Wednesday, January 30, 2019

Dore Memo Urging No Vote on HB 90

I. INTRODUCTION

I am a lawyer and president of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia.[1] The Act, HB 90, seeks to legalize medical “aid in dying,” a traditional euphemism for active euthanasia and physician-assisted suicide.[2]

HB 90 is based on similar statutes in Oregon and Washington State. If enacted, it will apply to people with years or decades to live. It will create new paths of abuse and exploitation.[3]

Individuals with money, meaning the middle class and above, will be especially at risk. I urge you to vote “No” on HB 90.


II. DEFINITIONS

A.  Physician-Assisted Suicide; Assisted Suicide; and                Euthanasia

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.”[4] For example:
[T]he physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide.[5]
Assisted suicide is a general term in which an assisting person is not necessarily a physician. Euthanasia is the administration of a lethal agent “by another person.”[6]

B.  Withholding or Withdrawing Treatment 

Withholding or withdrawing treatment (“pulling the plug”) is not euthanasia if the purpose is to remove burdensome treatment, as opposed to an intent to kill the patient. More importantly, the individual will not necessarily die. Consider this quote from Washington State regarding a man removed from a ventilator:
[I]nstead of dying as expected, [he] slowly began to get   better.[7]
III.  ASSISTING PERSONS CAN HAVE AN AGENDA

Persons assisting a suicide or euthanasia can have an agenda. Consider 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.[8] Consider also Graham Morant, recently convicted of counseling his wife to kill herself in Australia, to get the life insurance.[9] The Court found:
[Y]ou counseled and aided your wife to kill herself because you wanted ... the 1.4 million.[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. PUSH BACK AGAINST ASSISTED SUICIDE

A. Last Year, Utah Passed a Law Making Assisted Suicide a Felony 

Last year, Utah amended its manslaughter statute to clarify that aiding suicide is a felony.[13] The bill, HB 86, passed the legislature by a 2 to 1 margin.[14]

B. Two Years Ago, Alabama Passed an Act Banning Assisted 
      Suicide

Two years ago, Alabama enacted an “Assisted Suicide Ban Act,” which renders any person who deliberately assists a suicide, guilty of a felony.[15] The Act passed by an overwhelming majority.[16]

C. Five Other States Have Strengthened Their Laws Against 
      Assisted Suicide

In the last eight years, five other states have strengthened their laws against assisted suicide. These states are Arizona, Louisiana, Georgia, Idaho and Ohio.[17]

V. HOW THE ACT WORKS

The Act has a lethal dose request process, which includes a lethal dose request form.[18]

Once the lethal dose is issued by the pharmacy, there is no oversight. No doctor, not even a witness, is required to be present at the death.[19]

VI.  “ELIGIBLE” PERSONS MAY HAVE YEARS OR DECADES TO LIVE

A.  If New Mexico Follows Oregon, the Act Will Apply to Young 
     Adults With Chronic Conditions Such as Insulin Dependent 
     Diabetes

The Act applies to persons with a terminal illness, which is expected to result in death within six months. The Act states:
“[T]erminal illness” means a disease or condition that is incurable and irreversible and that, in accordance with reasonable medical judgment, will result in death within six months. [20]
Oregon’s law has a similar definition:
“Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.[21]
In Oregon, this similar definition is interpreted to include chronic conditions such as diabetes mellitus, better known as diabetes.[22] This is because the six months to live is determined without treatment. Oregon doctor, William Toffler, explains:
In Oregon, people with chronic conditions are “terminal,” if without their medications, they have less than six months to live.[23]
Dr. Toffler adds:
This is significant when you consider that a typical insulin-dependent 20 year-old will live less than a month without insulin. 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.[24]
If the proposed Act is enacted and New Mexico follows Oregon’s interpretation of terminal disease, medical “aid in dying” will be legalized for people with chronic conditions such as insulin dependent diabetes. Such persons can have decades to live.

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

Consider also Jeanette Hall, who was diagnosed with cancer in 2000 and made a settled decision to use Oregon’s law.[30] Her doctor convinced her to be treated instead.[31] In a 2018 declaration, she states:
It has now been 18 years since my diagnosis. If [my doctor] had believed in assisted suicide, I would be dead. Assisted suicide should not be legal.[32]
VII.  THE ACT WILL CREATE A PERFECT CRIME

A. The Definition of “Self-Administer” Does Not Require a 
      Qualified Individual to Know or Understand That He or She        Is Taking a Lethal Dose

The Act states:
"self-administer" means taking an affirmative, conscious, voluntary action to give oneself a pharmaceutical substance[33] 
With this definition, the qualified individual is not required to know or understand that the pharmaceutical substance is a lethal dose.

B.  The Cause of Death Will Be a Terminal Illness

The Act, Section 7, titled “Death Certificate–Cause of Death,” states:
The cause of death of a qualified individual who is deceased pursuant to self-administration of medical aid in dying medication [a lethal dose] pursuant to the Elizabeth Whitefield End of Life Options Act shall be the qualified individual's underlying terminal illness. (Emphasis added).[34]
The significance of requiring a terminal illness to be listed as the cause of death on the death certificate is that it will create an inability to prosecute. Even if the qualified individual thought that he or she was taking a cold medication instead of the lethal dose, the official legal cause of death will be a terminal illness (not murder) as a matter of law.

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.”[35] The inquiry also found:
that by issuing death certificates stating natural causes, the serial killer [Shipman] was able to evade investigation by coroners.[36]
According to a subsequent article in 2015, proposed reforms included having a medical examiner review death certificates, so as to improve patient safety.[37] Instead, the instant Act moves in the opposite direction to require a legal coverup in which doctors and other perpetrators will be able to kill patients with impunity.

IX. “EVEN IF A PATIENT STRUGGLED, WHO WOULD KNOW?”

The Act has no required oversight over administration of the lethal dose.[38] In addition, the drugs used are water and or alcohol soluble, such that they can be injected into a sleeping or restrained person without consent.[39] Alex Schadenberg, Executive Director for the Euthanasia Prevention Coalition, puts it this way:
With assisted suicide laws in Washington and Oregon [and with the proposed Act], 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 administration. Even if a patient struggled, “who would know?” (Emphasis added).[40]
X. EUTHANASIA WILL BE ALLOWED

The Act legalizes medical “aid in dying,” which is a traditional euphemism for active euthanasia.[41] The Act also describes the lethal dose as medication.[42] Generally accepted medical practice allows a doctor, or a person acting under the direction of a doctor, to administer medication.[43] Euthanasia is the administration of a lethal agent “by another person.”[44]

If for the purpose of argument, euthanasia is not allowed, it will nonetheless occur due to the Act’s complete lack of oversight over administration of the lethal dose and motives such as life insurance and inheritance money.[45] Consider also the quote below from an article in the New England Journal of Medicine, regarding a study of assisted suicide versus euthanasia.[46] Problems were experienced more frequently with assisted suicide, which led to euthanasia:
The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5).[47]
XI.  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.[48] 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.[49] 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.[50]
B.  My Clients Suffered Trauma in Oregon and Washington State

In Oregon and Washington State, I have had two cases where my clients and their family member patients suffered severe emotional 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 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. 

XI.  CONCLUSION

If enacted, HB 90 will apply to people with years or decades to live. This will be especially true if New Mexico follows Oregon practice to determine life expectancies without treatment. Young adults with chronic conditions, such as insulin dependent diabetes, will be considered terminal and therefore "eligible" for assisted suicide/euthanasia.

Assisting persons, including doctors and family members, can have an agenda, with the more obvious reasons being inheritance and life insurance, but also, as in the case of Dr. Swango, the thrill of seeing someone die. The lack of any required oversight at the deaths, coupled with the required falsification of the death certificate will provide cover for murder. Families and individuals will be traumatized.

Don’t make Oregon and Washington’s mistake. I urge you to vote “No” on HB 90.

Respectfully Submitted,

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

Appendix

[1]  See www.margaretdore.org, www.choiceillusion.org and the CV attached hereto in the Appendix, at pages 1 through 4.
[2]  The Act, as recently amended, is attached in the Appendix at pages 101 through 116. The Act can also be viewed at: https://nmlegis.gov/Sessions/19%20Regular/Amendments_In_Context/HB0090.pdf
[3]  Craig A. Brandt, “Model Aid-in-Dying Act,” Iowa Law Review, 1989 Oct; 75(1): 125-215, (“Subject: Active Euthanasia ....”), at  https://repository.library.georgetown.edu/handle/10822/738671, attached in the Appendix, page 5; and Maria T. CeloCruz, “Aid-in-Dying: Should We Decriminalize Physician-Assisted Suicide and Physician-Committed Euthanasia?,” American Journal of Law and Medicine 1992 (“Subject: Active Euthanasia ....”) at https://repository.library.georgetown.edu/handle/10822/744116, attached in the Appendix, page 6   
[4]  AMA Principles of Medical Ethics, § 5.7, Physician-Assisted Suicide, attached in the Appendix, at page 7.
[5]  Id.
[6]  Id., § 5.8, Euthanasia (lower half of the page)
[7]  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, 01/13/09; in the Appendix, beginning at page 8; quote at page 10.
[8]  KTVZ.com, “Sawyer Arraigned on State Fraud Charges,” Appendix page 11.
[9]  R v Morant [2018] QSC 251, Order, 11/02/18, pp. 1 & 11, ¶ 78, available at https://archive.sclqld.org.au/qjudgment/2018/QSC18-251.pdf, Appendix pages 12 and 13.
[10]  Id., Order page 11, ¶ 78; attached in the Appendix at page 13.
[11]  Charlie Leduff, “Prosecutors Say Doctor Killed to Feel a Thrill,” The New York Times, 09/07/00 (“Basically, Dr. Swango liked to kill people.  By his own admission in his diary, he killed because it thrilled him.”) Excerpts attached in the Appendix at pages 14-16.  See also: CBSNEWS.COM STAFF, “Life in Jail for Poison Doctor,” 07/12/00, www.cbsnews.com/news/life-in-jail-for-poison-doctor
[12]  David Batty, “Q & A: Harold Shipman,” The Guardian, 08/25/05, at https://www.theguardian.com/society/2005/aug/25/health.shipman, attached in the Appendix, pages 17 to 19.  See also Fiona Guy, “Healthcare Serial Killers: Doctors and Nurses Who Kill,” Crime Traveller, (2015, Sept 09), excerpts in the Appendix, pages 20 to 23, available at https://www.crimetraveller.org/2018/06/healthcare-medical-serial-killers
[13]   https://le.utah.gov/~2018/bills/static/HB0086.html
[14]  HB 86 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.”
[15]  See Alabama: Assisted Suicide Ban Act to Go Into Effect,” http://www.choiceillusion.org/2017/07/alabama-assisted-suicide-ban-act-to-go.html
[16]  Scroll down to view roll calls: https://legiscan.com/AL/bill/HB96/2017
[17]  See: AP, “Brewer signs bill targeting assisted suicide,” Arizona Capitol Times, 04/30/14, attached in the Appendix, page 25; AP, “La. assisted-suicide ban strengthened,” The Daily Comet, 04/24/12, Appendix, page 26; Georgia HB 1114, attached at A-27; “Idaho Strengthens Law Against Assisted Suicide,” attached in the Appendix, page 28 (”The bill explicitly provides that causing or aiding a suicide is a felony”); and Ohio §3795.04, Assisted Suicide, added by the 131st Ohio General Assembly, effective 03/21/17, http://codes.ohio.gov/orc/3795
[18]  The form is part of the Act, Section 3, attached at pages 105 to 107.
[19]  See the Act in its entirety, in the Appendix at pages 101 to 116.
[20]  HB 90, Section 2.K., in the Appendix at page A-103.
[21]  Or. Rev. Stat. 127.800 s.1.01(12), in the Appendix at page 33.
[22]  “Diabetes” is listed as an underlying illness sufficient for assisted suicide in Oregon government reports.  See for example, the report excerpt in the Appendix at page 35 (Toffler page A-4).
[23]  Declaration of William Toffler, ¶¶ 5 & 6, in the Appendix at page 30.
[24]  Id.
[25]  See: Jessica Firger, “12 million Americans misdiagnosed each year,” CBS NEWS, 4/17/14, at https://www.cbsnews.com/news/12-million-americans-misdiagnosed-each-year-study-says, attached in the Appendix at page 39; and Nina Shapiro, “Terminal Uncertainty,” excerpts attached in the Appendix at pages 8 to 10.
[26]  Affidavit of John Norton, attached in the Appendix, at pages 40 to 42.
[27]  Id., ¶ 1.
[28]  Id., ¶ 4
[29]  Id., ¶ 5.
[30]  Affidavit of Kenneth Stevens, MD, attached in the Appendix at pages 43 to 45, Jeanette discussed at pages 43 and 44.  Hall declaration attached in the Appendix at page 46.
[31]   Id.
[32]  Declaration of Jeanette Hall, ¶4, in the Appendix at page 46.
[33]  The Act, Section 2.I., attached in the Appendix, page 103.
[34]  The Act, attached hereto, in the Appendix at page 109.
[35]   David Batty, supra, attached hereto, in the Appendix at pages 17-19, quote set forth at page 19.
[36]  Id., Appendix page 15, second paragraph titled “What are its findings?”
[37]  Press Association, “Death certificate reform delays ‘incomprensible,’” The Guardian, January 21, 2015, Appendix pages 49 and 50.
[38]  See the proposed Act, attached in the Appendix, pages 101 to 116.
[39]  In Oregon, the drugs used include Secobarbital, Pentobarbital  (Nembutal) and Phenobarbital.  See the Oregon government report excerpt, Appendix page 36 (listing these drugs).  Secobarbital and Pentobarbital are soluble in water and alcohol.  See  http://www.drugs.com/pr/seconal-sodium.html and http://www.drugs.com/pro/nembutal.html.  Phenobarbital is soluble in alcohol.  See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2977013
[40]  Alex Schadenberg, Letter to the Editor, “Elder abuse a growing problem,” The Advocate, Official Publication of the Idaho State Bar, October 2010
[41]  Again see Craig A. Brandt, “Model Aid-in-Dying Act,” Iowa Law Review, 1989 Oct; 75(1): 125-215, (“Subject: Active Euthanasia ....”), at  https://repository.library.georgetown.edu/handle/10822/738671, which is attached as Appendix page 5.
[42]  The Act states:
"medical aid in dying" means the medical practice wherein a health care provider prescribes medication to a qualified individual who may self-administer that medication to end that individual's life in accordance with the provisions of the Elizabeth Whitefield End of Life Options Act (Emphasis added).
The Act, Section 10.B.(2), Appendix page 115.
[43]  Oregon doctor, Kenneth Stevens, MD, testifies:
Generally accepted medical practice allows a doctor, or a person acting under the direction of a doctor, to administer prescription drugs to a patient. Common examples of persons acting under the direction of a doctor, include: nurses and other healthcare professionals who act under the direction of a doctor to administer drugs to a patient in a hospital setting; parents who act under the direction of a doctor to administer drugs to their children in a home setting; and adult children who act under the direction of a doctor to administer drugs to their parents in a home setting. (Emphasis added).
Declaration of Kenneth Stevens, MD, January 19, 2016, Appendix page 45.
[44]  AMA Principles of Medical Ethics, § 5.8, Euthanasia, Appendix page 7 (lower half of the page).
[45]  See prior discussion regarding Graham Morant, Harold Shipman, Michael Swango and other similar perpetrators, beginning at    For yet another example, see Andrew Gregory, “Euthanasia patient fought back as doctor tried to give her lethal injection,” Mirror Online, 01/27/17, at https://www.mirror.co.uk/news/world-news/euthanasia-patient-fought-back-doctor-9707709
[46]  Johanna H. Groenewoud, M.D., “Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands,” The New England Journal of Medicine, 02/54/00, available at https://www.nejm.org/doi/full/10.1056/NEJM200002243420805
[47]  Id.
[48]  “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
[49]  Id.
[50]  Id.