Showing posts with label Oregon suicide rate. Show all posts
Showing posts with label Oregon suicide rate. Show all posts

Thursday, March 5, 2020

Oregon’s Suicide Crisis Worsens

This article was published by the National Review online on March 5, 2020.

Wesley Smith
By Wesley J Smith

Oregon, a state that has considerably liberalized its assisted-suicide laws, has an ongoing youth and general suicide crisis on its hands. From an Oregon Health Authority press release:
In February the Centers for Disease Control and Prevention released data showing that suicide was the leading cause of death among Oregon youth ages 10 to 24 in 2018, up from the second leading cause of death in 2017. Oregon is now ranked 11th highest in the nation for youth suicide death rates (up from 17th in 2017). 
The change in rank is due to multiple factors: There was a rise in the suicide rate as well as a drop in the rate of unintentional injury deaths, the former leading cause. The unintentional injury category includes overdose deaths and motor vehicle accidents. While the suicide rate has increased, the unintentional injury rate decreased from 2017 to 2018. 
“Suicide continues to be a concerning problem in Oregon across all age groups, including youth, as this new data confirms,” said Dana Hargunani, Oregon Health Authority’s chief medical officer. “We continue to prioritize work across Oregon to support young people in schools, at home and in our communities. Fortunately, we are able to apply best practices that work to prevent suicide, and there are many ways you can get involved.”
Of course, the state’s suicide numbers exclude the thousands of people who have died from assisted suicide since 1997, and state public-health bureaucrats remain clueless of the possibility that allowing assisted suicide for one group of people might give others the idea that self-killing is a splendid way to end suffering.

The OHA has conflicting mandates when it comes to suicide: promoting it for the sick while striving to prevent it among the young and others. Sorry, that’s not how life works.

Monday, April 22, 2019

Oregon assisted suicide. The myth of "oversight" and "control."

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

As the Executive Director of the Euthanasia Prevention Coalition (EPC) my position opposing assisted suicide is clear. For the sake of this article, I will simply share some information about assisted suicide in Oregon.


In 2018 two Oregon doctors were investigated for abuse of the assisted suicide act. Since the Oregon assisted suicide act uses a self-reporting system (the physician who assists the suicide is also the physician who reports) it is difficult to uncover abuse of the law.

A search of the Oregon Medical Board disciplinary actions on September 15, 2018, found that Dr Rose Kenny was disciplined by the Medical Board. The order from the meeting states:
3.1 Licensee must not prescribe or manage the prescriptions for any medication for any patient enrolled in hospice care,
3.2 Licensee must not prescribe or manage the prescriptions for any medication for any patient requesting Death with Dignity.
Recent assisted suicide research has uncovered excessive suffering related to death by assisted suicide. An article by JoNel Aleccia published by Kaiser Health News on March 5, 2017 reported that the following occurred while doing research on assisted suicide drug cocktails: 
The first Seconal alternative turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.
The myth that the Oregon assisted suicide law has effective oversight has enabled the assisted suicide lobby to push for an expansion of the Oregon assisted suicide law.

Oregon is proposing to expand the assisted suicide law.

The Oregon legislature is debating several bill including Bill HB 2217 to expand the assisted suicide law to permit euthanasia (homicide) by redefining the term "self administer" to allow  patients to take the lethal drugs into their body using any method, including an IV tube or injection. The bill states:
“Self-administer” means a qualified patient’s physical act of ingesting or delivering by another method medication to end his or her life in a humane and dignified manner.
Bill HB 2232  proposes to change the definition of terminal from a six month prognosis to:
a disease that will, within reasonable medical judgment, produce or substantially contribute to a patient’s death.
This new definition eliminates the requirement that a person, who dies by assisted suicide, be terminally ill. 

Many people have a disease that will within reasonable medical judgement, produce or substantially contribute to death, are not "terminally" ill. This new definition will give doctors the right to prescribe suicide drugs to many more people.

Oregon Bill SB 0579 enables a physician to wave the 15 waiting period in the assisted suicide law. SB 0579 states:
Notwithstanding subsection (1) of this section, if the qualified patient’s attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die before the expiration of at least one of the waiting periods described in subsection (1) of this section, the prescription for medication under ORS 127.800 to 127.897 may be written at any time following the later of the qualified patient’s written request or second oral request under ORS 127.840.
By waving the 15 day waiting period, a person who is approved for assisted suicide could receive the lethal drugs immediately with no opportunity for a depressed person to change their mind.

When analyzing the recent Oregon assisted suicide report we notice significant problems with the law beyond the fact that assisted suicide causes death.

The Oregon assisted suicide report states that there were 168 reported assisted suicide deaths in 2018 up from 158 reported assisted suicide deaths in 2017. The longest duration before death being 21 hours in 2018 while one person died 807 days (more than 2 years and 2 months) after being approved for assisted death.

In December 2017, Fabian Stahle, a Swedish researcher, communicated by email with a representative of the Oregon Health Authority.

Stahle confirmed that the definition of terminal illness, used by the Oregon Health Authority includes people who may become terminally ill if they refuse effective medical treatment.

The responses to Stahle from the Oregon Health Authority also confirmed that there is no effective oversight of the Oregon assisted suicide law.
Assisted suicide and "other" suicide deaths.

The Oregon suicide rate is increasing faster than the national average. In 2007 Oregon's conventional suicide rate was 35% higher than the national average while in 2014, Oregon's conventional suicide rate was 43% higher than the national average.


It has been argued that there is not a direct co-relation between the Oregon suicide rate and assisted suicide, nonetheless, it must be noted that there appears to be a suicide contagion effect.

Oregon assisted suicide law is designed to cover-up abuse of the law.

The Oregon law enables the physician who assesses a person requesting assisted suicide to be the same physician who prescribes the lethal assisted suicide drugs and then be the same physician who is required to report the assisted suicide death.

By law, the same doctor is the judge, the jury and the executioner.

The yearly Oregon DWD reports are based on data from the physicians who prescribe and carry-out the assisted suicide death and the data is not independently verified. Therefore, we don't know if the information from these reports is accurate or if abuse of the law occurs. There is no third party oversight or intervention it is all a mirage.

Since doctors rarely self-report abuse of the law or even self-report controversial decisions, therefore the law enabled a cover-up of any and all concerns.
Every state that has legalized assisted suicide has also employed the same system to cover-up potential problems with the law.

If the facts concerning assisted suicide were known and openly debated, people would reject assisted suicide and demand excellent care.

To share this information, order the pamphlet: Shedding Light on Assisted Suicide in America.

We believe in Caring Not Killing.

Thursday, March 14, 2019

Oregon's teen suicide rate doubled from 2006 to 2015.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The suicide rate in Oregon has been higher than the national average for many years. The fact that the youth suicide rate doubled from 2006 to 2015 should alert Oregon citizens especially when combined with the suicide contagion effect.


An article by Richard Hanners that was published in the Blue Mountain Eagle explains:
According to the Centers for Disease Control, suicide in 2012 was the 10th leading cause of death in the United States for people 16 years and older. About three-quarters of the suicide deaths that year were by males.

The percentage of teen deaths by suicide in Oregon doubled from 2006 to 2015, according to Children First of Oregon. At 38.3 percent, it was the No. 1 cause of death. And while the suicide rate among youths 10 to 24 years stayed roughly the same across the U.S., the rate in Oregon increased by 41 percent.

More than two-thirds of Oregon youths involved in suicide incidents from 2002 to 2012 had cited mental health problems before their attempts. More than a third had been diagnosed with a mental disorder.

...In Oregon, the highest suicide rate is for men over 85 years old: 72.4 per 100,000 individuals. For women, the highest rate was for ages 45 to 54. Men in Oregon were 3.6 times more likely to commit suicide than women, according to the Oregon Health Authority. About 25 percent of suicides in Oregon occurred among veterans.
The Oregon suicide data begs the question, does legalizing assisted suicide lead to higher rates of other suicides?

In her article: In Oregon, Other Suicides Have Increased with the Legalization of Assisted Suicide, elder law attorney, Margaret Dore states:

Since the passage of Oregon’s law allowing physician-assisted suicide, other suicides in Oregon have steadily increased. This is consistent with a suicide contagion in which the legalization of physician-assisted suicide has encouraged other suicides.
Dore makes her case based on the Oregon data. She explains:
  • Oregon legalized assisted suicide in 1997. 
  • By 2007, Oregon's suicide rate was 35% above the national average. 
  • By 2010, Oregon's suicide rate was 41% above the national average. 
  • By 2012, Oregon's suicide rate was 42% above the national average. 
  • By 2014, Oregon's suicide rate was 43.1% higher than the national average.
It is shocking that the youth suicide rate doubled between 2006 and 2015 in Oregon. Legalizing assisted suicide sends the message that suicide is an acceptable response to human difficulties.

Thursday, February 14, 2019

Why Norway and Sweden Should Not Allow Physician-Assisted Suicide

(youtube video of his presentation)
Mark Komrad completed a 4-lecture tour of Norway and Sweden where he presented arguments to prevent the development of legislation and associated policies that would permit physician-assisted suicide (PAS) or euthanasia. He spoke to Members of Parliament, academics, physicians, other health care professionals, students, advocacy organizations, and members of the public. He also debated with proponents of these practices in Norway.
 

This article was translated and published in newspapers in conjunction with his appearances and is reprinted with permission.

Dr Mark Komrad
By Mark S. Komrad, MD 
Faculty of Psychiatry: Johns Hopkins, University of Maryland, Tulane University

The 2300-year-old history of medical ethics is grounded in the core ethical foundations established at the dawn of medicine — the Hippocratic values “professed” by physicians as a covenant-based community of values. This is the meaning of the word “profession.” The most distinguishing principle of the Hippocratic Oath has been the tenant rejecting the practice of euthanasia: “I will give nobody a poison, nor counsel any others to do so.” This is the root of the mighty tree from which the House of Medicine was built, this value persisting as societies and their demands have come and gone. To this day, the World Medical Association and many other major medical organizations continue this venerable and persistent ethical stance against physician-assisted suicide and euthanasia.

Several governments, in the last two decades, have invited and permitted physicians to transgress this prohibition against killing their patients. For example, Oregon, Canada, and Benelux have asked physicians to provide the means for certain patients who request the means to commit suicide or receive a lethal injection. These laws have empowered one class of human beings (ironically, physicians) to literally take the life of another class of human beings. Originally, the class who can be voluntarily killed or helped to suicide was limited to those at the very end of life. However, principles of justice have made it very difficult to limit such procedures to that category of people. The more experience a country has with such practices, the more the horizon of eligibility has expanded far beyond extreme end-stage cases.

In Oregon there is no way to distinguish between encouragement and coercion by those who “support” terminally-ill loved ones taking lethal drugs prescribed to cause death. There are no regulations to keep lethal prescriptions from being diverted. There is evidence of a contagious increase in ordinary suicide, subsequent to legalizing assisted suicide. New legislation is being pursued there to move to more active euthanasia and to make prognostic criteria for eligibility more vague. The law even allows patients whose conditions are not considered “terminal” to make themselves so, by choosing to refuse life-sustaining treatments — diabetics stopping their insulin, for example.

In Canada, the rate of euthanasia increased by 30% in the last half of 2017. One province has declared that it is neither ethical nor legal for a conscientiously objecting physician to refuse to refer a patient to a colleague who is more open to providing euthanasia. As is the nature of assisted suicide and euthanasia laws, suicide has been converted from a freedom to a right. Refusing to participate in the chain of duty to service that right can have adverse legal and professional consequences for some Canadian doctors. In Sweden, there are already adverse professional consequences, supported by law, for those qualified health care practitioners who refuse to provide abortion on demand, prior to 18 weeks. Such an established pathway mandating physician participation, even against conscientious objection, would be an existing, facilitated channel into which legalized assisted suicide in Sweden would easily flow.

In the Benelux, where these practices have evolved over 18 years, and 4% of all human deaths are by physicians’ injections, the slope has slipped to include eligibility for those with non-terminal illnesses, psychiatric conditions, young children, and uncomfortable lifestyles. Advanced directives and proxy consent for euthanasia of the incompetent are honored. There are strong advocacy efforts to de-medicalize the criteria for such procedures by allowing those who are “tired of living” or feeling that their life is “complete” to ask for euthanasia, with the hopes of developing a “suicide pill” that can be obtained without a medical evaluation or prescription — a high sanctification of autonomy. Organ donation by those seeking euthanasia is encouraged as a “virtue opportunity.” 


The profound changes to a civilized society produced by such laws are unnecessary and undesirable. The suffering and disabled should have even more access to the very latest, state-of-the art palliative care, without it being economically or morally short-circuited by institutional killing promoted as a seductive virtue — referring to it as “dying with dignity” or self-determination. The so-called “choice“ that is offered to the suffering to end their lives is a pseudo-choice, filtered through a physician’s own values, and commonly forced, by having very limited choices in other domains — economics, social support, healthcare, etc. It is unjust, and therefore impossible, in a democratic society, to limit these procedures to some — like the terminally ill — but refuse it to others — like those with chronic physical and psychiatric disabilities. Yet, it signals that chronic disability and its sufferings might constitute a “life not worth living.” It is an unfair and confusing public health message to designate one category of people who are helped to suicide, but another who are actively prevented from doing so with psychiatric care. It elevates autonomy as a value that overshadows, even crushes, other values that are necessary for the common good. 

Medicalizing suicide out-sources to the medical establishment the moral responsibility for a taboo about taking one’s own life by suicide, reducing the moral deterrence to suicide and lowering the threshold of acceptability for all suicide. It takes the protected and vital ethos of health care professionals away from their millennia-old Hippocratic commitment to be providers of comfort, hope, and healing, to become providers of death, not just supporters of the dying.

Saturday, December 22, 2018

Female veterinarians have a much higher suicide rate. Is euthanasia a factor?

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition



According to new a study published in the Journal of the American Veterinary Association that examined the deaths of veterinarians from 1979 to 2015, veterinarians have a much higher suicide than members of the general population.

Death records from 11,620 veterinarians between 1979 and 2015 showed that at least 398 veterinarians died by suicide during this time period. 

The suicide rate for veterinarians is far higher than the national average but the suicide rate for female veterinarians is even more concerning. The study indicates that compared to the general population, male veterinarians were 2.1 times more likely and female veterinarians were 3.5 times more likely to die by suicide.

The study listed many risk factors for suicide including “long work hours, work overload, practice management responsibilities, client expectations and complaints, euthanasia procedures, and poor work-life balance.”



There are multiple contributing factors to the high suicide rate among veterinarians. The study explains why the practice of euthanasia is a risk factor. According to the study:
veterinarians are trained to view euthanasia as an acceptable method to relieve suffering in animals, which can affect the way veterinarians view human life, including a reduced fear about death, especially among those experiencing suicidal ideation.
The study found that access to euthanasia drugs is also a risk factor leading to higher suicide rates. The study explains that veterinarians are 2.5 times more likely to use lethal drugs for suicide than the general population. The use and access to euthanasia drugs contribute to veterinarians having a much higher suicide rate.



I wonder if the recent acceptance of euthanasia in Canada will lead to a higher suicide rate in the general population and an even higher suicide rate among physicians who participate in euthanasia?

Suicide is always a tragedy and it is preventable.

If you are experiencing suicidal ideation, contact a suicide prevention hotline immediately. 

Speak to someone, don't suffer in silence.

Friday, November 30, 2018

Maine Voices: Don’t sign petition to put flawed assisted-suicide law on state ballot

Signatures are currently being collected for a referendum to legalize assisted suicide in Maine.

This article was written by Mike Reynolds and published by Press Herald on November 28, 2019.
Maine residents are being asked to sign a petition calling for a referendum on legalizing assisted suicide to be placed on the 2019 ballot. The practice was legalized in Oregon in 1997. Since then, there have been far more problematic issues and unanswered questions than any assisted-suicide proponent claims. 
The Maine Legislature has voted down a number of attempts to legalize assisted suicide over the past two decades. The Health and Human Services Committee has never supported any version of this proposal, and an assisted-suicide measure has never passed the Legislature. In fact, the last time such a bill went to a floor vote, in 2017, it failed the House by 61 to 85, a larger margin than in recent history. 
The proponents of this law can’t pass this it in the Legislature, so now they are trying to get it through a statewide referendum. The problem is that the proponents have short memories: In 2000, Maine voters soundly rejected a referendum that mirrored Oregon’s law. Mainers have decided time and again against assisted suicide, and we don’t need another referendum funded primarily by out-of-state interests. 
If asked to sign a petition for the referendum, say “no,” and be firm. Assisted-suicide laws are the most blatant forms of discrimination based on disability in our society today. Does it make sense to tell a person who is battling cancer to consider suicide? Should we not be doing everything we can to support these people in having the best possible health care and home care so they have quality of life for however long they have?
 
With the experience of the laws in Oregon as a guide, the question of assisted suicide becomes, quite frankly, incompatible with Maine values. Oregon’s doctors have written suicide prescriptions for individuals whose medical basis for eligibility for assisted suicide was listed as diabetes. In Oregon, and in the referendum language, a person is terminally ill if he or she has a condition that could be reasonably considered terminal only if the patient refuses needed medication. By that definition, people could qualify as “terminal” who have epilepsy, ongoing infections and other illnesses that can be managed with medication. This petition is not limited in scope and is actually far more dangerous than the proponents want to admit. 
While much of our state is relatively close to adequate hospice and palliative care, there are huge gaps in northern and eastern Maine when it comes to these services. Before considering a public policy of assisted suicide, Maine must solve the vast disparity of access to hospice services and palliative care. It is not time to even consider a flawed law such as the one this referendum is proposing. Please, decline to sign. 
In Oregon, the rate of suicide is 33 percent above the national average, and the rate of teen suicide is soaring. There is a clear problem of suicide contagion. 
While the proponents claim there are safeguards, there is absolutely no oversight once the pills are prescribed. Under the Oregon law, a friend or relative – even an heir – can “encourage” an elder to make the request, sign the forms as a witness, pick up the prescription and even administer the drug (with or without consent) because no objective witness is required at death, so who would know? 
The method of dying that the referendum is trying to legalize involves taking 100 pills of a barbiturate, emptying the contents of each pill into a sweet solution, then drinking the solution. It can take up to 104 hours for people to die from the solution, and in seven Oregon cases, the person who took the solution woke up. 
This is not “death with dignity” – it’s a desperate effort to further a dangerous law and give it mainstream credibility, with no regard for the harm it causes, and it even gives full legal immunity to any medical personnel or other person who assists in the suicide. The only real protections in the law are for people other than the patient, foreclosing any realistic potential for investigation of foul play. 
For all of the reasons above, please decline to sign.
Mike Reynolds is a Lewiston resident and a member of Not Dead Yet, a disability rights group that opposes the legalization of assisted suicide.

Wednesday, August 22, 2018

Elder suicide rates are a reason to oppose assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition



The debate concerning the effect on suicide rates when assisted suicide is legal was re-awakened by a recent article by David Grube who claims that suicide rates decline when assisted suicide is legal. Grube is the medical director of an assisted suicide lobby group.

Grube stated in The Kansas City Star that:

There is absolutely no evidence that in states where medical aid in dying is authorized suicide rates have gone up. National and state level data from the Centers for Disease Control and Prevention’s National Vital Statistics System suggest that suicide rates have varied slightly, but overall have gone down in Oregon since its Death with Dignity Act went into effect in 1997.
Margaret Dore
Margaret Dore responded to Grube, in a letter to The Kansas City Star stating:

According to the Centers for Disease Control and Prevention’s “Vital Signs” website, Oregon’s suicide rate went up 28.2 percent from 1999 to 2016. 
Legal assisted suicide encourages other suicide. Don’t be fooled.
Yesterday, Today Online published an article by Singapore researcher, Michael Wee, who explains why elder suicide is a reason to oppose assisted suicide. Wee acknowledges that some researchers have suggested that suicide rates go down when assisted suicide is legal, but he explains that the data proves that the opposite is true. He states:
In 2015, two British scholars published a ground-breaking study in the Southern Medical Journal of US states that have legalised assisted suicide. 
The study looked not simply at suicide rates before and after legalising assisted suicide, but at the change in suicide rates in those states relative to the change in US states where assisted suicide is illegal, while taking into account state-specific factors like drug laws and the unemployment rate. 
This was in order to arrive at a more accurate assessment of the effect of assisted suicide laws on overall suicide rates. 
The study found that far from reducing suicides, legalising assisted suicide is associated with a 6.3 per cent increase in the total suicide rate – including both assisted and non-assisted suicides. For the over-65 age group, the increase is 14.5 per cent.
Wee then states:
the study simply reaffirms a common-sense view: Legalising assisted suicide may lead to similar behaviour in others, as more people become exposed to friends and relatives making that decision.
Margaret Dore warns us that legal assisted suicide encourages other suicide. Don’t be fooled.

Saturday, August 18, 2018

Legal assisted suicide encourages other suicide.

This letter was published in the Kansas City Star on August 17, 2018

I
Margaret Dore
am an attorney and president of Choice is an Illusion, a 501(c)(3) non-profit. Formed in 2010, Choice is an Illusion fights against assisted suicide and euthanasia throughout the United States and in other countries.

David Grube’s Aug. 5 guest commentary in The Star said Oregon’s suicide rates “overall have gone down ... since its Death with Dignity Act went into effect in 1997.” (23A, “Medical aid in dying different from suicide”) I disagree with this claim.

According to the Centers for Disease Control and Prevention’s “Vital Signs” website, Oregon’s suicide rate went up 28.2 percent from 1999 to 2016.

Legal assisted suicide encourages other suicide. Don’t be fooled.


Margaret Dore
Seattle

Tuesday, August 7, 2018

In Oregon, Other Suicides Have Increased with the Legalization of Assisted Suicide

The following article was published by Choice Is An Illusion Montana. (shortened version).

Margaret Dore
By Margaret Dore Esq


Since the passage of Oregon’s law allowing physician-assisted suicide, other suicides in Oregon have steadily increased. This is consistent with a suicide contagion in which the legalization of physician-assisted suicides has encouraged other suicides. In Oregon, the financial and emotional impacts of suicide on family members and the broader community are devastating and long-lasting.[1]

A.  Suicide is Contagious 

It is well known that suicide is contagious. A famous example is Marilyn Monroe.[2] Her widely reported suicide was followed by “a spate of suicides.”[3]

With the understanding that suicide is contagious, groups such as the National Institute of Mental Health and the World Health Organization have developed guidelines for the responsible reporting of suicide, to prevent contagion. Key points include that the risk of additional suicides increases:
[W]hen the story explicitly describes the suicide method, uses dramatic/graphic headlines or images, and repeated/extensive coverage sensationalizes or glamorizes a death.[4] 
B. Assisted Suicide in Oregon

In Oregon, prominent cases of physician-assisted suicide include Lovelle Svart and Brittany Maynard.

Lovelle Svart died in 2007.[5] The Oregonian, which is Oregon’s largest paper, violated the recommended guidelines for the responsible reporting of suicide by explicitly describing her suicide method and by employing “dramatic/graphic images.” Indeed, visitors to the paper’s website were invited “to hear and see when Lovelle swallowed the fatal dose.”[6] Today, ten years later, there are still photos of her online, lying in bed, dying.[7]

Brittany Maynard reportedly died from physician-assisted suicide in Oregon, on November 1, 2014. Contrary to the recommended guidelines, there was “repeated/extensive coverage” in multiple media, worldwide.[8] This coverage is ongoing, albeit on a smaller and less intense scale.

C. The Young Man Wanted to Die Like Brittany Maynard

A month after Ms. Maynard’s death, Dr. Will Johnston was presented with a twenty year old patient during an emergency appointment.[9] The young man, who had been brought in by his mother, was physically healthy, but had been acting oddly and talking about death.[10]

Dr. Johnston asked the young man if he had a plan.[11] The young man said "yes," that he had watched a video about Ms. Maynard.[12] He said that he was very impressed with her and that he identified with her and that he thought it was a good idea for him to die like her.[13] He also told Dr. Johnston that after watching the video he had been surfing the internet looking for suicide drugs.[14] Dr. Johnston’s declaration states:
He was actively suicidal and agreed to go to the hospital, where he stayed for five weeks until it was determined that he was sufficiently safe from self-harm to go home.[15]
The young man had wanted to die like Brittany Maynard.

D. In Oregon, Other Suicides Have Increased with Legalization of Assisted Suicide

Oregon government reports show the following positive correlation between the legalization of physician-assisted suicide and an increase in other suicides.  Per the reports:
  • Oregon legalized physician-assisted suicide “in late 1997.”[16]
  • By 2000, Oregon’s conventional suicide rate was "increasing significantly."[17]
  • By 2007, Oregon's conventional suicide rate was 35% above the national average.[18]
  • By 2010, Oregon's conventional suicide rate was 41% above the national average.[19]
  • By 2012, Oregon's conventional suicide rate was 42% above the national average.[20]
  • By 2014, Oregon's conventional suicide rate was 43.1% higher than the national average.[21]
E. The Financial and Emotional Cost of Suicide in Oregon 

Oregon’s report for 2012 describes the cost of suicide as “enormous.” The report states:
Suicide is the second leading cause of death among Oregonians aged 15 to 34 years, and the eighth leading cause of death among all ages in Oregon. The cost of suicide is enormous. In 201[2] alone, self-inflicted injury hospitalization charges in Oregon exceeded $54 million; and the estimate of total lifetime cost of suicide in Oregon was over $677 million. The loss to families and communities broadens the impact of each death. (footnotes omitted).[22]

Footnotes:

[1]  Shen X., Millet L., Suicides in Oregon: Trends and Associated Factors. 2003-2012, Oregon Health Authority, Portland Oregon, p.3, Executive Summary
[2]  Margot Sanger-Katz, “The Science Behind Suicide Contagion,” The New York Times, August 13, 2014.
[3]  Id.
[4]  "Recommendations for Reporting on Suicide,” The National Institute of Mental Health. See also “Preventing Suicide: A Resource for Media Professionals,” World Health Organization, at http://www.who.int/mental_health/prevention/suicide/resource_media.pdf.
[5]  Ed Madrid, “Lovelle Svart, 1945 - 2007, The Oregonian, September 28, 2007. 
[6]  Id.
[7]  The still shots at this link, are still up today, July 7, 2017.
[8]  The worldwide coverage of Ms. Maynard in multiple media started with an exclusive cover story in People Magazine. Other coverage has included TV, radio, print, web and social media.
[9]  Declaration of Williard Johnston, MD, May 24, 2015. 
[10]  Id.
[11]  Id.
[12]  Id.
[13]  Id.
[14]  Id.
[15]  Id.
[16]  Oregon's Death with Dignity report for 2016, p. 4, first line
[17]  Oregon Health Authority News Release, September 9, 2010, at https://choiceisanillusion.files.wordpress.com/2017/07/news-release-09-09-10.pdf ("After decreasing in the 1990s, suicide rates have been increasing significantly since 2000").  
[18]  Suicides in Oregon: Trend and Risk Factors, issued September 2010 (data through 2007). 
[19]  Suicides in Oregon: Trends and Risk Factors, 2012 Report (data through 2010). 
[20]  Suicides in Oregon: Trends and Associated Factors, 2003-2012 (data through 2012). 
[21] Oregon Vital Statistics Report 2015 (data through 2014;
at page 6-26, third full paragraph)

Monday, October 30, 2017

Margaret Dore: Analysis Opposing Victoria Australia Euthanasia Bill

Margaret Dore
I. Introduction

I am an attorney in Washington State USA where assisted suicide is legal.[1] I am also president of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia. Last year, I met with a parliamentary delegation from the Legal and Social Issues Committee, Parliament of Victoria, to discuss Oregon’s law and related issues.

Washington’s law is based on Oregon’s law. Both laws are similar to the proposed bill, titled the “Voluntary Assisted Dying Bill.” The bill, however, is not limited to voluntary deaths or to people near death. I urge you to reject this measure.

II. Definitions

Assisted suicide occurs when a person provides the means or information for another person to commit suicide, for example, by providing a gun or lethal drug. If the assisting person is a physician, a more precise term is “physician-assisted suicide.”[2]

“Euthanasia” is the direct administration of a lethal agent to cause another person’s death.[3] Euthanasia is also known as “mercy killing.”[4]

III. Assisting Persons Can Have An Agenda


Persons assisting a suicide can have an agenda. Consider Tammy Sawyer, trustee for Thomas Middleton in Oregon. Two days after his death by assisted suicide, she sold his home and deposited the proceeds into bank accounts for her own benefit.[5]

In other US states, reported motives for assisting suicide include: the “thrill” of getting other people to kill themselves; a desire for sympathy and attention; and “want[ing] to see someone die.”[6]

Medical professionals too can have an agenda, for example, to hide malpractice. There is also the occasional doctor who just likes to kill people, for example, Michael Swango, now incarcerated.[7]

IV. Push-back Against Assisted Suicide


Several US states have strengthened their laws against assisted suicide. These states include Alabama, Arizona, Georgia, Idaho and Louisiana.[8]

Last year, the Supreme Court of the State of New Mexico overturned a decision recognizing physician aid in dying, meaning physician assisted suicide.[9] Physician-assisted suicide is no longer legal in the State of New Mexico.

V. Few States Allow Assisted Suicide

Oregon and Washington State legalized assisted suicide through ballot measures in 1997 and 2008, respectively. Since then, just three US states and the District of Columbia have passed similar laws.[10] In the fine print, these laws also allow euthanasia.



VI. How The Victoria Bill Works

The Victoria bill has an application process to obtain the lethal dose, which may be administered by the patient.[11]

In the case of administration by a patient, there is no required oversight.[12] No witness, not even a doctor, is required to be present at the death.[13]

VII. The Bill Applies To People With Years To Live

The bill applies to people with a “disease, illness or medical condition,” which is expected to cause death in less than twelve months.[14] Such persons may, in fact, have years to live. This is true for three reasons:

A. Treatment Can Lead to Recovery. 
In 2000, Jeanette Hall was diagnosed with cancer in Oregon and made a settled decision to use Oregon’s law.[15] Her doctor convinced her to be treated instead, which eliminated the cancer.[16] Her declaration states:
It has now been 17 years since my diagnosis. If [my doctor] had believed in assisted suicide, I would be dead.[17]
B. Predictions of Life Expectancy Can Be Wrong 
Eligible persons may also have years 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.[18]

Consider John Norton, diagnosed with ALS at age 18.[19] He was told that he would get progressively worse (be paralyzed) and die in three to five years.[20] Instead, the disease progression stopped on its own.[21] 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.[22] 
C. If Victoria Follows Oregon, the Bill Will Apply to People With Insulin Dependent Diabetes
The bill applies to people expected to die in less than twelve months due to a “disease, illness or medical condition.”[23] Oregon’s law applies to people expected to die in less than six months due to a terminal disease.[24]

In practice, Oregon’s law is interpreted to include chronic conditions such as “diabetes mellitus,” better known as diabetes.[25] These conditions qualify for assisted suicide when there is dependence on medication, such as insulin, to live. Oregon doctor, William Toffler, explains:

[P]eople with chronic conditions are “terminal” [such that they qualify for assisted suicide] if without their medications, they have less than six months to live. This is significant when you consider that a typical insulin-dependent 20 year-old will live less than a month without insulin.[26]
Dr. Toffler adds:
Such persons, with insulin, are likely to have decades to live.[27]If Victoria enacts the proposed bill and follows Oregon practice, the bill will apply to people with insulin dependent diabetes. Such persons, with insulin, can have decades to live.
VIII. The Bill Applies To Older People

According to government statistics from Oregon and Washington State, most people who die under their laws are elders, aged 65 or older.[28] This demographic is already an especially at risk group for abuse and financial exploitation. This is true in both the US and Australia.

A. Elder Abuse and Financial Exploitation
Elder abuse and exploitation perpetrators are often family members.[29] They typically start out with small crimes, such as stealing jewelry and blank checks, before moving on to larger items or to coercing victims to sign over deeds to their homes, to change their wills or to liquidate their assets.[30] Amy Mix, an elder law attorney in the US, explains why older people are especially vulnerable:
The elderly are at an at-risk group for a lot of reasons, including, but not limited to diminished capacity, isolation from family and other caregivers, lack of sophistication when it comes to purchasing property, financing, or using computers . . . .  
[D]efendants are family members, lots are friends, often people who befriend a senior through church . . . . We had a senior victim who had given her life savings away to some scammer who told her that she’d won the lottery and would have to pay the taxes ahead of time. . . . The scammer found the victim using information in her husband’s obituary.[31]
B. Elder Abuse and Financial Exploitation Are Sometimes Fatal
In some cases, elder abuse and financial exploitation are fatal. More notorious cases include California’s “black widow” murders, in which two women took out life insurance policies on homeless men.[32] Their first victim was 73 year old Paul Vados, whose death was staged to look like a hit and run accident.[33] The women collected $589,124.93.[34]

Consider also, People v. Stuart in which an adult child killed her mother with a pillow, allowing the child to inherit. The Court observed:

Financial considerations [are] an all too common motivation for killing someone.[35]

C. Victims Do Not Report
In both Australia and the US, victims do not report abuse. For example, in Victoria, it is estimated that there are more than 20,000 unreported cases of abuse, neglect and exploitation each year and approximately 100,000 in Australia nationwide.[36] Meanwhile, in the US, it’s estimated that only 1 in 14 cases ever comes to the attention of the authorities.”[37] In another study, it was 1 out of 25 cases.[38] Reasons for the lack of reporting include:

Many who suffer from abuse . . . don’t want to report their own child as an abuser.[39]


IX. The Bill Creates The Perfect Crime
A. “Even If a Patient Struggled, Who Would Know?
”The bill allows a patient to administer the lethal dose in private, without a witness or doctor present.[40] In addition, the drugs typically used are water and alcohol soluble, such that they can be injected into a sleeping or restrained person without consent.[41] 

Alex Schadenberg, Executive Director for the Euthanasia Prevention Coalition, puts it this way:
With assisted suicide laws in Washington and Oregon [and with proposed bill], 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).[42]
B. The Cause of Death Will Be Registered as a “Disease, Illness or Medical Condition,” Which Will Prevent Prosecution for Murder
The bill amends the Births, Deaths and Marriages Registration Act 1996, by requiring a death under the bill to be registered as a “disease, illness or medical condition.” The amendment states:
The Registrar, on being notified by a doctor of a death under section 37 and in accordance with section 67 of the Voluntary Assisted Dying Act 2017, must register the death in the Register by making an entry about the death that records the cause of death as the disease, illness or medical condition that was the grounds for a person to access voluntary assisted dying. (Emphasis changed).[43]
The significance of requiring a disease, illness or medical condition to be listed as the cause of death is that it creates a legal inability to prosecute. The official legal cause of death is a disease, illness or medical condition (not murder) as a matter of law.

X. Patients Otherwise Lack Protection

A. Participants in a Patient’s Death Are Merely Required to Act in “Accordance” With the Bill, Which Renders Patient Protections Unenforceable
The bill has page after page of patient protections, including that the co-ordinating medical practitioner “must” refer the person to another registered medical practitioner for a consulting assessment and that the person’s final request “must” be according to a specified time frame.[44]

The bill also holds medical practitioners and other participants in a patient’s death to an “accordance” standard.[45] Indeed, the bill uses the term nearly 50 times.[46]

The bill does not define accordance.[47] Dictionary definitions include “in the spirit of,” meaning “in thought or intention.”[48] With these definitions, a participant’s mere thought or intention to comply with the bill is good enough. Patient protections are not enforceable.

B. In an Orwellian Twist, the Term, “Self-Administer,” May Allow Someone Else to Administer the Lethal Dose to the Patient
The bill repeatedly describes the lethal dose as being “self-administered” by the patient, a term which is not defined.[49] The term or a variation thereof is used in the bill at least 50 times.[50]

The bill does not define “self-administer.”[51] In Washington State, the term is specially defined to allow someone else to administer the lethal dose to the patient. Washington’s law states:

“Self-administer” means a qualified patient’s act of ingesting medication to end his or her life . . . (Emphasis added).[52]
Washington’s law does not define “ingest.” Dictionary definitions include:
[T]o take (food, drugs, etc.) into the body, as by swallowing, inhaling, or absorbing. (Emphasis added).[53]
With these definitions, someone else putting the lethal dose in the patient’s mouth qualifies as self-administration because the patient will be “swallowing” the lethal dose, i.e., “ingesting” it. Someone else placing a medication patch on the patient’s arm will qualify because the patient will be “absorbing” the lethal dose, i.e., “ingesting” it. Gas administration, similarly, will qualify because the patient will be “inhaling” the lethal dose, i.e., “ingesting” it.

With the bill’s failure to define “self-administer,” and given Washington’s definition, the bill may be determined to allow someone else, such as a family member, to administer the lethal dose. Family members are common abusers.[54] Patients will not necessarily be in control of their fate.

XI. Other Considerations

A. The Swiss Study: Physician-Assisted Suicide Can Be Traumatic for Family Members
A European research study addressed trauma suffered by persons who witnessed legal physician-assisted suicide in Switzerland.[55] The study found that one out of five family members or friends present at an assisted suicide was traumatized. These people,
experienced full or sub-threshold PTSD (Post Traumatic Stress Disorder) related to the loss of a close person through assisted suicide.[56]
B. My Clients Suffered Trauma in Oregon and Washington State
I have had two cases where my clients suffered trauma due to legal assisted suicide. In the first case, one side of my client’s family wanted her father 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 was severely traumatized. The father did not take the lethal dose and died a natural death.

In the other case, my client’s father died via the lethal dose at a suicide party. It’s not clear, however, that administration of the lethal dose was voluntary. A man who was present told my client that his 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 who told this to my client subsequently changed his story.

My client, although he was not present, was traumatized over the incident, and also by the sudden loss of his father.

C. In Oregon, Other Suicides Have Increased with Legalization of Physician-Assisted Suicide
Government reports from Oregon show a positive correlation between the legalization of physician-assisted suicide and an increase in other (conventional) suicides. This correlation is consistent with a suicide contagion in which legalizing physician-assisted suicide encouraged other suicides. Consider the following:

Oregon's assisted suicide act went into effect “in late 1997.”[57]

  • By 2000, Oregon's conventional suicide rate was "increasing significantly."[58] 
  • By 2007, Oregon's conventional suicide rate was 35% above the national average.[59]
  • By 2010, Oregon's conventional suicide rate was 41% above the national average.[60]
  • By 2012, Oregon's conventional suicide rate was 42% above the national average.[61]
For a more detailed discussion of suicide contagion in Oregon, see Margaret Dore, “In Oregon, Other Suicides Have Increased with Legalization of Assisted Suicide.”[62]
D. The Oregon Statistics Provide Little, If Any, Support for the Idea That the Passage Is Needed Due to Physical Pain
I am not aware of any case in which Oregon’s law has been used for physical pain. According to Oregon’s most recent annual report, there were 47 people who died under the law in 2016 who expressed the following concern:
Inadequate pain control or concern about it. (Emphasis added).[]
With use of the word, “or,” the total number of persons who had inadequate pain control could be zero. In the alternative, the total number could be as high as 47.

If, for the purpose of argument, all 47 had inadequate pain control, this would be 47 people out of approximately 35,000 deaths in Oregon, which is far less than one percent (.127%) and/or not statistically significant.

The Oregon statistics provide little, if any, support for the idea that passage of the bill is needed due to physical pain. The argument is not supported by the evidence.

XII. Conclusion

The bill allows administration of the lethal dose to occur in private without a doctor or witness present. Even if a patient struggled, who would know? The death record will list a “disease, illness or medical condition” as the legal cause of death, which will prevent prosecution for murder. The bill, if enacted, will create the perfect crime.

Elder abuse and financial exploitation are already a problem in Victoria. Passage of the bill will make a bad situation worse. People with years or decades to live will have their lives ended due to the desires, wants and greed of other people.

I urge you to reject the proposed bill seeking to legalize assisted suicide and euthanasia.

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
www.margaretdore.org
1001 4th Avenue, Suite 4400
Seattle, WA USA 98154
001 206 697 1217

Endnotes

[1] For more information, see my CV at this link: https://choiceisanillusion.files.wordpress.com/2016/04/dore-cv-04-22-16.pdf
[2] See e.g., The American Medical Association Code of Medical Ethics, Opinion 5.7 (defining physician-assisted suicide).
[3] Id., Opinion 5.8, “Euthanasia,” (lower half of the page).
[4] “Mercy killing” - The Free Legal Dictionary
[5] KTVZ.com, “Sawyer Arraigned on State Fraud Charges,” 07/14/11, at https://choiceisanillusion.files.wordpress.com/2016/10/sawyer-arraigned-a-63.pdf
[6] See: Associated Press for Minnesota, “Former nurse helped instruct man on how to commit suicide, court rules,” The Guardian, 12/28/15 (“he told police he did it ‘for the thrill of the chase’”) a; “Woman in texting suicide wanted sympathy, attention, prosecutor says,” CBS News, June 6, 2017; and Ben Winslow, “Teen accused of helping friend commit suicide could face trial for murder,” (Deputy Utah County Attorney argued that the defendant “wanted to see someone die”). Available at https://www.aol.com/article/news/2017/10/12/teen-accused-of-helping-friend-commit-suicide-could-face-trial-for-murder/23241619/
[7] See: CBSNEWS.COM STAFF, “Life in Jail for Poison Doctor, July 12, 2000, at https://www.cbsnews.com/news/life-in-jail-for-poison-doctor; James B. Stewart, “Blind Eye: The Terrifying Story of a Doctor Who Got Away With Murder,” Simon and Schuster, copyright 1999; and https://en.wikipedia.org/wiki/Michael_Swango
[8] See Margaret Dore, Alabama: Assisted Suicide Ban Act to Go Into Effect,” http://www.choiceillusion.org/2017/07/alabama-assisted-suicide-ban-act-to-go.html; Kansascity.com, “Brewer signs bill targeting assisted suicide,” available http://www.choiceillusion.org/2014/05/arizona-strengthens-its-law-against.html; Georgia General Assembly printout 06/08/15; Margaret Dore,“Idaho Strengthens Law Against Assisted-Suicide,” July 4, 2011, at http://www.choiceillusionidaho.org/2011/07/idaho-strengthens-law.html; and Associated Press, “La. assisted-suicide ban strengthened,” April 24, 2012.
[9] Morris v. Brandenburg, 376 P.3d 836 (2016). See also “New Mexico Upholds Assisted Suicide Prohibition,” July 1, 2016 at http://newmexicoagainstassistedsuicide.org/2016/07/new-mexico-upholds-assisted-suicide.html
[10] Vermont, California and Colorado.
[11] Bill Clause 45 (allowing a patient to “use and self-administer” a lethal substance). The bill also allows a medical practitioner to administer the lethal dose. See Clause 46 (allowing a “co-ordinating medical practitioner” to administer a lethal substance to cause the person’s death).
[12] See the bill in its entirety, available at http://www.legislation.vic.gov.au/domino/Web_Notes/LDMS/PubPDocs.nsf/ee665e366dcb6cb0ca256da400837f6b/D162E1F2FCC3F7C3CA2581A1007A8903/$FILE/581392bi1.pdf
[13] Id.
[14] The bill, Clause 9(1)(d), states:
[T]he person must be diagnosed with a disease, illness or medical condition that -
(i) is incurable; and
(ii) is advanced, progressive and will cause death; and
(iii)is expected to cause death within weeks or months, not exceeding 12 months ...
[15] Affidavit of Kenneth Stevens, MD, Hall declaration, in the appendix at A-33
[16] Id.
[17] Affidavit of Jeanette Hall, ¶ 4.
[18] Cf. Jessica Firger, “12 million Americans misdiagnosed each year,” CBS NEWS, 4/17/14, and 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, 01/14/09.
[19] Affidavit of John Norton, 08/18/12
[20] Id., ¶ 1
[21] Id., ¶ 4
[22] Id., ¶ 5
[23] Bill Clause 9(1)(d).
[24] Oregon’s law states: “Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months. Or. Rev. Stat. 127.800 s.1.01(12)
[25] “Diabetes mellitus” is listed as a qualifying terminal disease in Oregon government reports. See Declaration of William Toffler, MD, pp. A-14 to A-15, ¶¶ 2-4, and report excerpts at A-17 & A-18.
[26] Toffler Declaration at A-15, ¶ 5.
[27] Id., ¶ 6
[28] Appendix, at A-34 and A-35
[29] See Met Life Mature Market Institute, Broken Trust: Elders, Family and Finances,” March 2009, https://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf and Facts on Elder Abuse - Australia, at http://www.ohchr.org/Documents/Issues/OlderPersons/Submissions/ElderAbusePreventionAssociation.pdf
[30] Metlife supra, at p.14.
[31] Kathryn Alfisi, “Breaking the Silence on Elder Abuse,” Washington Lawyer, February 2015. https://www.dcbar.org/bar-resources/publications/washington-lawyer/articles/february-2015-elder-abuse.cfm
[32] See People v. Rutterschmidt, 55 Cal.4th 650 (2012) and https://en.wikipedia.org/wiki/Black_Widow_Murders
[33] Rutterschmidt, at 652-3.
[34] Id. at 652.
[35] 67 Cal.Rptr.3d 129, 143 (2007).
[36] Facts on Elder Abuse-Australia, available at http://www.ohchr.org/Documents/Issues/OlderPersons/Submissions/ElderAbusePreventionAssociation.pdf
[37] Nat’l Center on Elder Abuse, http://www.ncea.aoa.gov/Library/Data/
[38] Id.
[39] “Adult Abuse,” District of Columbia, Department of Human Services, as of April 5, 2016. See also http://dhs.dc.gov/service/adult-abuse
[40] See the bill in its entirety, at http://www.legislation.vic.gov.au/domino/Web_Notes/LDMS/PubPDocs.nsf/ee665e366dcb6cb0ca256da400837f6b/D162E1F2FCC3F7C3CA2581A1007A8903/$FILE/581392bi1.pdf
[41] The drugs typically used in Oregon and Washington State include Secobarbital, Pentobarbital and Phenobarbital, which are water and/or alcohol soluble. See excerpt from Oregon’s and Washington’s most recent annual reports, in the appendix at A-44 & A-45 (listing these drugs). See also http://www.drugs.com/pr/seconal-sodium.html, http://www.drugs.com/pro/nembutal.html and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2977013
[42] 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.margaretdore.com/info/October_Letters.pdf
[43] The Bill, Clause 117.
[44] Id., Clauses 22 and 38.
[45] See, for example, the Bill, Division 2, “Protection from liability for those who assist, facilitate, do not act or act in accordance with this Act.” (Emphasis added). See also Bill Clause 79, which states:
A person who in good faith does something or fails to do something
(a) that assists or facilitates any other person who the person believes on reasonable grounds is requesting access to or is accessing voluntary assisted dying in accordance with this Act; and
(b) that apart from this section, would constitute an offence at common law or under any other enactment-does not commit the offense.
[46] See the bill in its entirety
[47] Id.
[48] See definitions in the appendix at A-57 and A-58.
[49] See the bill in its entirety
[50] Id.
[51] Id.
[52] RCW 70.245.010(12), in the appendix at A-67.
[53] www.yourdictionary.com, in the appendix at A-59.
[54] Facts on Elder Abuse-Australia, p. 2, in the appendix at A-49, "Victimisation Facts” (“Among known perpetrators of abuse and neglect, the perpetrator is a family member in 90 percent of the cases. Two-thirds of the perpetrators are adult children or spouses. The offender is most commonly a close relative ....”)
[55] “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 (Cover page in the appendix at A-60)
[56] Id.
[57] Oregon’s assisted suicide report for 2014, first line, at http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf
[58] See Oregon Health Authority News Release, 09/09/10. ("After decreasing in the 1990s, suicide rates have been increasing significantly since 2000"). (Attached in the appendix at A-61).
[59] Report excerpts in the appendix at A-62 & A-63.
[60] Oregon Health Authority Report excerpts, attached in the appendix at A-64 & A-65.
[61] Oregon State Report attached in the appendix at A-66
[62] And http://www.choiceillusionsouthdakota.org/2017/06/in-oregon-other-suicides-have-increased_18.html (a different version)
[63] Oregon report excerpt for 2016 in the appendix at A-68. To view the entire 2016 report, click here
[64] See Oregon’s report for 2016 attached in the appendix at A-69 (listing 35,709 Oregon resident deaths in 2015).