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).

Physician-assisted suicide: Permission is recipe for abuse

January 30, 2013 8:30 am

In the 2011 legislative session, Sen. Anders Blewett and I introduced competing bills in response to the Montana Supreme Court’s assisted-suicide case, Baxter v. State. The case did not legalize assisted-suicide. Its language was, however, a “toe in the door,” which could lead to legalization in the future.

Neither bill passed. His bill had sought to legalize assisted-suicide; mine had sought to reverse Baxter. This legislative session, there will likely be a similar contest.

The vast majority of states to consider assisted suicide have rejected it. In the past two years, three states have strengthened their laws against assisted suicide: Georgia, Louisiana and Idaho. Only two states allow it, Oregon and Washington. Their laws were enacted by initiative campaigns.

No such law has made it through the scrutiny of a legislature despite more than 100 attempts.

Legal assisted suicide is, regardless, a recipe for elder abuse in which heirs are empowered to pressure and abuse older people to cut short their lives. I urge you to tell your legislators that you support legislation to close on the door on assisted suicide in Montana.

To learn more, see this website: www.choiceillusionmontana.org

Greg Hinkle, Thompson Falls

Physician-assisted suicide runs risk of invisible coercion

http://mtstandard.com/news/opinion/mailbag/physician-assisted-suicide-runs-risk-of-invisible-coercion/article_121a9ba4-681a-11e2-b046-0019bb2963f4.html?print=true&cid=print

Ben Mattlin writes in The New York Times on Oct. 31, 2012, that he counts himself as a pro-choice liberal who ought to support physician-assisted suicide, but as a lifelong disabled person, he cannot.

Physician-assisted suicide is a person swallowing a lethal drug prescribed by a doctor. With plenty of room for abuse, Mattlin says, it’s a bad idea.

In Montana, the issue of physician-assisted suicide has been kicked around in the Legislature and in the courts, including the Montana Supreme Court, resulting in a mixed message that needs clarity. This Legislature will try again.

Here’s Mattlin: “My problem, ultimately, is this: I’ve lived so close to death for so long that I know how thin and porous the border between coercion and free choice is, how easy it is for someone to inadvertently influence you to feel devalued and hopeless — to pressure you ever so slightly but decidedly into being ‘reasonable’ to unburdening others, to ‘letting go.’”

He goes on to say that, while the push for physician-assisted suicide comes from many who have seen a loved one suffer, supporters of it can’t truly conceive of the many “subtle forces — invariably well-meaning, kindhearted, even gentle, yet as persuasive as a tsunami — that emerge when your physical autonomy is hopelessly compromised.”

Mattlin was born with spinal muscular atrophy. He has never walked, stood, or had much use of his hands. Half of babies with this condition die within two years. Today, Mattlin, almost 50, is a husband, father, journalist and author.

When a hospital blunder compromised his heath further, doctors questioned whether his life was worth saving. Mattlin writes, “They didn’t know about my family, my career, my aspirations.” His wife rescued him.

From this he learned how easy it is to be perceived as someone whose quality of life is untenable and how this becomes one of many invisible forces of coercion. Others include, “that certain look of exhaustion in a loved one’s eyes, or the way nurses or friends sigh in your presence while you are zoned out in a hospital bed.”

Mattlin writes that this can cast a dangerous cloud of depression upon even the most cheery of optimists. He says, “advocates of Death with Dignity laws who say that patients themselves should decide whether to live or die are fantasizing. We are inexorably affected by our immediate environment. The deck is stacked.”

Cort Freeman
2950 Bayard St.
Butte

Assisted suicide would exacerbate problem of elder abuse in Montana

http://missoulian.com/news/opinion/mailbag/assisted-suicide-would-exacerbate-problem-of-elder-abuse-in-mt/article_bffd5bbc-68d3-11e2-ae9f-0019bb2963f4.html?print=true&cid=print

For over 20 years, I have been an internal medicine physician with a high percentage of older patients. I have had the painful misfortune of personally observing countless instances of elder abuse.

Elder abuse is horrific and on the rise. Perpetrators of the abuse include hired caregivers, neighbors and family members. In my experience, the motive is usually financial gain. This was true in the case of one of my patients, where a much younger man obtained financial control (became payee for Social Security and retirement benefits) by taking advantage of an elderly woman’s loneliness and dementia. He feigned romantic interest in her, flattering her to the point that she took his side against her family members. She became isolated and totally dependent on him. After many months, Adult Protective Services was able to provide a guardian. This same motive of greed could lead to coerced assisted suicide if there was anticipated financial gain, and death could occur quickly if assisted suicide was legal – before protection could be put in place.

In Oregon and Washington, where assisted suicide is legal, portions of those states’ statutes lend themselves to elder abuse, such as the fact that no witness is required at the time of death. An elderly patient of mine recently died peacefully and of natural causes in his home, surrounded by family. His daughter was devastated when a family member visiting from Oregon asked if they had given him pills to end his life, as they would have done in her state.

Elder abuse is already a huge problem in Montana. I hope Montana’s legislators will have the courage to stop legalization of assisted suicide here and thereby protect the elderly and disabled.

For more information, including a summary of this important issue, see www.montanansagainstassistedsuicide.org.

Annie Bukacek,
Kalispell

Oregon doctor could not save patient from assisted suicide

http://mtstandard.com/news/opinion/mailbag/oregon-doctor-could-not-save-patient-from-assisted-suicide/article_a4b605ba-6767-11e2-bf94-0019bb2963f4.html

I am a doctor in Oregon, where assisted suicide is legal. A few years ago, I was caring for a 76-year-old man who presented to my office a sore on his arm, eventually diagnosed as melanoma. I referred him to specialists for evaluation and therapy.

I had known this patient and his wife for more than a decade. He was an avid hiker, a popular hobby here in Oregon. As his disease progressed, he was less able to do this activity, becoming depressed, which was documented in his chart.

During this time, my patient expressed a wish for assisted suicide to one of the specialists. Rather than take the time to address his depression, or ask me as his primary care physician to talk with him, she called me and asked me to be the “second opinion” for his suicide. She told me that barbiturate overdoses “work very well” for patients like this, and that she had done this many times before.

I told her that assisted suicide was not appropriate for this patient and that I did not concur. I was very concerned about my patient’s mental state, and told her that addressing his underlying issues would be better than simply giving him a lethal prescription. Unfortunately, my concerns were ignored, and two weeks later my depressed patient was dead from an overdose prescribed by this doctor.

Under Oregon’s law, I was not able to protect my depressed patient. If assisted suicide becomes legal in Montana, you may not be able to protect your friends or family members.

I urge you to contact your legislators to tell them to keep assisted suicide out of Montana. Don’t make Oregon’s mistake.

Dr. Charles J. Bentz
Portland, Ore.

Oregon Assisted Suicide Law is Not Safe According to Lawyer

http://mtstandard.com/news/opinion/mailbag/oregon-assisted-suicide-law-is-not-safe-according-to-lawyer/article_329524a6-629a-11e2-bea8-0019bb2963f4.html?print=true&cid=print

I am a lawyer in Oregon who specializes in injury claims including wrongful death cases. I understand that Montana will be considering assisted suicide legislation this session. I write to inform your readers that Oregon’s assisted suicide law lacks transparency. Even law enforcement is denied access to information collected by the State. Moreover, this is official state policy.

In 2010, I was retained by a client whose father had died under our assisted-suicide act. Unlike other deaths I have investigated, it was difficult to get basic information.

After I wrote the state epidemiologist, I received a letter from the Attorney General’s Office that the agency charged with collecting assisted-suicide data, the Oregon Health Authority, “may only make public annual statistical information.” The letter also referred me to the Oregon Medical Board and law enforcement.

The Board wrote me that there could be no investigation without an allegation of misconduct against a physician. At my request, a police officer was assigned to the case. Per his confidential report, the Oregon Health Authority would neither confirm nor deny that my client’s father had died under our act. Per the report, the officer did, however, talk to the doctor signing the death certificate who said that he did not know that the death had involved assisted-suicide. The death certificate listed the immediate cause of death as “cancer” and the manner of death as “natural.”

Per the report, the officer also spoke with potential perpetrators who assured him that the death had been voluntary. He closed the case.

This is a link to Oregon’s data release policy as of Jan. 1, that it “will not confirm on a case-by-case basis whether an individual has used, or a provider has been involved, with Death with Dignity.” http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/policy.aspx

Without transparency our law is not safe.

Isaac Jackson
Box 41240
Eugene, Ore.