Thursday, January 10, 2013

Quick facts about Assisted Suicide

The following article was originally published on the Montanans Against Assisted Suicide website.
Margaret Dore

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

Barbara Wagner

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 month, 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 suicide­once 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.") 

31 comments:

Winston said...

Should we also make refusal of treatment illegal? After all, that's suicide too, especially in cases of diabetics refusing insulin, or individuals with kidney failure refusing dialysis.

Alex Schadenberg said...

Dear Winston:

Refusal of treatment is not suicide. There is a clear difference between intentionally causing death and refusing treatment, even when the refusal is likely to result in death.

The other issue is that we do not oppose suicide we oppose assisted suicide.

Winston said...

Alex - why would someone refuse a respirator or life-saving pills unless they wished to die in the first place?

The Nicklinson case is another example. You're only against assisted suicide when it's swift and merciful.

To sum up:

Suicide by cop: Yes.
Suicide by starvation: Yes.
Suicide by barbiturate overdose: No.

Alex Schadenberg said...

Your comments about Suicide by cop or Suicide by starvation are in fact disgusting. We are not in favour of any form of assisted suicide and the concept of suicide by cop is insane.

The facts are clear, we are opposed to assisted suicide we are not opposed to refusing treatment. They are not the same thing.

I do not appreciate trivializing the concepts of suicide by cop or suicide by starvation. Read my blog further, it is very consistent.

Alex Schadenberg said...
This comment has been removed by the author.
Alex Schadenberg said...
This comment has been removed by the author.
Winston said...

Alex: You would make an exception for cases of self-defense, correct? Therefore, you are inadvertently giving tacit approval to a loophole in the current assisted suicide law (suicide by cop).

It is also assisted suicide when an individual refuses treatment and chooses to be starved to death. Especially since they must be sedated to evade the suffering caused by such a barbaric act. Tony Nicklinson is a case in point. It was a situation where refusing treatment and committing suicide were one and the same.

Alex Schadenberg said...

Dear Winston:

There is no exception to assisted suicide, your argument about self-defence refers to killing another person, but in assisted suicide there cannot be a self-defence exception.

You seem to have a fixation with suicide by cop. If you have a problem I am willing to talk to you, if it would help.

As for death by starvation, if you read the blog further you will notice that death by starvation is nearly impossible, but death by dehydration is possible.

I don't advocate for death by dehydration, and yes death by dehydration can be a form of euthanasia.

Winston said...

But Alex, an exception for self-defense would allow the brutal act of provoking the police into killing oneself (in such instances, that would be assisted suicide).

We regularly put down dogs that are dangerous. It is also very feasibly for humans to do the same and induce the police to shoot them.

Alex Schadenberg said...

Dear Winston:

I have a friend who is a professional counsellor who can help you with your fixation.

Winston said...

I'm perfectly stable mentally, Alex. I was simply pointing out that in the absence of compassionate end-of-life legislation, suicide by cop is one of the most painless ways to die.

Your stance on pain control and the double effect would prohibit doctors prescribing morphine pills. After all, you never know who's going to stockpile and overdose on them. It would take a greater amount, but it's certainly possible.

It would also mean more suffering, since the patient would not be able to build up a resistance to the drug.

Alex Schadenberg said...

Dear Winston:

There is a clear ethical line between being intentionally involved with causing death by knowingly prescribing a lethal dose and a person saving up morphine.

Since you don't get it, let me explain. It is wrong to give someone else in society, such as a doctor, the right in law to either intentionally cause my death or be involved with intentionally causing my death.

All of these false comparisons, such as suicide by cop, do not fit and are simply an attempt to create false and inaccurate and even worse (suicide by cop) destructive comparisons.

There is a clear difference between euthanasia and assisted suicide but the similarity rests on the right in law for one person to actually cause or be involved with intentionally causing the death of another person.

Alex Schadenberg said...
This comment has been removed by the author.
Alex Schadenberg said...
This comment has been removed by the author.
Alex Schadenberg said...
This comment has been removed by the author.
Winston said...

Alex: Stockpiling morphine can only be done with a physician's aid.

Suicide is perfectly legal, so why must it be limited to violent (shotgun) slow (self-dehydration) and/or unreliable methods (shotgun/pistols)?

Why should doctors and vets be the only ones with access to a swift, peaceful, merciful and guaranteed compassionate end?

Alex Schadenberg said...

Winston:

Your comments really help my argument against assisted suicide.

Winston said...

Alex: So you prefer the status quo? If I believed in miracles, the complete lack of terminally ill suicide bombers would qualify.

As a society, modern Western world treats suffering animals with infinitely more compassion than they do suffering human beings.

Alex Schadenberg said...

I don't support the status quo, I believe we should provide much better care for vulnerable people.

But I don't compare humans to animals, and I don't believe in giving doctors or any other group the right to kill me.

Winston said...

Alex: If compassion means anything, it must mean the same thing for humans and for animals. Under the current regime, animals have more rights than we do when it comes to the relief of suffering.

As for terminal sedation, most would rather die quickly rather than linger on in a coma for several weeks.

Why should suicide only be available to those who can physically commit it? That leaves quadriplegics and those unfortunate enough to suffer from locked-in syndrome with no option save self-dehydration.

Hardly compassionate in any sense.

Winston said...

I've watched your speech and Q&A interface with students at the U of T campus (talk about preaching to the choir).

You haven't said anything about how to determine the motives of a doctor who administers high doses of morphine.

How do you distinguish between just enough terminal sedation and too much terminal sedation that hastens death?

Alex Schadenberg said...

Dear Winston:

I am glad you are watching my old speech.

The problem of abuse is pretty serious and further to that, the average person has a hard time recognizing when normal treatment of pain is occurring or an abuse is occurs.

It would only get worse if we legalize euthanasia.

Winston said...

Why would it get worse under a system of regulation and scrutiny?

Under the current situation, the easiest way to get away with murder would be to increase morphine until death occurs, and then lie to the coroner about one's motives.

Alex Schadenberg said...

You obviously haven't read my book. In jurisdictions where euthanasia is legal, the abuse continues and the number of deaths by dehydrations increase.

Read my book or read more of my blog articles.

Look to the articles on the recent Netherlands statistics and the Belgium studies.

Winston said...

It's more likely that abuse becomes more visible. The rates are almost impossible to determine the level of abuse without scrutiny.

Here's an article you should analyse before assuming that we will go down the slippery slope instead of up it:

http://www.utilitarian.net/singer/by/200508--.htm

More specifically:

"In addition, studies have been carried out in Australia and in Belgium to ascertain whether there was more abuse in the Netherlands than in other comparable countries where euthanasia was illegal and could not be practiced openly. The Australian study found that while the rate of active voluntary euthanasia in Australia was slightly lower than that shown in the more recent Dutch study (1.8 percent as against 2.3 percent), the rate of explicit nonvoluntary euthanasia in Australia was, at 3.5 percent, much higher than the Dutch rate of 0.8 percent. Rates for other end-of-life decisions, such as withdrawing life support or giving pain relief foreseen to be life-shortening, were also higher than in the Netherlands. The Belgian study, which examined deaths in the country's northern Flemish-speaking region before voluntary euthanasia was legalized in that country, came to broadly similar conclusions. The rate of voluntary euthanasia was, at 1.3 percent of all deaths, again lower than in the Netherlands, but the proportion of patients given a lethal injection without having requested it was, at 3 percent of all deaths, similar to the Australian rate and also like it, much higher than the rate in the Netherlands. These two studies discredit assertions that the open practice of active voluntary euthanasia in the Netherlands had led to an increase in nonvoluntary euthanasia. There is no evidence to support the claim that laws against physician-assisted suicide or voluntary euthanasia prevent harm to vulnerable people. Those who still seek to paint the situation in the Netherlands in dark colors now need to explain the fact that that country's neighbor, Belgium, has chosen to follow its lead. The Belgian parliament voted, by large margins in both the upper and lower houses, to allow doctors to act on a patient's request for assistance in dying. The majority of Belgium's citizens speak Flemish, a language so close to Dutch that they have no difficulty in reading Dutch newspapers and books or watching Dutch television. If voluntary euthanasia in the Netherlands really were rife with abuses, why would the country that is better placed than all others to know what goes on in the Netherlands be keen to pass a similar law?"

Alex Schadenberg said...

You obviously haven't read my book or the Belgium studies.

The euthanasia lobby always tosses false arguments into the debate.

You are comparing apples to oranges.

Winston said...

As I mentioned before, any amount of reporting is leagues better than the current situation (deception, the fabrication of destroyed morphine, lack of patient-physician communication regarding terminal sedation etc).

I suggest you read Angels of Death by Roger Magnusson.

Alex Schadenberg said...

I have read Angels of death by Magnusson. I have read all of the euthanasia lobby books and they are all full of it.

Once you give a doctor the right, in law, to kill you, you have opened up a serious problem.

No one should have the right in law to kill me or you, even if I ask for it. You will never control it.

Winston said...

Another red herring. It's not about the doctor's right, but about the patient's right to obtain assistance to die.

Doctors can already abuse the doctrine of double effect. Even allowing doctors to shorten lives under the guise of "pain control" encourages them to lie about their intentions.

And unless they cause death in two minutes instead of two days, the chance of being able to prove anything is essentially non-existent.

Alex Schadenberg said...

Dear Winston:

I think I have wasted enough time on your comments.

Suicide could be about a person's choice or "right to die" but assisted suicide and euthanasia is about someone else either involved in or causing the act.

What is illegal is the other person involved with causing death and this is the way it should be.

No one should be involved with causing my or your death. It is wrong and it is not safe.

Winston said...

Once again you attempt to create an artificial distinction between hastening death through pain relief and directly causing death via the same methods.

You haven't provided any distinguishing characteristics of administering analgesics that hasten death and directly causing death through a massive overdose.

If one is dangerous, then so is the other.

Angels of Death is about the hows and whys of euthanasia in jurisdictions where it is illegal. It is about shedding light on events that occur whether society is willing to face up to their reality or not.