NY Association on Independent Living Opposes Assisted Suicide Bill A2383A

The following article was published by Not Dead Yet on April 23, 2018.

Testimony of Mel Tanzman on Behalf of NY Association on Independent Living Opposing Assisted Suicide Bill A2383A (April 20, 2018)

Testimony to the New York State Assembly Health Committee on the Death with Dignity Act

Hello and thank you for the opportunity to testify here today. The New York Association on Independent Living (NYAIL) is strongly opposed to A.2383A, known as the Medical Aid in Dying Act, which would legalize physician assisted suicide in New York State.

A major concern for people with disabilities is that assisted suicide reinforces negative perceptions about being disabled and the idea our lives are not worth living. Fears of becoming disabled and facing functional loss, whether the cause is injury or illness, are often reported by doctors as reasons patients request assisted suicide in states where it is legal. Oregon released data from 2017 which showed that the top three end-of-life concerns cited by Oregon patients requesting suicide pills had nothing to do with physical pain and suffering. These concerns were: decreasing ability to participate in enjoyable activities; loss of autonomy; and loss of dignity (1). The disability community strongly opposes the belief that requiring the assistance of another individual for activities of daily living, such as dressing, bathing and toileting, is undignified or a legitimate reason for New York State to legalize physician assisted suicide.

Most people become disabled toward the end of their life. The disability community understands that becoming disabled and losing the ability to do things like walk, dress or go to the bathroom independently is very difficult and causes depression. Yet, this law does not have adequate safe guards to ensure people are not seeking this option due to depression or other concerns which can be addressed. Though frequently insist that as a key safeguard, depressed people are ineligible, psychological supporters of the proposed legislation screenings are not required, leaving it to a physician to determine whether someone requires a psychological evaluation.

In Oregon, Michael Freeland was a 64 year old man with a 43-year medical history of acute depression and suicide attempts (2). Yet, the doctor he consulted with when seeking assisted suicide medication said he didn’t think that a psychiatric consultation was “necessary.” In fact, Oregon’s statistics for the years 2011 – 2014 show that each year, only 3% of patients (or fewer) were referred for psychological evaluation or counseling before receiving their prescriptions for lethal drugs. The proposed Medical Aid in Dying Act only mandates an attending physician refer the patient for a mental health screening if they lack the capacity to make the decision.

If you are still wondering why the disability community is so opposed to legalizing physician assisted suicide, consider the reports that came out of Oregon in January. Oregon state officials have confirmed that people with chronic conditions like Diabetes are eligible for physician assisted suicide if they stop treatment (3). According to Craig New, a Research Analyst for the Oregon Health Authority, who studies the Death with Dignity Act “The law is best seen as a permissive law, and states only that patients must have a terminal illness with six months or less to live. It does not compel patients to have exhausted all treatment options first, or to continue current treatment. It is up to the patient and doctor to discuss disease and treatment options. But if the patient decides they don’t want treatment, that is their choice.” New goes onto say that if a patient can’t afford treatment, then they can be considered terminal under the law as well. Diabetes and many other chronic diseases can be treated and allow people to live long lives. This interpretation creates a serious danger for people with disabilities and chronic conditions. Oregon’s law allows people with disabilities who could otherwise seek treatment to kill themselves with the help of a doctor. There are no safeguards in the proposed legislation to ensure this is not permitted in New York.

NYAIL is also concerned about the deadly mix between our profit-driven health care system and legalizing assisted suicide, which will be the cheapest so-called treatment. Direct coercion is not even necessary. If insurers deny, or even merely delay, expensive live-saving treatment, the person will be steered toward assisted suicide. Take Barbara Wagner and Randy Stroup: two Oregon residents who had cancer. Both Wagner and Stroup were prescribed treatments, but their health plans denied the prescribed treatment, offering physician assisted suicide as an alternative (4). What happened to these patients underscores the danger of legalizing assisted suicide in the context of our broken U.S. health care system.

Proponents of physician assisted suicide often argue that this option is necessary to prevent suffering at the end of life. This is not the case as there are alternative options to prevent suffering. It is already legal in New York for individuals to refuse life-sustaining treatment at any time, and to create an advance directive to cease treatment under any circumstance they choose if they are no longer able to make and communicate decisions. Palliative care is available and can provide pain relief to ensure a person is not in pain, even in those rare cases in which total palliative sedation is required. Unfortunately, medical schools do not mandate their students learn about end of life options and so may not be educating their patients on all their options. New York should invest in educating the community about these options and focus on promoting and expanding palliative care so that it is an available option to anyone facing a painful illness. What happened to these patients underscores the danger of legalizing assisted suicide in the context of our broken U.S. health care system.

People vastly prefer to live and die in their homes, as opposed to a hospital. Unfortunately, hospice is not always an available option for people facing terminal illness, and is severely underutilized in New York State, which is 48 among the states in using hospice services. There are barriers for people who live in assisted living facilities from getting hospice services. There are also barriers to people receiving home care once on hospice. The State should focus on addressing these barriers rather than on legalizing physician assisted suicide.

Finally, the disability community is deeply concerned about coercion and abuse. The proposed legislation is based on the laws in Washington and Oregon, which have proven to have ineffectual safeguards against abuse. One upsetting example from Oregon is Kate Chaney, an 85-year-old woman with dementia who died by assisted suicide (5). She first approached her physician, who would not prescribe her the lethal prescription. She then went to a second doctor, who ordered a psychiatric evaluation, which found that Cheney lacked “the very high level of capacity required to weigh options about assisted suicide.” Cheney’s request was denied, and it has been reported that her daughter “became angry.” A second evaluation was then done with another psychologist, who insisted on doing the evaluation with Chaney alone. Disturbingly, the psychologist deemed Cheney competent while still noting that her “choices may be influenced by her family’s wishes and her daughter, Erika, may be somewhat coercive.” Cheney soon took the drugs and died, but only after spending a week in a nursing home. This is a very disturbing example of doctor shopping and the lack of safe guards in place in Oregon.

A.2383/S.3151A does not prevent a coercive family member or caregiver from doctor shopping with the individual to find a physician who will provide the fatal drug, such as in the case of Kate Chaney. There is nothing in the proposed legislation that would prevent an abusive caregiver or family member from steering the individual toward physician assisted suicide, witnessing the request form, picking up the lethal dose, and even administering the drug. Because no independent witness is required at the death, there is no assurance of self- administration or even consent.

For all of the reasons above, we strongly urge the Assembly’s Health Committee not to pass this dangerous legislation.

Respectfully submitted,

Mel Tanzman
Executive Director of Westchester Disabled on the Move NYAIL Board Member and Health Committee Chair

1 Oregon Death With Dignity Act: 2015 Data Summary

2 Gregory Hamilton, M.D. and Catherine Hamilton, M.A., Competing Paradigms of Responding to Assisted-Suicide Requests in Oregon: Case Report, presented at the American Psychiatric Association Annual Meeting, New York, New York, May 6, 2004.

3 Bradford Richardson, Diabetics eligible for physician-assisted suicide in Oregon, state officials say, The Washington Times, January 11, 2018.

4 Kenneth R. Stevens, Jr., M.D., Oregon Rationing Cancer Treatment But Offering Assisted Suicide to Cancer Patients—Paying to Die But Not to Live, Physicians for Compassionate Care Educational Foundation, June 6, 2008, (accessed July 9, 2009).

5 DHS news release, “No authority to investigate Death with Dignity case, DHS says,” March 4, 2005.

Nevada doctor: Insurance companies are denying treatment to patients and offering to pay for assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

According to an article by Bradford Richardson that was published in the Washington Times on May 31, 2017, a Nevada physician is reporting that in states where assisted suicide is legal, insurance companies are denying treatment for patients but offering to pay for assisted suicide. Youtube video of Brian Callister telling his story.

The Washington Times article stated:

Brian Callister, associate professor of internal medicine at the University of Nevada, said he tried to transfer two patients to California and Oregon for procedures not performed at his hospital. Representatives from two different insurance companies denied those transfer requests by phone, he said. 

“And in both cases, the insurance medical director said to me, ‘Brian, we’re not going to cover that procedure or the transfer, but would you consider assisted suicide?’ ” Dr. Callister told The Washington Times. 

The phone calls took place last year within the span of a month, Dr. Callister said. He said he did nothing to prompt the suggestion in either case.
The patients were not terminal, but “would have become terminal without the procedures.” 

“It was estimated that their chance for cure — cure, not just adding time — of about 50 percent in one case and 70 percent in the other case,” Dr. Callister said.

Several years ago Oregon residents Barbara Wagner and Randy Stroup were denied medical treatment but offered assisted suicide.

Legalizing assisted suicide is not about patient choice or autonomy, but rather it gives physicians and others the right in law to be directly involved with causing your death.

Washington DC assisted suicide Act puts patients at risk and prioritizes cost over compassion.

This article was published by the National Review on February 3, 2017

Representatives Brad Wenstrup and Phil Roe

Two members of Congress, both physicians, urge caution.

Do no harm.” Three short words, but to physicians they represent a sacred charge. Three short words that now hang in the balance here in the District of Columbia, after the D.C. council passed the Death with Dignity Act (Act 21-577), legalizing physician-assisted suicide in the nation’s capital. In authorizing doctors to violate the Hippocratic oath of “do no harm,” physician-assisted suicide undermines a key safeguard that protects our nation’s most vulnerable citizens and helps to ensure our loved ones receive the best medical care when they need it most.

Rep Brad Wenstrup

As doctors, we are concerned about providing care and comfort to those facing the heart-wrenching difficulty of dealing with a terminal disease. It is an issue close to our hearts. However, for patients with terminal diseases who are not seeking treatment and instead coping with the complexities of end-of-life preparations, there are already a myriad of end-of-life care options currently at a patient’s disposal.

Instead of simply providing end-of-life comfort, D.C.’s new law is poised to do more harm than good. Even those disagreeing on the merits of the larger issue should take a close look at the text of Act 21-577, which leaves patients unprotected, doctors unaccountable, and our most vulnerable citizens at risk of having fewer medical options at their disposal rather than more. 

Sign the petition supporting H.J. Res 27, to reject the DC assisted suicide Act 21-577.

Phil Roe

Act 21-577 allows adults diagnosed with a terminal disease, having less than six months to live, to receive a prescription for medication to end their life. There are concerns that the definition of “terminal disease” is too broad, since most doctors will admit that accurately predicting life expectancy is almost impossible. Additionally, many conditions, such as diabetes and HIV, are considered “incurable and irreversible” or “terminal” if left untreated.

One of the greatest concerns that medical professionals have about Act 21-577 is its failure to adequately protect patients from potential coercion and abuse. When someone is considering ending his or her own life, regardless of the reason, he or she is in a vulnerable mental and emotional state. A report by the National Institute of Health found that, contrary to popular belief, pain is not the primary factor motivating patients to seek assisted suicide. More frequently cited motivations include depression, hopelessness, dependency, and loss of control or autonomy. Despite the fact that depression is commonly associated with a patient’s seeking assisted suicide, D.C.’s legislation does not make screening for mental illness mandatory. It also has no safeguard against pressure that family members, heirs, or health-care providers might exert on a patient to choose assisted suicide. This leaves some of our nation’s most vulnerable citizens — the disabled, the elderly, and those fighting mental illnesses — at the most risk under this law.

Additionally, a stunning lack of accountability is built into the bill, as doctors self-report their participation in assisted suicide and their compliance with regulation. Compliance with the bill’s limited safeguards is difficult to track because the bill directs doctors not to place the actual cause and manner of death (assisted suicide) on the death certificate, and the reporting requirements in the bill are not subject to the Freedom of Information Act. Once the prescription for lethal medication is filled, oversight is non-existent. This means that after the lethal medication, which can cause death in hours, leaves the pharmacy, it can be left unsecured in the medicine cabinet or on a bedside table. The lack of oversight opens up a number of potential nightmare scenarios: The medication could be accidentally taken by a child. It could be administered to a patient against his or her will. It could be used on an individual for whom the medication was not intended.

Perhaps most troubling of all, under the new law, patients may end up with fewer options, not more. D.C. residents who are not able to pay for health care out of pocket may find their options severely limited when facing a new diagnosis, suffering from a chronic illness, facing a disability, or struggling with mental illness. For certain medical conditions, assisted suicide could become the cheapest option. By some estimates, lethal medication costs no more than $300. The consequences could be harmful on two levels: given less incentive, innovative treatments could become less likely to develop, and then insurance programs could deny payment for costly treatment options even if they prove to be successful for many cases.

At age 53, Randy Stroup was living in Oregon after assisted suicide was legalized there. Uninsured and fighting prostate cancer, he was relying on Oregon’s state-run health plan for care when he applied for an expensive form of chemotherapy that his doctor recommended and was denied. Instead, he received a letter informing him that the state of Oregon would pay for physician-assisted suicide. As much as we wish it weren’t the case, cost factors into practical implementation of health-care policy. Because assisted suicide could end up being the cheapest “treatment,” it’s not difficult to see how patients could be incentivized to end their lives when the alternative is a costlier treatment option.

Ultimately, whatever its intentions, D.C.’s new law puts patients at risk and could limit their access to high-quality health care. It prioritizes cost over compassion. Since the Constitution charges Congress with legislative jurisdiction over D.C., Congress has a duty to carefully scrutinize this bill, its impact on medical patients, and its effects on our health-care system. We have weighed the legislation and found it wanting. D.C. residents deserve better. 

Sign the petition supporting H.J. Res 27, to reject the DC assisted suicide Act 21-577.

Brad Wenstrup, of Ohio’s second congressional district, is a member of the House of Representatives. Phil Roe represents Tennessee’s first congressional district.

California Assisted suicide law prompts insurance company to deny coverage to terminally ill woman

Stephanie Packer

Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

The Washington Times reported that the California Assisted-suicide law prompted an insurance company to deny coverage to a terminally ill California woman.

Insurers use assisted suicide law to deny treatment for terminally ill patients.

Bradford Richardson, from the Washington Times reported that Stephanie Packer, a wife and mother of four who was diagnosed with a terminal form of scleroderma, said that her insurance company initially indicated it would pay for her to switch her chemotherapy drug based on the recommendation of her doctors but shortly after the California assisted suicide law went into effect, her insurance company denied her treatment.

Richardson reported Packer as saying:

“And when the law was passed, it was a week later I received a letter in the mail saying they were going to deny coverage for the chemotherapy that we were asking for,” 

She said she called her insurance company to find out why her coverage had been denied. On the call, she also asked whether suicide pills were covered under her plan. 

“And she says, ‘Yes, we do provide that to our patients, and you would only have to pay $1.20 for the medication,’”Mrs. Packer said.

Stephanie Packer believes that legalizing assisted suicide creates an incentive for insurance companies to deny terminally ill people coverage. Packer stated:

“As soon as this law was passed — and you see it everywhere, when these laws are passed — patients fighting for a longer life end up getting denied treatment, because this will always be the cheapest option,” 

Attitude have also changed in her support group:

After the right-to-die movement began garnering national attention, Mrs. Packer said she noticed a change in tone at her support groups for terminally ill patients. While the meetings were formerly positive and encouraging, she said the specter of suicide now hangs above them like a dark cloud. 

“And people, once they became depressed, it became negative, and it started consuming people,” she said in the video. “And then they said, ‘You know what? I wish I could just end it.’ “

Stephanie Parker is not the first person to be denied chemotherapy but offered assisted suicide. Several years ago Barbara Wagner and Randy Stroup, in Oregon, were denied medical treatment but offered assisted suicide.

John Kelly’s Testimony Opposing New Jersey Assisted Suicide Bill A2451

This article was published on the Not Dead Yet website on September 6, 2016.

[Editor’s Note: John Kelly lived in New Jersey in his younger years and traveled back there to testify on October 6, 2016 in opposition to the latest assisted suicide bill, A2451. His oral testimony is below, and his full written testimony is here.]

Chair Burzichelli, Vice Chair Lagana, Members of the Committee:

John Kelly testifying in Connecticut.

My name is John Kelly, and I am the New England Regional Director for Not Dead Yet, the national disability rights group that has long opposed euthanasia and assisted suicide. I am also the director of Second Thoughts Massachusetts, Not Dead Yet’s Massachusetts affiliate.

We are concerned that this bill is before the Appropriations Committee. It suggests that cost-containment really is a major factor behind the push for assisted suicide laws. So when in the state of Oregon, Barbara Wagner and Randy Stroup received letters from Oregon Medicaid denying coverage for prescribed chemotherapy. The letters did, however, offer to cover the negligible cost of assisted suicide. Because assisted suicide will always be the cheapest treatment, its availability will inevitably affect medical decision-making. This will actually end up constraining choice.

A2451 threatens you, every single resident of New Jersey, because all of us are vulnerable to misdiagnosis. “Terminally ill” is defined as:

“Terminally ill” means that the patient is in the terminal stage of an irreversibly fatal illness, disease, or condition with a prognosis, based upon reasonable medical certainty, of a life expectancy of six months or less.”

When it comes to life and death, there is no such thing as “reasonable medical certainty.” Of the millions of misdiagnoses every year, many are terminal misdiagnoses. We know this because of the thousands of people who “graduate” from hospice each year. Every year in Oregon, people have lived longer than their six-month terminal diagnosis.

John Kelly with Amy Hasbrouck

Every year in New Jersey, it is estimated that 1/10 people over the age of 60 are abused, almost always by adult children and caregivers. Although “self administration” is touted as one of the key “safeguards”, in about half of Oregon program deaths, there is no evidence of consent or self-administration in the death. If the drugs were administered by others without consent, no one would know. The request form constitutes a virtual blanket of legal immunity covering all participants in the process.

Assisted suicide laws inevitably take the lives of innocent people through mistakes, coercion, and abuse. Please reject this bill.

California's Assisted Suicide Bill AB 15: Governor Brown Not Impressed; Bill Is A "New Number With the Same Song."

This article was published by Choice Is An Illusion on August 19, 2015

Margaret Dore

By Margaret Dore, Esq., MBA

Yesterday, the deceptively named Compassion & Choices unveiled its "new" deceptively named End of Life Option Act to great fanfare in a press credentialed only press conference.

Governor Jerry Brown has already weighed in that the present special session "is not the appropriate venue to consider the issue."

The new bill, AB 15, is in substance an old bill (SB 128) that was unable to make it out of committee.

AB 15 has some new provisions and puts some of the old bill's provisions in a different order. AB 15 is in substance the same bill as the old bill. Key points include:

• AB 15 applies to patients with a "terminal disease." In Oregon, which has a similar law, such persons include young adults with chronic conditions such as insulin dependent diabetes and chronic lower respiratory disease. People living with HIV/AIDS, who are dependent on their medication to live, also qualify as "terminal." Such persons can have years, even decades, to live. 
• Once a person is "labeled 'terminal,' an easy justification can be made that his or her treatment or coverage should be denied in favor of someone more deserving."[1] In Oregon, where assisted suicide is legal, patients are not only denied coverage for treatment, they are offered assisted suicide instead.[2] Well known cases are Barbara Wagner and Randy Stroup.[3]
• The bill remains a recipe for elder abuse in which the patient's heir, who will financially benefit from his or her death, is allowed to actively participate in signing the patient up for the lethal dose. This fact alone does not meet the "stink test." 
• Once the lethal dose is issued by the pharmacy, there is no oversight. Not even a witness is required at the death. If the patient struggled, who would know?
• The death certificate is required to be falsified to reflect a natural death. The significance is a lack of transparency and an inability to prosecute for murder even in a case of outright murder for the money.

AB 15 is but a new number with the same song. Don't be fooled.

To view a detailed legal/policy analysis of AB 15, please click on the following links: Executive summary and index; Memo; and Appendix/Attachments.

1. Opinion Letter by Richard Wonderly MD and Attorney Theresa Schrempp, available athttps://choiceisanillusion.files.wordpress.com/2012/07/schrempp_wonderly_opn_ltr1.pdf
2. Id.
3. Id.

Assisted suicide, "some people's lives will be ended without consent, through mistakes and abuse."

By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Liz Carr

Liz Carr is an actress and disability campaigner in the UK. Carr is a spokesperson for Not Dead Yet UK

ITV news published an article on August 14 by Liz Carr.

Carr explains that she is not religious and she is not "anti-choice," but she works with Not Dead Yet to oppose the legalization of assisted suicide. She explains:

We believe that if the Assisted Dying Bill passes, that some people’s lives will be ended without their consent, through mistakes and abuse. 

No safeguards have ever been enacted or proposed that can prevent this outcome – which can never be undone. The only guaranteed safeguard is to not legalise assisted suicide. 

And we’re not alone in thinking this.

She explains that no organisations of disabled people support assisted suicide and most doctors oppose it. This is important to her.

As someone who has spent a lot of her life needing extensive health care, I am relieved to hear this. I wouldn’t be alive without the NHS but I recognise that it is currently understaffed and under resourced. Against a backdrop of longer shifts, difficulty in obtaining appointments and the rationing of certain treatments, should we really be pushing further pressures onto our reluctant doctors?

Liz Carr at a suicide clinic
in Switzerland.

Carr continues by explaining that the assisted suicide bill that will be debated in the British parliament is based on the Oregon assisted suicide law. She says:

We’re told there’s been no problems with this law but that is to ignore the experiences of Barbara Wagner and Randy Stroup. Both Oregonians with terminal cancer, their life extending drugs were denied to them based on cost. Instead, they were offered a range of choices, including cheaper drugs to enable them to end their life. 

If you think this wouldn’t happen in England, it already is. Changes to England’s Cancer Drugs Fund mean that from April 2015, new cancer patients have been denied a number of expensive treatments that were previously available on the NHS. The fund normally supports palliative treatment, enabling people with metastatic cancers to access drugs that can add several months to their lives. From April however, only people who are already on the treatments in question will receive them whilst new patients will no longer be eligible.

Carr then challenges the concept that legalizing assisted suicide provides choice.

So when supporters of these bills say they’re about individual choice, I have to disagree. They offer one particular choice - physician assisted suicide. People do have other choices at the end of their lives, like palliative and hospice care, yet these choices are currently being denied to people. 

In a recent survey of attitudes to dying, two-thirds said they would prefer to die at home yet the UK still has some of the highest rates of hospital death among older people in Europe.

Carr supports the assisted suicide law.

Supporters of assisted suicide will tell you that the current law is broken but the current law is exactly where it needs to be when the consequences of making a mistake would be murder. 

Safety of the many has to overrule the desires of the few. What is broken, however, are the social and health care support systems which are currently failing us all, both during and at the end of our lives.

Denied the support to live – or die - with dignity, is it any surprise that people feel they have no choice but to end their lives? What terminally ill and disabled people need is an Assisted Living not an Assisted Dying Bill.

She concludes that legalising medically assisted suicide is not the solution.

• Summary of Liz Carr's speech at Not Dead Yet UK rally.

Follow the Money: Oregon pays for assisted suicide but not suicide prevention for adults.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Wesley Smith

Bioethicist, lawyer and cultural commentator, Wesley Smith, examines the Oregon policy of paying for assisted suicide in an article that was published, today, in the Weekly Standard.

In his article, Smith first comments on the celebration of Brittany Maynard's death, that became a massive campaign by the assisted suicide lobby, as compared to the near silence surrounding the life and death of Lauren Hill, who had the same condition but choose to live, continue to play basketball on her college team and raise money to fight cancer.

Smith examines the policies that have led to 859 Oregonians dying by assisted suicide, a state that also has the second highest "other suicide" rate that is 41% higher than the national average. Smith states:

A government’s priorities dictate its spending choices. Oregon uses federal and state money for youth suicide prevention. But even though one in five suicides in Oregon occurs among “older adults,” the anti-assisted-suicide Physicians for Compassionate Care found that the Oregon Health Authority does not fund adult suicide prevention services. As an OHA bureaucrat responded when answering an inquiry from a state legislator, “Staff resources to work on older adult suicide development have not been developed in OHA.” 

In contrast, Oregon does fund assisted suicides under Medicaid, using state funds (federal Medicaid dollars cannot legally pay for assisted suicide). So Oregon taxpayers pay the costs of terminally ill adults seeking death, but no state funds are dispensed to prevent adults from killing themselves. 

Not only that, but Medicaid is explicitly rationed under Oregon law. As one example, some poor patients with late-stage cancer are denied life-extending (as opposed to curative) chemotherapies, but assisted suicide is never rationed. Indeed, readers might recall that Barbara Wagner and Randy Stroup​—​two terminally ill cancer patients​—​were denied Medicaid coverage for chemotherapy in 2008, but told in their rejection letters that the state would fund their suicides.

In fact, the Oregon Health Authority has explicitly stated that assisted suicide is "covered" for the poor. Smith quotes:

It is the intent of the Commission that services under [the Oregon Death with Dignity Act] be covered for those that wish to avail themselves to those serv­ices. Such services include but are not limited to attending physician visits, consulting physician confirmation, mental health evaluation and counseling, and prescription medications.

As Smith says, the message is obvious:

No poor Oregonian will ever be rationed out of assisted suicide​—​after all, what “end of life treatment” could be more cost effective? The message is unequivocal: The state will always pay the tab of the poor wanting to kill themselves, but will not necessarily pay for their fight to remain alive.

Smith concludes his article by re-stating Oregon's spending priorities:

Asked about Oregon’s funding priorities, oncologist Dr. Kenneth Stevens, president of Physicians for Compassionate Care, lamented, “You would think with the concern about the state’s high geriatric suicide rate and the similar crisis among military veterans, the state would fund suicide prevention for adults and the elderly.” 

That would be true in an anti-suicide culture. But that isn’t Oregon. By following the money, we can see what the state cares most about: facilitating some​—​rather than preventing all​—​adult suicides.

The Oregon suicide rate has experienced a steady increase since 2000 and last year alone, Oregon assisted suicide rate increased by 44%.

• Oregon's suicide rate continues to increase faster than the national average.
• Assisted suicide and the suicide contagion effect.
• Assisted suicide increased by 44% in Oregon - 2014 assisted suicide report.

Assisted suicide would be fraught with problems and abuses

This Op-Ed was published in the Connecticut Mirror on March 6, 2015.

By Stephen Mendelsohn, leader of the disability rights group Second Thoughts Connecticut.

The Public Health Committee of the Connecticut General Assembly has twice rejected doctor-prescribed suicide legislation after hearing testimony about the dangers it posed to seniors and people with disabilities. Some 140 attempts to legalize assisted suicide in other states have also been rejected.

Led by a vocal disability community, opposition to assisted suicide cannot be reduced to soundbites. Death is far too important for six-word slogans like “My Life. My Death. My Choice.” Instead, let us examine the real issues—the mistakes, coercion, and abuse that are inevitable and which cannot be fixed.

No assisted suicide bill proposed to date requires witnesses at the time of death. Bills do, however, allow the witnesses to the suicide request to be an heir and a close friend of that heir. There is no way to know whether the individual took the life-ending drugs voluntarily or was pressured. Existing laws have no investigative authority. Moreover, doctors are required to falsify death certificates, stating as the cause of death the underlying illness rather than the lethal prescription.

The case of Tami Sawyer and Thomas Middleton is instructive. Middleton had ALS and moved into Sawyer’s home, where he died a month later under Oregon’s assisted suicide law. Two days after the death, Sawyer sold Middleton's house and deposited the proceeds into her account. Sawyer pleaded guilty to fraud and money laundering in a pyramid scheme. A second case involving Middleton’s estate was dropped only because she was already serving jail time. We will never know whether this was merely fraud or murder for profit.

So when proponents claim that there have been no abuses in Oregon, let us remember Thomas Middleton. Let us remember Barbara Wagner and Randy Stroup, denied chemotherapy by Oregon Medicaid, which offered to pay instead for their assisted suicides.

Let us remember Kate Cheney, age 85 and with dementia. Although a psychiatrist concluded that she had dementia and was being pressured by her daughter, she died after taking the suicide prescription. Let us remember Michael Freeland, with a history of depression and suicide attempts, who was prescribed lethal drugs. Let us remember Patrick Matheny, Cynthia Barrett, David Prueitt, and Wendy Melcher. These are just the cases we know about; what about those that have gone unreported?

When proponents deny evidence of suicide contagion, let us remember that since its legalization of assisted suicide, Oregon’s suicide rate has climbed much faster than the national average. According to the Centers for Disease Control, for people age 35-64 from 1999 through 2010, the increase was 49 percent for Oregon versus 28percent nationally.

Let us remember that for mercilessly bullied autistic and LGBT teenagers, physician-assisted suicide sends the dangerous message that “my death” is “my choice.”

Let us honor Connecticut’s progressive tradition against discrimination by ensuring equal access to noncoercive suicide prevention services for old, ill, and disabled people, rather than offering suicide assistance.

And when proponents claim that this law is only for people who are mentally competent and have less than six months to live, let us remember all who outlived their terminal prognosis—often by years, even decades. Senator Ted Kennedy, Valerie Harper, Jeanette Hall, John Norton, and Rahamim Melamed-Cohen are better-known examples.

Let us remember the statements by leading proponents calling for expansion after this initial law is passed. When Compassion and Choices president Barbara Coombs Lee came to Hartford last October, she declared her support for assisted suicide for people with dementia and cognitive disabilities unable to consent. CT News Junkie quoted her saying, “It is an issue for another day but is no less compelling.” Dr. Marcia Angell, leading proponent of Massachusetts assisted suicide ballot question, recently wrote that she now favors euthanasia as well as assisted suicide.

Finally, let us remember our social interconnectedness. Rev. Dr. Martin Luther King, Jr. wrote, “We are caught in an inescapable web of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.”

People with disabilities understand interdependence in our daily lives. We value everyone as having inherent dignity which is not lost by needing assistance with bodily functions like eating, dressing, or toileting. Our opposition to assisted suicide is based on basic civil rights.

Stephen Mendelsohn is one of the leaders of Second Thoughts Connecticut, a disability advocacy organization opposed to the legalization of assisted suicide.

Euthanasia is contagious.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Newsweek published an extensive article titled: Dying Dutch. The article focuses on stories supporting euthanasia and assisted suicide and information from people like Theo Boer, who, for nine years was a member of a Euthanasia Evaluation Committee but now opposes it, because euthanasia in the Netherlands has become out-of-control.

Under the heading - Death is Contagious, The Newsweek article reports:

In the first few years after the Netherlands decriminalized euthanasia in 2002, the number of cases declined. Then, in 2007, the statistics began a steady climb, an average jump of 15 percent a year...

Theo Boer, the ethicist, has some theories. Once a supporter of euthanasia, he’s now one of its most vocal critics. Among the reasons for the euthanasia boom, Boer suggests, is propaganda. Over the past decade, he says, Dutch journalist Gerbert van Loenen has been tracking a series of documentary films that depict euthanasia in a wholly positive light. “They do ask certain questions,” Boer says. “But they systematically ignore most critical questions, so that the general public is presented with an opinion that is completely good, and has no risks. This is contagious.”

Theo Boer

The number of deaths and the reasons for euthanasia is growing.

Another key factor: It’s getting easier each year to qualify for euthanasia. In the beginning, most of those eligible were terminally ill. Now doctors are helping people die if they no longer want to bear depression, autism, blindness or even being dependent on the care of others. “There are increasing numbers of double euthanasia—one of the partners is terminal and the other partner is care-dependent, they don’t want to live alone,” says Boer. One in 10 of the past 500 dossiers he has read contains some reference to “loneliness,” he adds. “Those are the cases where I have become increasingly uneasy.” 

The numbers support Boer. In 2012, 13 patients were euthanized after convincing a doctor they were suffering unbearably from mental illnesses ranging from depression to schizophrenia. The following year, the figure more than tripled, to 44. The number of patients with dementia who killed themselves grew from 43 in 2012 to 97 in 2013. “I’m afraid,” Boer says, “the situation in the Netherlands is out of control.” 

In 2005, lawmakers decriminalized another form of euthanasia—for babies. ...

Assisted Suicide is bad medicine.

This article was published in the Sacramento Bee on November 1, 2014

By Marilyn Golden 

Marilyn Golden

Why, when listing opponents, did The Sacramento Bee editorial pushing an assisted-suicide law ignore the disability community? (“Give the dying the right to pick how and when to die”: Editorials, Oct. 26) We could be those most affected.

As a disability-rights advocate and person living with a disability, I know our concerns aren’t just “fear-mongering.” Rather, legalizing assisted-suicide is a direct threat to our community as well as to the elderly, people with chronic illness and others marginalized by society.

The Oregon assisted-suicide experiment has major problems.

When Oregonian Barbara Wagner was prescribed chemotherapy for aggressive lung cancer, the Oregon health plan refused to cover it. They offered, instead, among other things, to pay for her assisted suicide. Randy Stroup, another Oregonian with cancer, received a similar denial. Is there any wonder why? Treating people with terminal or chronic illness is expensive. At roughly $300, assisted suicide is the cheapest “treatment.”

Direct coercion is not even necessary. Denying, or even merely delaying, expensive, life-sustaining treatment can drive patients toward assisted suicide. It is a deadly mix with our cost-driven health care system.

This is partly why every major disability organization taking a position opposes legalizing assisted suicide.

Assisted suicide laws are more dangerous than people acknowledge

This article was published by NewJersey.com on October 31, 2014

John Kelly

By John B Kelly - the New England regional director for Not Dead Yet, a grassroots disability group opposed to the legalization of assisted suicide.

The media is flush with the sympathetic story of Brittany Maynard, the 29-year-old newlywed with aggressive brain cancer. Her video advocating expanded assisted suicide laws has been seen millions of times, prompting another push in the State Assembly to pass an assisted suicide bill.

When the focus is on an individual, assisted suicide can sound good – who’s against compassion or relieving suffering? But a closer look reveals that assisted suicide puts vulnerable people in mortal danger. The more people learn about the real-world implications of these bills, the more they oppose them. (Our group takes its name – Second Thoughts – from this fact). Last year, the Legislatures of New Hampshire, Massachusetts and Connecticut rejected assisted suicide bills.

The simple truth is that not all families are loving. Elder abuse is a nationally recognized epidemic. Every year, New Jersey elders suffer an estimated 175,000 cases of reported and unreported abuse, most by adult children and caregivers. Financial gain or emotional relief creates motives for steering someone toward death. The two witnesses to the death request could be an heir and the heir’s accomplice. Once the lethal prescription leaves the pharmacy, there is no further supervision and no independent witness required at the death to ensure that the lethal dose is self-administered.

Depressed people will be harmed. Under Oregon’s program, Michael Freeland obtained a lethal prescription for his terminal diagnosis, despite a 43-year history of severe depression, suicide attempts and paranoia. The prescribing doctor said a psychological consult was not “necessary.” When Freeland received volunteer suicide prevention services, he was able to reconcile with his estranged daughter and lived two years post-diagnosis. Oregon’s statistics for the last four years show that only 2 percent of patients are being referred for psychological evaluations.

The Danger of Assisted Suicide laws.

The following article was written by Marilyn Golden and published by CNN on October 13. Golden is a senior policy analyst with the Disability Rights Education and Defense Fund (DREDF). The views expressed are her own.

Marilyn Golden

By Marilyn Golden

My heart goes out to Brittany Maynard, who is dying of brain cancer and who wrote last week about her desire for what is often referred to as "death with dignity."

Yet while I have every sympathy for her situation, it is important to remember that for every case such as this, there are hundreds -- or thousands -- more people who could be significantly harmed if assisted suicide is legal.

The legalization of assisted suicide always appears acceptable when the focus is solely on an individual. But it is important to remember that doing so would have repercussions across all of society, and would put many people at risk of immense harm. After all, not every terminal prognosis is correct, and not everyone has a loving husband, family or support system.

As an advocate working on behalf of disability rights for 37 years, and as someone who uses a wheelchair, I am all too familiar with the explicit and implicit pressures faced by people living with chronic or serious disability or disease. But the reality is that legalizing assisted suicide is a deadly mix with the broken, profit-driven health care system we have in the United States

At less than $300, assisted suicide is, to put it bluntly, the cheapest treatment for a terminal illness. This means that in places where assisted suicide is legal, coercion is not even necessary. If life-sustaining expensive treatment is denied or even merely delayed, patients will be steered toward assisted suicide, where it is legal.

This problem applies to government-funded health care as well.

Barbara Wagner

In 2008, came the story that Barbara Wagner, a Springfield, Oregon, woman diagnosed with lung cancer and prescribed a chemotherapy drug by her personal physician, had reportedly received a letter from the Oregon Health Plan stating that her chemotherapy treatment would not be covered. She said she was told that instead, they would pay for, among other things, her assisted suicide.

"To say to someone: "We'll pay for you to die, but not for you to live" -- it's cruel," she said.

Another Oregon resident, 53-year-old Randy Stroup, was diagnosed with prostate cancer. Like Wagner, Stroup was reportedly denied approval of his prescribed chemotherapy treatment and instead offered coverage for assisted suicide.

Meanwhile, where assisted suicide is legal, an heir or abusive caregiver may steer someone towards assisted suicide, witness the request, pick up the lethal dose, and even give the drug -- no witnesses are required at the death, so who would know? This can occur despite the fact that diagnoses of terminal illness are often wrong, leading people to give up on treatment and lose good years of their lives.

Washington state ‘Death with Dignity’ law imperils the poor

By Margaret Dore - President Choice Is An Illusion.

Originally published by Realchangenews on July 2, 2014.

Margaret Dore

Last week’s article by an assisted suicide/euthanasia advocate struck me as a bizarre article for Real Change, which advocates for the dignity and self-determination of the poor. (“Terminally ill patients face shortage of right-to-die drug amid controversy over capital punishment,” Real Change, June 18)

Washington’s assisted suicide law was passed in 2008 and went into effect in 2009. This was after a deceptive initiative campaign promised us that “only” the patient would be allowed to take the lethal dose. Our law does not say that anywhere. See Margaret K. Dore, “’Death with Dignity,” What Do We Advise Our Clients?,” King County Bar Association, Bar Bulletin, May 2009.

In Oregon, which has a similar law, there are documented cases of that state’s Medicaid program using the law to steer patients to suicide. In other words, indigent patients are offered suicide in lieu of desired treatments to cure or to extend life. The most well-known cases are Barbara Wagner and Randy Stroup. See: Susan Donaldson James, “Death Drugs Cause Uproar in Oregon,” ABC News, August 6, 2008, at ; and “Letter noting assisted suicide raises questions,” KATU TV, July 30, 2008, See also the Affidavit of Kenneth Stevens, MD, filed by the Canadian government in Leblanc v. Canada.

Finally, consider this quote from a March 8, 2012 Jerry Large column in the Seattle Times. He says that at least a couple of his readers suggested euthanasia “if you couldn’t save enough money to see you through your old age.” For the poor, this would be non-voluntary or involuntary euthanasia.

So much for the dignity and self-determination of the poor.

Margaret Dore, Esq., MBA *
Seattle Washington

Assisted Suicide: Just Too Dangerous.

This article was originally published by the PolitickerNJ on June 26, 2014.

By John Kelly, the regional coordinator for the disability rights group - Not Dead Yet.

John Kelly

No matter how many amendments get added to the New Jersey assisted suicide bill, A2270, whether for a prettier name (out goes“Death With Dignity,” in comes “Aid in Dying for the Terminally Ill”) or for a changed-then-changed-back-again definition of “terminal illness,” the bill is too dangerous. 

Similar bills have been submitted all over the Northeast, and they sound good at first – who’s against relieving suffering, who opposes personal autonomy? Health and Senior Services committee chair Herb Conaway summed it up before his yes vote, "People have the right to self-determination.”

But a closer look reveals the opposite – these bills inevitably and ineradicably compromise personal autonomy. And of the more people learn about these bills, the more they oppose them. New Hampshire, Massachusetts, and Connecticut each rejected assisted suicide bills this session.

Sign the Declaration of Hope to oppose assisted suicide in America.

A2270, like the other bills, draws on shoddy science to create reckless public health policy. First of all, it is simply not possible to predict accurately when someone will die. When Sen. Ted Kennedy was diagnosed with aggressive brain cancer in 2008, he was given 2-4 months to live. As his widow Victoria wrote in an editorial in 2012, “that prognosis was wrong. Teddy lived 15 more productive months.”

In the disability community, everyone knows people who have been labeled “terminal,” it’s actually a bit of a joke. Morristown’s Dawn Teresa Parkot's testified at the hearing on A2270 that doctors predicted she would be "a mindless vegetable ... lucky to survive to age 5." Parkot spoke of her bachelor degrees in computer science and engineering, and said, "Often patients are misdiagnosed and could make an irreversible decision to die based on the wrong information."

Barbara Wagner

In this age of induced austerity, the media is full of calls for healthcare cost containment. Denying treatment is another way that people’s autonomy gets compromised. In Oregon, Barbara Wagner and Randy Stroup received letters from Oregon Medicaid denying coverage for prescribed chemotherapy. The letters noted, however, that the state would cover the minimal cost of assisted suicide drugs. Because assisted suicide will always be the cheapest treatment, its availability will inevitably affect medical decision-making.

Depressed people will be harmed by this bill. Oregonian Michael Freeland easily obtained a lethal prescription for his terminal diagnosis, despite a 43-year history of severe depression, suicide attempts, and paranoia. The prescribing doctor said he didn't think a psychological consult was "necessary." Oregon’s statistics for the last four years show that an absurdly low 2% of patients were referred for a psychological evaluation. Experts agree that doctors are not capable of identifying such psychological problems.

Vulnerable elders will be put at risk. Every year in New Jersey, it is estimated that out of 1 ½ million people over age 60, there are 175,000 reported and unreported cases of abuse. Only in the fantasy world of the proponents are all families, including the thousands of abusive and dysfunctional ones, happily gathered around the peaceful and willing suicide.

Dangers of New Jersey assisted suicide bill too many to overlook.

In the aftermath of the New Jersey Health and Senior Services Committee hearing on assisted suicide, the public debate has continued in the press. One example is George Amick’s column in favor of legalization.

John Kelly

John Kelly, the New England Regional Director for Not Dead Yet was published on June 14 in the Times of Trenton in response to George Amick's column. Not Dead Yet also published Kelly's letter.

Dangers of assisted suicide bill too many to overlook 

George Amick’s column “Bill would allow terminally ill patients to die in humane, dignified manner” (June 9) ignores the many dangers of legalized assisted suicide. 

Assisted suicide makes for a deadly mix with our profit-driven healthcare system. With a lethal prescription costing a mere few hundred dollars, assisted suicide will immediately become the cheapest “treatment.” For example, Oregon Medicaid refused to cover prescribed chemotherapy for Barbara Wagner and Randy Stroup, while offering the cheaper assisted suicide. Such distorted medical decision-making is one reason disability rights groups across the country oppose assisted suicide. Connecticut, Massachusetts and New Hampshire listened to our objections and rejected bills this year. 

Assisted suicide endangers people who experience depression. Oregonian Michael Freeland easily received a prescription despite a 43-year history of severe depression and suicide attempts. Freeland’s prescribing doctor later said that he didn’t think a psychological consultation was “necessary.” 

If Assemblyman Burzichelli is open to adjustments, he should look to Connecticut, where the legislature listened to disability rights advocates and rejected assisted suicide, then got to work with advocates to craft a pilot program for medical orders for life-sustaining treatment (MOLST). This program, which will protect everyone’s right both to receive and decline medical treatment, passed the Connecticut House unanimously and is now state law. 

– John Kelly
Boston MA 

The writer grew up in Middletown Township and is now New England regional director for the national disability rights group Not Dead Yet.

Sign the Declaration of HOPE to oppose assisted suicide in America.

Disability rights leaders speak out against New Jersey assisted suicide bill.

The New Jersey Health and Senior Services Committee had a hearing on assisted suicide Bill A 2270 on June 5, 2014. 

The following two are the letters from Disability Right leaders: Diane Coleman, President of Not Dead Yet and Marilyn Golden, Policy Analyst for the Disability Rights Education & Defense Fund (DREDF)

Dear Health and Senior Services Committee Members:

Diane Coleman

Not Dead Yet is a national disability rights group with members in New Jersey. On behalf of our members, I write to say that we are extremely concerned about A2270, the bill to legalize assisted-suicide, and urge you to oppose it.

Leading proponents of bills to legalize assisted suicide for the terminally ill often claim that the views of disability organizations aren’t relevant. While it’s true that people with disabilities aren’t usually terminally ill, the terminally ill are almost always disabled. This is one of many reasons that our perspective may shed some light on this complex issue.

People with disabilities and chronic conditions live on the front lines of the health care system that serves (and too often underserves) dying people. One might view us as the proverbial “canaries in the coal mine” who are alerting others to dangers we see first.

Assisted suicide supporters paint themselves as “compassionate progressives” fighting for freedom against the “religious right.” It’s a simple message, and it goes down well, if you ignore inconvenient truths, such as:

● Predictions that someone will die in six months are often wrong;
● People who want to die usually have treatable depression and/or need better palliative care;
● Pressures to cut health care costs in the current fiscal climate make this the wrong time to add doctor prescribed suicide to the options;
● Abuse of elders and people with disabilities is a growing but often undetected problem, making coercion virtually impossible to identify or prevent.

It’s not the proponents’ good intentions but the language and implementation of assisted suicide laws that legislators need to consider.

As one of countless disabled people who’s survived a mistaken terminal prediction, I can’t help but become concerned when the accuracy of a terminal prognosis determines whether someone gets suicide assistance rather than suicide prevention.

The Oregon Reports themselves show that non terminal people are getting lethal prescriptions – up to 1009 days have passed between the request for a lethal prescription and death. One of the many things the Reports hide is specifically how many lived longer than six months, but we do know that there’s no consequence to the assisting doctors for this or any other mistake in the assisted suicide process.

Proponents also claim that 15 years of data from Oregon show that safeguards to ensure that it's voluntary are working. How would they know? The Oregon Reports only tell us what the prescribing doctors indicated were the patients’ reasons for wanting assisted suicide by checking off one or more of seven reasons on a multiple choice state government form.

One of the reasons is feelings of being a burden on others, checked in 49% of the cases last year. But there’s no corresponding requirement that home care options be disclosed as part of informed consent under the law, much less that they be offered or funded.

Although the Oregon Reports admit that the state can’t assess compliance with the safeguards, some independent articles find that safeguards failed in individual cases (see, e.g., Hendin & Foley, MDs, “Physician-Assisted Suicide in Oregon: A Medical Perspective”, Michigan Law Review, June 2008. But the law includes no authority for investigation or enforcement, so nothing happens as a result.

It has been estimated that there are over 175,000 reported and unreported cases of elder abuse annually in New Jersey. Statistically, 90% of elder abusers are a family member or trusted other. Similarly, people with disabilities are up to four times more likely to be abused than their same-age nondisabled peers. In Oregon and Washington, legal assisted suicide has opened new paths of abuse against persons who may qualify to use these laws. One of the most obvious problems is a complete lack of oversight when the lethal drug is administered. If an abuser were to administer the drug without the person’s consent, who would know?

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

We urge you to vote against A2270.

Diane Coleman, JD, MBA
President/CEO Not Dead Yet
497 State Street Rochester, NY 14608
www.notdeadyet.org