so bad that Wes actually became fearful of this doctor and asked us and a friend to not leave him alone with her."[4]

Kathryn Judson, in Oregon, similarly, became afraid for her husband. This was after his doctor gave him an unsolicited pitch for suicide. She states:

"We got a different doctor, and David lived another five years or so. But after that nightmare in the first doctor's office, and encounters with a 'death with dignity' inclined nurse, I was afraid to leave my husband alone again with doctors and nurses, for fear they'd morph from care providers to enemies, with no one around to stop them."[5]

Footnotes: 

[1]  "Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide," B. Wagner, J. Muller, A. Maercker; European Psychiatry 27 (2012) 542-546, available at http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf 
[2]  Id.
[3]  Id.
[4]  Ron Olfert and Marlene Deakins RN, Letter to the Board of Medical Examiners, "He made the mistake of asking for information about assisted suicide," June 29, 2012, available at http://www.montanansagainstassistedsuicide.org/2012/06/dear-board-of-medical-examiners-we-are.html  (Accuracy confirmed by Margaret Dore, the writer of this post, who spoke with both Ron Olfert and Marlene Deakins).
[5]  Kathryn Judson, "I was afraid to leave my husband alone," Hawaii Free Press, February 15, 2011, available at http://www.montanansagainstassistedsuicide.org/2013/01/i-was-afraid-to-leave-my-husband-alone.html

Quick Facts About Assisted Suicide

By Margaret Dore, Esq.*

For a new print version, suitable for a handout, click here.

1.  Assisted Suicide

Assisted suicide means that someone provides the means and/or information for another person to commit suicide.  When a physician is involved, the practice is physician-assisted suicide.[1]

2. The Oregon and Washington Laws

In Oregon, physician-assisted suicide was legalized in 1997 via a ballot measure.[2]  In Washington State, a similar law was passed via another ballot measure in 2008 and went into effect in 2009.[3]  No such law has made it through the scrutiny of a legislature despite more than 100 attempts.[4]

3.  Patients are Not Necessarily Dying

The Oregon and Washington laws are restricted to patients predicted to have less than six months to live.[5]  Such persons are not necessarily dying.  Doctors can be wrong.[6]  Moreover, treatment can lead to recovery.  Consider Jeanette Hall, who was diagnosed with cancer and given six months to a year to live.[7]  She was adamant that she would "do" Oregon’s law, but her doctor, Ken Stevens, convinced her to be treated instead.[8] She is still alive 12 years later.[9]

4.  A Recipe for Elder Abuse

The Washington and Oregon laws are a recipe for elder abuse. The most obvious reason is due to a lack of oversight when the lethal dose is administered.[10] For example, there are no witnesses required at the death; the death is allowed occur in private.[11] With this situation, the opportunity is created for an heir, or some other person who will benefit from the patient’s death, to administer the lethal dose to the patient without his consent.  Even if he struggled, who would know?

5. Empowering the Healthcare System

In Oregon, patients desiring treatment under the Oregon Health Plan have been offered assisted suicide instead. 

The most well known cases involve Barbara Wagner and Randy Stroup.[12] Each wanted treatment.[13] The Plan denied their requests and steered them to suicide by offering to pay for their suicides.[14] Neither Wagner nor Stroup saw this scenario as a celebration of their "choice." Wagner said: "I'm not ready to die."[15] Stroup said: "This is my life they’re playing with."[16]

Wagner and Stroup were steered to suicide. Moreover, it was the Oregon Health Plan, a government entity, doing the steering.[17]

6. Suicide Contagion

Oregon's suicide rate, which excludes suicides under its physician-assisted suicide law, has been "increasing significantly" since 2000.[18] 

Just three years prior, Oregon legalized physician-assisted suicide. This increased suicide rate is consistent with a suicide contagion. In other words, legalizing one type of suicide encouraged other suicides.  Montana already has one of the highest suicide rates in the nation.[19]

7.  A "Wedge" Issue

In Washington State, where assisted suicide was legalized four years ago, there is already a discussion to expand its law to direct euthanasia for non-terminal people.[20]  Indeed, last March, there was a Seattle Times newspaper column describing reader suggestions for euthanasia for people unable to afford care, which would be involuntary euthanasia.[21]

* 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.  For more information, see www.margaretdore.com and www.choiceillusion.org 

[1]  Compare: American Medical Association, 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]  The Oregon and Washington laws are similar.  For a short article about Washington’s law, see Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009, available at https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm
[3]  Id.
[4]  http://epcdocuments.files.wordpress.com/2011/10/attempts_to_legalize_001.pdf
[5]  See ORS 127.800 s.1.01(12) and RCW 70.245.010(13).
[6]  See e.g., 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?," 01/14/09, available at http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty 
[7]  See Jeanette Hall, Letter to the editor, "She pushed for legal right to die, and - thankfully - was rebuffed, Boston Globe, October 4, 2011 ("I am so happy to be alive!), available at http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2011/10/04/she_pushed_for_legal_right_to_die_and___thankfully___was_rebuffed/ Kenneth Stevens MD, Letter to the Editor, "Oregon mistake costs lives," The Advocate, the official publication of the Idaho State Bar, Sept. 2010, (scroll down to last letter at www.margaretdore.com/info/Stevens.pdf ).
[8]  Id.
[9]  Per her telephone call today.
[10]  The Oregon and Washington Acts can be viewed in their entirety here and here.
[11]  Id.
[12]  See Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, August 6, 2008, at http://abcnews.go.com/Health/story?id=5517492&page=1; "Letter noting assisted suicide raises questions," KATU TV, July 30, 2008, at http://www.katu.com/news/specialreports/26119539.html ; and Ken Stevens, MD, Letter to Editor, "Oregon mistake costs lives," The Advocate, the official publication of the Idaho State Bar, September 2011, to view, scroll down to bottom of second page here: http://www.margaretdore.com/info/September_Letters.pdf
[13] Id.
[14] Id.
[15] KATU TV at note 12
[16] ABC News at note 12
[17]  See also Affidavit of Ken Stevens MD (Leblanc v. Canada), with attachments, available at http://maasdocuments.files.wordpress.com/2012/09/signed-stevens-aff-9-18-12.pdf 
[18]  See "Suicides in Oregon: Trends and Risk Factors," Oregon Department of Human Services, Public Health Division, September 2010, page 6, ("Deaths relating to the death with Dignity Act (physician-assisted suicides) are not classified as suicides by Oregon law and therefore excluded from this report"), available at http://epcdocuments.files.wordpress.com/2011/10/or_suicide_report_001.pdf
See also Oregon Health Authority, News Release, "Rising suicide rate in Oregon reaches higher than national average," September 9, 2010, ("suicide rates have been increasing significantly since 2000") available at http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf
[19]  Cindy Uken, "State of Dispair: High-Country Crisis, Montana’s suicide rate leads the nation," Billings Gazetter, November 25, 2012, http://billingsgazette.com/news/state-and-regional/montana/montana-s-suicide-rate-leads-the-nation/article_b7b6f110-3e5c-5425-b7f6-792cc666008d.html?print=true&cid=print
[20]  See 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
[21]  See Jerry Large, "Planning for old age at a premium," The Seattle Times, March 8, 2012 at http://seattletimes.nwsource.com/text/2017693023.html ("After Monday's column,  . . . a few [readers] suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out. At least a couple mentioned euthanasia as a solution.")  (Emphasis added).

Updated Quick Facts About Assisted Suicide

By Margaret Dore, Esq.*

For a new print version, suitable for a handout, click here.

1.  Assisted Suicide

Assisted suicide means that someone provides the means and/or information for another person to commit suicide.  When a physician is involved, the practice is physician-assisted suicide.[1]

2. The Oregon and Washington Laws

In Oregon, physician-assisted suicide was legalized in 1997 via a ballot measure.[2]  In Washington State, a similar law was passed via another ballot measure in 2008 and went into effect in 2009.[3]  No such law has made it through the scrutiny of a legislature despite more than 100 attempts.[4]

3.  Patients are Not Necessarily Dying

The Oregon and Washington laws are restricted to patients predicted to have less than six months to live.[5]  Such persons are not necessarily dying.  Doctors can be wrong.[6]  Moreover, treatment can lead to recovery.  Consider Jeanette Hall, who was diagnosed with cancer and given six months to a year to live.[7]  She was adamant that she would "do" Oregon’s law, but her doctor, Ken Stevens, convinced her to be treated instead.[8] She is still alive 12 years later.[9]

4.  A Recipe for Elder Abuse

The Washington and Oregon laws are a recipe for elder abuse. The most obvious reason is due to a lack of oversight when the lethal dose is administered.[10] For example, there are no witnesses required at the death; the death is allowed occur in private.[11] With this situation, the opportunity is created for an heir, or some other person who will benefit from the patient’s death, to administer the lethal dose to the patient without his consent.  Even if he struggled, who would know?

5. Empowering the Healthcare System

In Oregon, patients desiring treatment under the Oregon Health Plan have been offered assisted suicide instead. 

The most well known cases involve Barbara Wagner and Randy Stroup.[12] Each wanted treatment.[13] The Plan denied their requests and steered them to suicide by offering to pay for their suicides.[14] Neither Wagner nor Stroup saw this scenario as a celebration of their "choice." Wagner said: "I'm not ready to die."[15] Stroup said: "This is my life they’re playing with."[16]

Wagner and Stroup were steered to suicide. Moreover, it was the Oregon Health Plan, a government entity, doing the steering.[17]

6. Suicide Contagion

Oregon's suicide rate, which excludes suicides under its physician-assisted suicide law, has been "increasing significantly" since 2000.[18] 

Just three years prior, Oregon legalized physician-assisted suicide. This increased suicide rate is consistent with a suicide contagion. In other words, legalizing one type of suicide encouraged other suicides.  Montana already has one of the highest suicide rates in the nation.[19]

7.  A "Wedge" Issue

In Washington State, where assisted suicide was legalized four years ago, there is already a discussion to expand its law to direct euthanasia for non-terminal people.[20]  Indeed, last March, there was a column describing reader suggestions for euthanasia for people unable to afford care, which would be on an involuntary basis for people who want to live.[21]

* 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.  For more information, see www.margaretdore.com and www.choiceillusion.org 

[1]  Compare: American Medical Association, 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]  The Oregon and Washington laws are similar.  For a short article about Washington’s law, see Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009, available at https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm
[3]  Id.
[4]  http://epcdocuments.files.wordpress.com/2011/10/attempts_to_legalize_001.pdf
[5]  See ORS 127.800 s.1.01(12) and RCW 70.245.010(13).
[6]  See e.g., 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?," 01/14/09, available at http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty 
[7]  See Jeanette Hall, Letter to the editor, "She pushed for legal right to die, and - thankfully - was rebuffed, Boston Globe, October 4, 2011 ("I am so happy to be alive!), available at http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2011/10/04/she_pushed_for_legal_right_to_die_and___thankfully___was_rebuffed/ Kenneth Stevens MD, Letter to the Editor, "Oregon mistake costs lives," The Advocate, the official publication of the Idaho State Bar, Sept. 2010, (scroll down to last letter at www.margaretdore.com/info/Stevens.pdf ).
[8]  Id.
[9]  Per her telephone call today.
[10]  The Oregon and Washington Acts can be viewed in their entirety here and here.
[11]  Id.
[12]  See Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, August 6, 2008, at http://abcnews.go.com/Health/story?id=5517492&page=1; "Letter noting assisted suicide raises questions," KATU TV, July 30, 2008, at http://www.katu.com/news/specialreports/26119539.html ; and Ken Stevens, MD, Letter to Editor, "Oregon mistake costs lives," The Advocate, the official publication of the Idaho State Bar, September 2011, to view, scroll down to bottom of second page here: http://www.margaretdore.com/info/September_Letters.pdf
[13] Id.
[14] Id.
[15] KATU TV at note 12
[16] ABC News at note 12
[17]  See also Affidavit of Ken Stevens MD (Leblanc v. Canada), with attachments, available at http://maasdocuments.files.wordpress.com/2012/09/signed-stevens-aff-9-18-12.pdf 
[18]  See "Suicides in Oregon: Trends and Risk Factors," Oregon Department of Human Services, Public Health Division, September 2010, page 6, ("Deaths relating to the death with Dignity Act (physician-assisted suicides) are not classified as suicides by Oregon law and therefore excluded from this report"), available at http://epcdocuments.files.wordpress.com/2011/10/or_suicide_report_001.pdf
See also Oregon Health Authority, News Release, "Rising suicide rate in Oregon reaches higher than national average," September 9, 2010, ("suicide rates have been increasing significantly since 2000") available at http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf[19]  Cindy Uken, "State of Dispair: High-Country Crisis, Montana’s suicide rate leads the nation," Billings Gazetter, November 25, 2012, http://billingsgazette.com/news/state-and-regional/montana/montana-s-suicide-rate-leads-the-nation/article_b7b6f110-3e5c-5425-b7f6-792cc666008d.html?print=true&cid=print
[20]  See 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
[21]  See Jerry Large, "Planning for old age at a premium," The Seattle Times, March 8, 2012 at http://seattletimes.nwsource.com/text/2017693023.html ("After Monday's column, some readers were unsympathetic, a few suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out. At least a couple mentioned euthanasia as a solution.")

Quick Facts About Assisted Suicide

By Margaret Dore, Esq.*

For a print version, click here.

1.  Assisted Suicide

Assisted suicide means that someone provides the means and/or information for another person to commit suicide.  When a physician is involved, the practice is physician-assisted suicide.[1]

2. The Oregon and Washington Laws

In Oregon, physician-assisted suicide was legalized in 1997 via a ballot measure.[2]  In Washington State, a similar law was passed via another ballot measure in 2008 and went into effect in 2009.[3]  No such law has made it through the scrutiny of a legislature despite more than 100 attempts.[4]

3.  Patients are Not Necessarily Dying

The Oregon and Washington laws are restricted to patients predicted to have less than six months to live.[5]  Such persons are not necessarily dying.  Doctors can be wrong.[6]  Moreover, treatment can lead to recovery.  Consider Jeanette Hall, who was diagnosed with cancer and given six months to a year to live.[7]  She was adamant that she would "do" Oregon’s law, but her doctor, Ken Stevens, convinced her to be treated instead.[8] She is still alive 12 years later.[9]

4.  A Recipe for Elder Abuse

The Washington and Oregon laws are a recipe for elder abuse. The most obvious reason is due to a lack of oversight when the lethal dose is administered.[10] For example, there are no witnesses required at the death; the death is allowed occur in private.[11] With this situation, the opportunity is created for an heir, or some other person who will benefit from the patient’s death, to administer the lethal dose to the patient without his consent.  Even if he struggled, who would know?

5. Empowering the Healthcare System

In Oregon, patients desiring treatment under the Oregon Health Plan have been offered assisted suicide instead. 

The most well known cases involve Barbara Wagner and Randy Stroup.[12] Each wanted treatment.[13] The Plan denied their requests and steered them to suicide by offering to pay for their suicides.[14] Neither Wagner nor Stroup saw this scenario as a celebration of their "choice." Wagner said: "I'm not ready to die."[15] Stroup said: "This is my life they’re playing with."[16]

Wagner and Stroup were steered to suicide. Moreover, it was the Oregon Health Plan, a government entity, doing the steering.[17]

6. Suicide Contagion

Oregon's suicide rate, which excludes suicides under its physician-assisted suicide law, has been "increasing significantly" since 2000.[18] 

Just three years prior, Oregon legalized physician-assisted suicide. This increased suicide rate is consistent with a suicide contagion. In other words, legalizing one type of suicide encouraged other suicides.  Montana already has one of the highest suicide rates in the nation.[19]

7.  A "Wedge" Issue

In Washington State, where assisted suicide was legalized four years ago, there is already a discussion to expand its law to direct euthanasia for non-terminal people.[20]  Indeed, last March, there was a column describing reader suggestions for euthanasia for people unable to afford care, which would be on an involuntary basis for people who want to live.[21]

* 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.  For more information, see www.margaretdore.com and www.choiceillusion.org 

[1]  Compare: American Medical Association, 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]  The Oregon and Washington laws are similar.  For a short article about Washington’s law, see Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009, available at https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm
[3]  Id.
[4]  http://epcdocuments.files.wordpress.com/2011/10/attempts_to_legalize_001.pdf
[5]  See ORS 127.800 s.1.01(12) and RCW 70.245.010(13).
[6]  See e.g., 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?," 01/14/09, available at http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty 
[7]  See Jeanette Hall, Letter to the editor, "She pushed for legal right to die, and - thankfully - was rebuffed, Boston Globe, October 4, 2011 ("I am so happy to be alive!), available at http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2011/10/04/she_pushed_for_legal_right_to_die_and___thankfully___was_rebuffed/ Kenneth Stevens MD, Letter to the Editor, "Oregon mistake costs lives," The Advocate, the official publication of the Idaho State Bar, Sept. 2010, (scroll down to last letter at www.margaretdore.com/info/Stevens.pdf ).
[8]  Id.
[9]  Per her telephone call today.
[10]  The Oregon and Washington Acts can be viewed in their entirety here and here.
[11]  Id.
[12]  See Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, August 6, 2008, at http://abcnews.go.com/Health/story?id=5517492&page=1; "Letter noting assisted suicide raises questions," KATU TV, July 30, 2008, at http://www.katu.com/news/specialreports/26119539.html ; and Ken Stevens, MD, Letter to Editor, "Oregon mistake costs lives," The Advocate, the official publication of the Idaho State Bar, September 2011, to view, scroll down to bottom of second page here: http://www.margaretdore.com/info/September_Letters.pdf
[13] Id.
[14] Id.
[15] KATU TV at note 12
[16] ABC News at note 12
[17]  See also Affidavit of Ken Stevens MD (Leblanc v. Canada), with attachments, available at http://maasdocuments.files.wordpress.com/2012/09/signed-stevens-aff-9-18-12.pdf 
[18]  See "Suicides in Oregon: Trends and Risk Factors," Oregon Department of Human Services, Public Health Division, September 2010, page 6, ("Deaths relating to the death with Dignity Act (physician-assisted suicides) are not classified as suicides by Oregon law and therefore excluded from this report"), available at http://epcdocuments.files.wordpress.com/2011/10/or_suicide_report_001.pdf
See also Oregon Health Authority, News Release, "Rising suicide rate in Oregon reaches higher than national average," September 9, 2010, ("suicide rates have been increasing significantly since 2000") available at http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf[19]  Cindy Uken, "State of Dispair: High-Country Crisis, Montana’s suicide rate leads the nation," Billings Gazetter, November 25, 2012, http://billingsgazette.com/news/state-and-regional/montana/montana-s-suicide-rate-leads-the-nation/article_b7b6f110-3e5c-5425-b7f6-792cc666008d.html?print=true&cid=print
[20]  See 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
[21]  See Jerry Large, "Planning for old age at a premium," The Seattle Times, March 8, 2012 at http://seattletimes.nwsource.com/text/2017693023.html ("After Monday's column, some readers were unsympathetic, a few suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out. At least a couple mentioned euthanasia as a solution.")

"Assisted suicide in Washington and Oregon is a recipe for elder abuse and cloaked in secrecy"

http://missoulian.com/news/opinion/mailbag/oregon-washington-assisted-suicide-laws-include-no-protections-for-patients/article_074c4378-507b-11e2-8348-001a4bcf887a.html

By, Margaret Dore, Esq.

 

Supporting documentation follows letter, below.

I disagree with Susan Hancock’s description of how the Washington and Oregon assisted suicide laws work.   (Dec. 20, guest column)  I disagree that assisted suicide cannot be forced upon an unwilling person.

The Oregon and Washington assisted suicide acts have a formal application process. The acts allow an heir, who will benefit from the patient’s death, to actively participate in this process.

Once the lethal dose is issued by the pharmacy, there is no oversight. For example, there is no witness required at the death. Without disinterested witnesses, the opportunity is created for an heir, or for another person who will benefit from the patient’s death, to administer the lethal dose to the patient without his consent. One method would be by injection when the patient is sleeping. The drugs used in Oregon and Washington are water soluble and therefore injectable. If the patient woke up and struggled, who would know?

The Washington and Oregon acts require the state health departments to collect statistical information for the purpose of annual reports. According to these reports, users of assisted-suicide are overwhelmingly white and generally well-educated. Many have private insurance. Most are age 65 and older. Typically persons with these attributes are seniors with money, which would be the middle class and above, a group disproportionately at risk of financial abuse and exploitation.

The forms used to collect the statistical information do not ask about abuse. Moreover, not even law enforcement is allowed to access information about a particular case. Alicia Parkman a mortality research analyst at the Center for Health Statistics, Oregon Health Authority, wrote me: “We have been contacted by law enforcement and legal representatives in the past, but have not provided identifying information of any type.“

Assisted suicide in Washington and Oregon is a recipe for elder abuse and cloaked in secrecy. Don’t make our mistake.

Supporting documentation below.

Margaret Dore, Esq.

Seattle, Wash.

Time to strengthen assisted suicide law

http://helenair.com/news/opinion/readers_alley/time-to-strengthen-assisted-suicide-law/article_b8257dd0-45be-11e2-b96a-0019bb2963f4.html

December 13, 2012, Independent Record

I have several concerns about the practice of assisted suicide, which has been rejected by most states and is currently legal in only two states (Washington and Oregon). 1) The potential for elder abuse is very real. Patients in Oregon with a “terminally ill” diagnosis have been refused treatment and steered toward assisted suicide. Patients can be pressured by a relative, who can even administer the dose. 2) A “terminally ill” diagnosis can be wrong. Some patients recover with treatment and may live a long time. 3) Montana already has a high suicide rate and state policy is directed at lowering that rate. The suicide rate in Oregon has increased since their law was passed.

Please tell your legislators to clarify and strengthen our law against assisted suicide.

Ruth Plesner
Victor

Liberal Massachusetts Defeated Assisted Suicide

http://www.lowellsun.com/todaysheadlines/ci_22157064/support-withered-assisted-suicide-ballot-question#ixzz2Egbgwy23

Support withered for assisted-suicide question

By Chris Camire

In late September, polls showed a ballot initiative that would make physician-assisted suicide legal for terminally ill patients had support from 68 percent of Massachusetts voters.

Over the next month, that support steadily eroded, and on Election Day the measure failed by a razor-thin 51-49 percent margin.

How did a proposal that seemed sure to pass just five weeks before the election come up short?

Joseph Baerlein, president of Rasky Baerlein Strategic Communications, who handled public relations for the Committee Against Physician Assisted Suicide, said the measure's opponents had to convince voters who supported the idea of assisted suicide that the bill before them was flawed.

"We focused our campaign strategy on looking at those weaknesses," said Baerlein.

Assisted suicide: Idea is repugnant

http://missoulian.com/news/opinion/mailbag/assisted-suicide-idea-is-repugnant/article_f498f69c-407e-11e2-afae-001a4bcf887a.html

I was glad to see the letter in your publication by Brad Williams  (Nov. 28). Assisted suicide is an important topic for Montana, where proponents are wrongly claiming that the practice is legal and the majority of the population are senior citizens (over 50 years of age).

I retired from the Motion Picture Pension and Health Plans in Studio City, Calif., as the chief financial officer. One reason that I retired to Montana was that I had the perception that it was senior-citizen friendly, i.e., unlike Oregon and Washington, which have adopted laws allowing doctors and family members to assist people in killing themselves. That was repugnant to me.

The proposed legalization is for terminally ill persons. "Terminally ill" is a term that I am all too familiar with. In my previous employment, one would need to be terminally ill to qualify for a pension if they had not reached a specified age. Many, many times doctors deemed someone terminally ill and they wound up outliving their caregivers; not really, but they lived many years. If these persons had instead been applying for a lethal dose and used it, they would have been dead before their time.

Ted Friesen, Bigfork 

National disability rights group concerned Montana could legalize assisted suicide

http://missoulian.com/news/opinion/mailbag/national-disability-rights-group-concerned-montana-could-legalize-assisted-suicide/article_19f98ef0-38b0-11e2-ab52-0019bb2963f4.html

December 02, 2012

Not Dead Yet is a national disability rights group with members in Montana, some of whom are seniors. On behalf of our members, I write to say that we are extremely concerned that assisted suicide, sometimes euphemistically called "aid in dying," could be legalized in Montana.

It is estimated that there are 21,265 cases of elder abuse annually in Montana, reported and unreported (http://www.eadaily.com/15/elder-abuse-statistics).

Statistically, 90 percent of elder abusers are a family member or trusted other. Similarly, people with disabilities are up to four times more likely to be abused than their same-age nondisabled peers.

In Oregon and Washington, legal assisted suicide has opened new paths of abuse against persons who "qualify" to use these laws. A more obvious problem is a complete lack of oversight when the lethal drug is administered. If an abuser were to administer the drug without the person's consent, who would know?

It is simply naive to suggest that assisted suicide can be added to the array of medical treatment options, without taking into account the harsh realities of elder abuse and the related potential for coercion.

For more information about problems with legalization of assisted suicide, please see www.notdeadyet.org and www.montanansagainstassistedsuicide.org.Diane Coleman,
President/CEO,
Not Dead Yet,
Rochester, New York

Also published in the Ravalli Republic at
http://www.ravallirepublic.com/news/opinion/mailbag/article_f695c2f6-65c7-5194-9276-43365fd08f35.html?print=true&cid=print

Assisted suicide makes it easier to cover up elder abuse, even murder

http://www.ravallirepublic.com/news/opinion/mailbag/article_3fafcdd7-df10-5c31-baa6-d51d57078f77.html?print=true&cid=print

November 29, 2012

 

Re: Assisted Suicide and Elder Abuse

 

This letter responds to your recent AP article about assisted-suicide (Associated Press, Nov. 16). I write to emphasize elder financial abuse as a reason to keep assisted suicide out of Montana.

The landmark 2009 report by MetLife Mature Market Institute describes elder financial abuse as a crime “growing in intensity.” (See www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf, p.16.) The perpetrators are often family members, some of whom feel themselves “entitled” to the elder’s assets (Id, pp. 13-14.) The report states that they 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 (Id, p. 14.) The report states that victims “may even be murdered” by perpetrators (Id., p. 24.)

With legal assisted suicide in Oregon and Washington state, perpetrators are instead able to take a “legal” route by getting an elder to sign a lethal dose request. Once the prescription is filled, there is no supervision over administration. The elder could be cajoled or coerced into taking the lethal dose, for example, while under the influence of alcohol. The lethal dose could be administered while the elder slept. If he awoke and struggled, who would know?

Alex Schadenberg,
Euthanasia Prevention Coalition,
London, Ontario, Canada,

Assisted suicide a bad proposition

http://helenair.com/news/opinion/readers_alley/assisted-suicide-a-bad-proposition/article_0ca98042-3537-11e2-957f-001a4bcf887a.html?print=true&cid=print

Letter to the Editor:

November 23, 2012 12:00 am

 

I have been following assisted suicide issues in various states for several years. Who could have ever imagined that a free society would come to this?

Last year, many of us attended a meeting where we heard from lawyers and doctors from Washington and Oregon speak out about assisted suicide in their states. Their true accounts of elder abuse, suicide parties, fraud, theft, legal wrangling and what can only be called murder were very unsettling.

I sat there stunned and sick inside, thinking of all the misdeeds that had been done under the guise of mercy.

Friends, do we want to bring this type of debacle to our great state? I think not. Assisted suicide is not legal in Montana — though some would like us to think otherwise. Let us work together and take steps to keep it out. As a member of Montanans Against Assisted Suicide, I ask you to join us in our opposition to this barbaric practice. Many vulnerable folks are counting on us to get this one right.

Mrs. Garnett Rope

Vaughn

Assisted Suicide not legal in state, needs clarification

http://mtstandard.com/news/opinion/mailbag/our-readers-speak-assisted-suicide-not-legal-in-state-needs/article_6d1ca724-337f-11e2-9eee-001a4bcf887a.html

November 21, 2012 12:15 am  •  by David W. Hafer

A recent Associated Press article, which appeared last Friday in most major newspapers in our state, incorrectly stated that Montana is the third state to allow assisted suicide, along with Washington and Oregon.

Attorneys Greg Jackson and Matt Bowman did an extensive analysis of the case and concluded it “did not legalize assisted suicide and it continues to carry both criminal and civil liability for any doctor, institution, or lay person involved.”  [Click here to see Jackson/Bowman article]

The Montana Lawyer, the official publication of the Montana State Bar concluded the issue is open to argument, confirming that the Legislature needs to clarify the issue this coming session. [Click here for link to Montana Lawyer article, with this headline:  "The aid-in-dying debate: Can a physician legally help a patient die in Montana? Court ruling still leaves the issue open to argument"]

"It wasn't the father saying that he wanted to die"

Dear Montana Board of Medical Examiners:
   
My wife and I operate two adult family homes in Washington State where assisted suicide is legal.  I am writing to urge you to not make Washington's mistake.

Our assisted suicide law was passed via a ballot initiative in November 2008.  During the election, that law was promoted as a right of individual people to make their own choices.  That has not been our experience.  We have also noticed a shift in the attitudes of doctors and nurses towards our typically elderly clients, to eliminate their choices.

Four days after the election, an adult child of one of our clients asked about getting the pills (to kill the father).  It wasn't the father saying that he wanted to die.

"He made the mistake of asking for information about assisted suicide"

Dear Board of Medical Examiners: 

We are disturbed to hear that the Board has been asked to legalize assisted suicide in Montana.  We are writing to express our extreme objection to this development.

Our brother, Wes Olfert, recently died in Washington State where assisted suicide is legal.  When he was first admitted to the hospital, he made the mistake of asking for information about assisted suicide.  We say a mistake, because this set off a chain of events that interfered with his care and caused him unnecessary stress in what turned out to be the last months of his life.

By asking the question, he was given a "palliative care" consult by a doctor who heavily and continually pressured him to give up on treatment before he was ready to do so.  It got so bad that Wes actually became fearful of this doctor and asked us and a friend to not leave him alone with her.

Justified or not, Wes was afraid that the doctor would do something to him or have him sign something if she would find him alone.  In fact, even though he was on heavy doses of narcotic pain medications and not in a clear state of mind to sign documents without someone to advocate for him, this palliative care MD actually did try to get him to sign a DNR or “Do Not Resuscitate” form without his Durable POA or any family member present.  Fortunately, his close friend / POA arrived at that moment in time to stop this from happening.

Some of the other doctors and staff members seemed to also write Wes off once they learned that he had asked about assisted suicide. 

We object to any move by this Board to legalize assisted suicide in Montana.

We also question whether this Board would have the authority to do so. Thank you.

Ron Olfert
Marlene Deakins, RN 
Sanders County, MT  

Compassion & Choices of WA Embraces Derek Humphry

Just in from Washington State:

Compassion & Choices of Washington has announced that Derek Humphry will be the keynote speaker at its 2011 annual meeting.[1]

Derek Humphry has recently been in the news as a promoter of suicide kits from a company now shut down by the FBI.  According to an article in Oregon's Register-Guard newspaper:

"A spotlight was cast on the mail-order suicide kit business after a 29-year-old Eugene man committed suicide in December using a helium hood kit. The Register-Guard traced the $60 kit to [the company, which] has no website and does no advertising; clients find [the] address through the writings of Humphry."[2]

With the choice of Humphry as its keynote speaker, Compassion & Choices shows its true colors?

* * *

[1]  See current newsletter for Compassion & Choices of Washington, stating :  "Derek Humphry to be Keynote Speaker at 2011 Annual Meeting."  To view the newsletter, go to the following link and scroll down to the lower half of the page:  http://choiceisanillusion.files.wordpress.com/2011/10/derek.pdf
[2]  See e.g., Jack Moran, "Police kick in door in confusion over suicide kit:  The FBI message to police about the purchase of the gear failed to mention it was bought seven months ago, "  The Register-Guard, September 21, 2011.

Washington State: "Hear No Evil, See No Evil"

Dear Editor:

Margaret K. Dore's article regarding Washington's assisted suicide law [Bar Bulletin, July] highlights a troubling disconnect between this statute and the commendable trend in Washington law to recognize and protect elders from abuse.

On the one hand, the Slayer's Statute, RCW 11.84, was recently amended to penalize heirs who financially exploit a vulnerable adult. On the other hand, safeguards for assisted suicide are minimal, far less than the standards demanded for executing a valid will. As Ms. Dore points out, record-keeping by the state appears to consist of the "hear-no-evil, see-no-evil" variety.

Theresa Schrempp
Sonkin & Schrempp, PLLC

To view Dore's article, "Assisted-Suicide Report Lacks Information about Consent, click here.

To view Washington's official report, click here.

To view the above letter, go here (the link may not work for non-bar members):  https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=09&Year=2011&AID=letters.htm

Assisted Suicide is not Legal in Montana

Assisted Suicide: Not Legal in Montana;

 A Recipe for Elder Abuse and More

By Margaret Dore, July 15, 2011*

A. Introduction

 Proponents claim that physician-assisted suicide is legal in Montana. This is untrue. A bill that would have accomplished that goal was defeated in the 2011 legislature.

Legal physician-assisted suicide is, regardless, a recipe for elder abuse. It empowers heirs and others at the expense of older people.  In Oregon, where physician-assisted suicide is legal, legalization has empowered the Oregon Health Plan to steer patients to suicide.  There are multiple other problems.

B. 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." (AMA 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 AMA rejects physician-assisted suicide. Id. Assisted suicide is also opposed by disability rights groups such as the Disability Rights and Education Defense Fund, and Not Dead Yet.

C.  Most States do not Allow Physician-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 immunity from criminal and civil liability arising out of a patient's suicide (euphemistically termed "death with dignity").  See e.g. RCW 70.245.190(1)(a).  These statutes were passed via ballot initiatives.  No such law has ever made it through the scrutiny of a legislature.

D.  Current Montana Law

Under current Montana law, assisting a suicide exposes the assister to civil and criminal liability. Doctors and others can be held civilly liable for: (1) causing another to commit suicide; or (2) failing to prevent a suicide in a custodial situation where the suicide is foreseeable.[1]  This latter situation would typically occur in a hospital or prison.[2]  Those who assist a suicide can also be prosecuted for homicide under Mont. Code Ann. § 45-5-102(1).  Doctors, however, have the right to assert an affirmative defense based on the victim’s consent and other factors. This is due to the Montana Supreme Court decision, Baxter v. State, 354 Mont. 234, ¶¶ 10 & 50, 224 P.3d 1211 (2009).[3]

E. 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 affirmative defense; and SB 167, which would have legalized assisted suicide by providing doctors and others with immunity from civil and criminal 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."[4]

F. Legalization Will Create New Paths of Abuse

In Montana, there has been a rapid growth of elder abuse.[5]  Elders’ vulnerabilities and larger net worth make them a prime target for financial abuse.[6]  The perpetrators are often family members interested in an inheritance.[7] 

In Montana, preventing elder abuse is official state policy.[8]  If Montana would legalize physician-assisted suicide, a new path of abuse would be created against the elderly.  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?"[9]

G. "Terminally Ill" Does Not Mean Dying

Baxter’s affirmative defense applies when patients are "terminally ill," a term that Baxter does not define.  During the Baxter litigation, the plaintiffs offered this definition:

"'Terminally ill adult patient' means '[an adult] who has an incurable or irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of his or her attending physician, result in death within a relatively short time.'"[10]

This definition is broad enough to include patients with chronic conditions who could "live for decades."  Attorney Theresa Schrempp and doctor Richard Wonderly state:

"[The] definition is broad enough to include an 18 year old who is insulin dependent or dependent on kidney dialysis, or a young adult with stable HIV/AIDS.  Each of these patients could live for decades with appropriate medical treatment.  Yet they are 'terminally ill' according to the definition promoted by advocates of assisted suicide."[11]

H. 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, ABC News).[12]  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." Stroup said: "This is my life they’re playing with." Wagner said: "I’m not ready to die."

Stroup and Wagner were steered to suicide. Moreover, it was the Oregon Health Plan doing the steering. Oregon’s law empowered the Oregon Health Plan, not individual patients. 

I. In Oregon, Legalization of Physician-Assisted Suicide is Correlated to an Increase in Other Suicides

Oregon's suicide rate, which excludes suicide under Oregon's physician-assisted suicide law, has been "increasing significantly" since 2000.[13]  Just three years prior, in 1997, Oregon legalized physician-assisted suicide. [14]  In Oregon, legalization of physician-assisted suicide is statistically correlated with an increased rate of other suicides.

J.  The Oregon Reports do not Prove That Assisted-Suicide is "Safe"

 During the 2011 legislative session in Montana, proponents claimed that annual reports from Oregon demonstrated the safety of physician-assisted suicide.  These reports do not discuss whether the people who died consented when the lethal dose was administered.  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 against – to that patient is going to be turning themselves in for the commission of a homicide."[15]

K.  SB 167 was Defeated in the Senate Judiciary Committee

During the hearing on SB 167, Senator Essman also stated:

"There’s inadequate protection in [SB 167] for the powerless.  It’s our obligation to protect the powerless. . . .  I’m going to vote no."[16]

SB 167, seeking to legalize physician-assisted suicide in Montana, was defeated in the Senate Judiciary Committee.[17] 

L. Conclusion

 Legal assisted suicide is a recipe for elder abuse.  The practice has multiple other problems.  Don't make Oregon's and Washington's mistake.  Keep assisted suicide out of Montana.


*  Margaret Dore is an attorney in Washington State where assisted suicide is legal.  She was an amicus curie in the Baxter litigation.  She testified before the Montana Senate Judiciary Committee against SB 167, which had sought to legalize physician-assisted suicide in Montana.  Her publications include Margaret K. Dore, "Aid in Dying: Not Legal in Idaho; Not About Choice," The Advocate, official publication of the Idaho State Bar, Vol. 52, No. 9, pages 18-20, September 2010.

* * *

[1]   Krieg v. Massey, 239 Mont. 469, 472-3, 781 P.2d 277 (1989). 

[2]  Id.
[3]  To view Baxter, go here.  To view an analysis of Baxter, go here.
[4]  Go here to see a transcript of this quote and other quotes by Senator Blewett. 
[5]  Great Falls Tribune, "Forum will focus on the rapid growth in abuse of elders," June 10 2009 ("The statistics are frightening, and unless human nature takes a turn for the better, they’re almost certain to get worse").  See also Nicole Grigg, Elder Abuse Prevention, Kulr8.com, June 15, 2010 and Big Sky Prevention of Elder Abuse Program, What is Elder Abuse.
[6]  MetLife Mature Market Institute Study:  Broken Trust: Elders, Family, and Finances, 2009. 
[7]  Id.
[8]  See e.g., the "Montana Elder and Persons With Developmental Disabilities Abuse Prevention Act," 52-3-801, MCA; the Protective Services Act for Aged Persons or Disabled Adults, 52-3-201, MCA; and the "Montana Older Americans Act," 52-3-501, et. al., MCA.  Also go here. 
[9]  Alex Schadenberg, Letter to the Editor, "Elder abuse a growing problem," The Advocate, official publication of the Idaho State Bar, October 2010, page 14, available at http://www.isb.idaho.gov/pdf/advocate/issues/adv10oct.pdf. 
[10]  Plaintiffs’ Answer to Interrogatory No. 4, available at page 3, here:  http://www.euthanasiaprevention.on.ca/ConnMemo02.pdf  
[11]  Opinion Letter from Dr. Richard Wonderly and Theresa Schrempp, Esq., to Alex Schadenberg, available here:  http://www.euthanasiaprevention.on.ca/ConnMemo02.pdf
[12]  See Susan Harding and KATU web staff, "Letter noting assisted suicide raises questions," July 30, 2008 and Susan Donaldson James, "Death drugs Cause Uproar in Oregon," ABC News, August 6, 2008.  See also Ken Stevens, MD, "Oregon mistake costs lives," official publication of the Idaho State Bar, September 2010, pages 16-17, available at http://www.isb.idaho.gov/pdf/advocate/issues/adv10sep.pdf ("In Oregon, the mere presence of legal assisted-suicide steers patients to suicide . . . ").
[13]  See Oregon Government News Release, September 9, 2010 ("suicide rates have been increasing significantly since 2000"); and "Suicides in Oregon, Trends and Risk Factors, September 2010 ("Deaths relating to the death with Dignity Act (physician-assisted suicides) are not classified as suicides by Oregon law and therefore excluded from this report").
[14]  See e.g., "Oregon's Death with Dignity Act:  The First Year's Experience," page 1 ("On October 27, 1997, physician-assisted suicide became a legal medical option for terminally ill Oregonians").
[15]  Montana Senate Judiciary Hearing, February 10, 2011, Transcript, p. 15, lines 1 to 11, available here. 
[16]  Id., lines 12 to 14.
[17]  See Montana Legislative website at
http://www.leg.mt.gov/css/default.asp (SB 167 was tabled in Committee on February 10, 2010).