Source: https://www.choiceillusion.org/2013/05/
Timestamp: 2019-04-24 20:47:22+00:00

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The “assisted suicide bill” does exactly what it is designed not to do. It will eliminate choice for the most vulnerable. Unintended consequences are sure to follow. We need more, not fewer rights. Government-approved suicide as an end-of-life option does not give more rights — in reality it takes them away.
Some legislators promise “safeguards.” There are no safeguards that can ensure that there will not be abuse. Some of the most vulnerable will be pressured to end it all for the convenience and sometimes for the financial benefit of others. Patients will be unduly influenced into giving in to family members. Many elderly/disabled have loving supportive families. It is those who do not who are at the highest risk. There is no way that abuse can be prevented. Imagine being isolated with caregivers — Stockholm syndrome.
The assisted suicide law will deprive many of choice. Recent history shows that more than 300 cases of reported abuse of the disabled/elderly have been ignored by the state. This is evidence that the state cannot protect the vulnerable. The assisted suicide law will add another layer of risk. It will make things worse.
Wake up, Dorothy. You’re not in Oregon anymore.
The final week of the political path to death with dignity in Vermont was a reminder of how a cadre of politicians can want something so desperately that they push it through even if abandoning key promises.
For months — no, for years — Vermonters have been told that Oregon’s experience of physician-assisted suicide has demonstrated that extending this compassionate option to persons who want it comes at no risk to the vulnerable.
The mantra has been Oregon. Oregon protections. Oregon data. Everything has worked flawlessly in Oregon, so if we follow the exact model as Oregon, we can ignore the fears of the naysayers.
When the Senate was short one vote in February to pass the Oregon model, it sent a narrow bill to the House that focused instead on independent actions of a patient rather than on prescriptions for intentionally lethal medication. It was roundly criticized for lacking the protections of the Oregon bill.
The House restored the Oregon, active-prescription version. Proponents were emphatic on the House floor that it was because every one of the Oregon protections were locked into place that members could be assured there could be no coercion, no errors in diagnosis, and no one making the choice lacking full informed consent.
When it pingponged back, the Senate still couldn’t muster the votes to pass it. So a few backers patched and pasted an assorted set of new and old language together directed exclusively at gaining the one extra vote needed.
Gone were both the Oregon model and any model that left the doctor out of the role of prescribing lethal drugs. Enter the land of political Oz.
— There is no longer any written informed consent required.
— A guardian or an agent for an advance directive is no longer barred from taking the place of a direct patient request.
— There is no longer a second opinion required to assess whether a patient has the rational judgment capacity to make an informed decision.
— There are no requirements for follow-up by the Department of Health. The required review of patient files is gone. The requirement to collect statistical data and publish annual reports is gone.
This last is particularly ironic, because it has been the patient information and report data from Oregon that has been the basis for assuring Vermonters that all is well in Oregon.
The new Vermont bill sunsets even the “Oregon-lite” approach in 2016, then eliminates all remaining structural protections. But there isn’t any data being required to assess how the process works in those first three years.
Despite all this, House members who wanted to see a bill pass stuck by what they had so strongly criticized before: a bill that no longer maintained many of the long-promised protections. Only a few looked twice and voted against accepting what the Senate had done. The winning vote margin dropped from 17 to 10.
Our radical new social policy that endorses having doctors write prescriptions that will kill their patients, cobbled together by just a few individuals from bits and pieces of language drafted on the fly, was passed by two votes in the Senate and 10 votes in the House.
But no, Dorothy. We’re no longer in Oregon.
Rep. Anne Donahue, a Republican from Northfield, is a member of the House Human Services Committee, which passed the Oregon-style bill on a 7-4 vote in April. She was an opponent.
Yesterday, the Vermont House passed S.77, which if signed by the Governor, will create new legal paths of abuse and exploitation against persons who fall within its terms. This article focuses on two of those paths.
Met Life Mature Market Institute has issued two landmark studies on elder abuse in the United States. In the first study, from 2009, the estimated annual financial loss by victims was $2.6 billion. In the second study, from 2011, the estimated annual loss was increased to $2.9 billion. Again, these are yearly figures.
Two elderly women were beaten to death with a crowbar by their trusted handyman. He took and pawned all of their valuables.
A 74-year-old man was stomped to death during a home invasion burglary.
A son and his two friends extracted money from his dying mother by threatening to burn down her home and throw her dog against a wall.
Abuse and exploitation are not limited to the elderly. Last year, a 46 year old lottery winner died the day after receiving his winnings. The cause of death was found to be cyanide poisoning.
S.77 legalizes physician-assisted suicide, which means that a doctor writes a prescription for a lethal dose of medication for the purpose of a patient's committing suicide. Under S.77, the patient is required to have a "terminal condition," defined as having a medical prediction of less that six months to live. Such patients are not necessarily dying and can have years to live. This is because doctor predictions of life expectancy can be wrong and because the requirement of six months to live is based on the patient' s not being treated.
(5) the patient makes an independent decision to self-administer a lethal dose of the medication.
Also, when applying for the lethal dose, patients may be requesting it "just in case." i.e., without a definite intent to take it.
Once the lethal dose is picked up at the pharmacy, there is no oversight. The death is not required to be witnessed. Indeed, no one is required to be present.
As noted above, S.77 does not require witnesses at the death. Without disinterested witnesses, the opportunity is created for the patient’s heir, or for another person who will benefit financially from the patient's death, to administer the lethal dose to the patient without his consent. Even if he struggled, who would know?
Under the streamlined procedure scheduled to come into effect in 2016, the scope of S.77 will be expanded to patients who have no intention of engaging in assisted suicide. As described below, patients prescribed medication for the purpose of cure or treatment will be at risk of being killed under S.77.
The patient is a competent woman with cancer. Without surgery, she is terminal as defined in S.77 (she is expected to die in less than six months). But, with surgery, her prospects are good. As part of informed consent, the doctor informs her about the risks of the surgery and end of life services including palliative care, comfort care, hospice care, and pain control.
With the stress of her situation, the woman has been experiencing insomnia, for which the doctor prescribes Pentobarbital (nembutal). If taken in excess, Pentobarbital may be lethal.. He prescribes a month's supply and advises the woman of the foreseeable risks. She obtains the prescription but doesn't take any. The bottle with the unused prescription is in her home. She is scheduled for surgery in a few days. She has no intention of killing herself. The doctor has no intention of her killing herself.
A family member, interested in an inheritance, tricks the woman into drinking the pentobarbital mixed with water by saying that it's another medication - say for sinus congestion.
The situation looks like a suicide.
"[N]o person shall be subject to civil or criminal liability solely for being present when a patient with a terminal condition self-administers a lethal dose of medication or for not acting to prevent the patient from self-administering a lethal dose of medication."
So the woman was not in control of her fate. She is legally murdered by her heir.
S.77, as passed by the House for the Governor's signature, is a dangerous and irresponsible bill, in which there is no oversight over administration of the lethal dose such that it can be administered without the patient's consent. Once the streamlined procedure goes into effect, patients engaged in drug treatments will also be unwittingly under its scope. Their doctors and the medical profession will also be compromised. Even if you are for assisted suicide, not this bill.
 A copy of S.77, "An act relating to patient choice and control at end of life," as passed by the Senate and the House, can be viewed here: http://choiceisanillusion.files.wordpress.com/2013/05/s-77-house-final-version-05-13-13.pdf The definition of "terminal condition" is in § 5281(a)(10)("Terminal condition" means an incurable and irreversible disease which would, within reasonable medical judgment, result in death within six months).
 I have had two cases in which my client's parent signed up for the lethal dose. In both cases, the parents did not have a set wish to take the lethal dose. They signed up "just in case."
A man who thought he would be dead within six months after being incorrectly diagnosed with brain cancer at the Fort Harrison VA Medical Center has been awarded $59,820 for the grief and stress it caused him and his family.
In documents filed this week, U.S. District Court Judge Donald Molloy wrote that Mark Templin and his family’s distress was caused by Dr. Patrick Morrow’s “negligent failure to meet the standard of care” while Templin was a patient of Morrow’s at the VA.
Molloy noted that at one point, Templin considered suicide so that his family wouldn’t have to watch him wither away.
The case began on Jan. 28, 2009, when Templin arrived at the VA northwest of Helena complaining of acute chest pain. He had a stent inserted and appeared to be recovering well, but a week later he developed problems with his memory, vision and speech, and was having headaches.
Morrow, an internist at the VA, referred Templin to an ophthalmologist, who suspected Templin had suffered a stroke and recommended a CT scan, which was administered. The scan showed brain abnormalities, which Morrow discussed with a neuroradiologist, who told him Templin could be suffering from a variety of diagnoses, including a brain tumor or a stroke.
The neuroradiologist added that further diagnostic testing was needed be more definitive. However, later that day, Morrow met with the VA’s tumor board and presented the case as a strong suspicion of brain cancer, but apparently didn’t mention that it could have been a stroke, according to court documents.
Morrow testified that he told Templin and his family that his “greatest fear” was brain cancer and that further diagnostics were needed, and that he advised Templin to undergo an MRI.
However, Molloy wrote that there was no indication in Templin’s medical records that Morrow suggested any further diagnostic workup and that Templin and his family understood that he had brain cancer and was expected to die within six months.
They talked about cancer treatment, but after learning that it would only ease his pain and not cure him, Templin decided that he didn’t want to sacrifice the “quality of his life for any potential increase in quantity,” according to court documents.
Templin was prescribed two drugs used to treat brain cancer, one of which is not supposed to be given to stroke patients. He also was ordered hospice care, which is for terminally ill patients not expected to live longer than six months.
He sold his truck, quit his job and put his affairs in order, which included prominently displaying a “Do Not Resuscitate” notice on his refrigerator so any emergency medical responders would let him die. His family held a “last birthday” dinner from him and he arranged and paid for his funeral service. His son-in-law made a wooden box for his ashes.
Molloy wrote that after Templin’s discharge in February 2009, hospice records say he was “very depressed and preoccupied with his diagnosis.” Templin testified at a recent court hearing that he cried often and considered shooting himself to spare his family from going through the pain and distress associated with his diagnosed terminal illness.
“While under the impression that he was afflicted with metastatic brain cancer, Mr. Templin wondered each day whether it would be his last,” Molloy wrote.
Yet he started feeling better, and in June he terminated hospice care. In July, he underwent additional testing at Fort Harrison, and this time a doctor told him the CT scan showed multiple small strokes, but no brain cancer. An MRI in December 2009 confirmed that it was a stroke, not brain cancer, that caused his symptoms earlier in the year.
Molloy wrote that Faust Alvarez, the chief of staff at the VA at the time, sent Templin a letter confirming that he suffered a stroke, not brain cancer, although Faust later testified that the statements weren’t an admission of fault or that the diagnosis was faulty.
Molloy decided to award $500 per day for the initial period of severe mental and emotional distress from Feb. 4, 2009 to April 15, 2009, and $300 per day for the latter period until his new diagnosis. He also ordered the VA to repay Templin for the cost of his “last” birthday celebration and for the prearranged funeral service.
Assistant U.S. Attorney Jessica Fehr, with the U.S. Attorney’s Office in Billings, which represents the VA, said they have 30 days to decide whether to file an appeal and hadn’t made a decision yet on whether to do so.
S.77 allows an heir, or another person who will benefit financially from a patient’s death, to help the patient sign up for the lethal dose. S.77 also allows an heir, or someone else who will benefit financially from the death, to pick up the lethal dose at the pharmacy. Once the lethal dose is in the house, there is no oversight.
S.77 is sold as promoting patient choice and control. The bill is instead a recipe for elder abuse. Don’t make Washington’s mistake.
The American Medical Association (AMA) defines physician-assisted suicide as occurring “when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act.” An example would be a doctor’s prescription of a lethal dose to facilitate a patient’s suicide. The AMA rejects this practice, stating: "Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks."
Oregon and Washington are the only states where physician-assisted suicide is legal. Oregon’s law was enacted by a ballot initiative in 1997. Washington's law was enacted by another initiative in 2008 and went into effect in 2009. No such law has made it through the scrutiny of a legislature despite more than 100 attempts. In a third state, Montana, there is a court decision that gives doctors who assist a suicide a defense to prosecution for homicide. The meaning of this decision is subject to ongoing litigation.
In the last two years, three states have strengthened their laws against assisted suicide. These states are: Idaho; Georgia; and Louisiana.
"This July, it was 12 years since my diagnosis. If [my doctor] had believed in assisted suicide, I would be dead."
S.77 has an application process to obtain a lethal dose, which includes a written request with two required witnesses.
Once the lethal dose is picked up at the pharmacy, there is no oversight. The death is not required to be witnessed. No one, not even a doctor, is required to be present.
As noted above, S.77 does not require witnesses at the death. Without disinterested witnesses, the opportunity is created for the patient’s heir, or for another person who will benefit financially from the death, to administer the lethal dose to the patient without his consent. Even if the patient struggled, who would know?
Without disinterested witnesses, the patient’s choice and control over his death is not guaranteed.
"'Capable' means that a patient has the ability to make and communicate health care decisions to a physician, including communication through persons familiar with the patient’s manner of communicating . . .” (Emphasis added).
The person talking for the patient is not required to be a trusted person designated by the patient, for example, an agent under an advanced directive. The person talking for the patient is allowed to be an heir. With this circumstance, the patient is not necessarily in control of his fate.
S.77 prohibits an heir from acting as a witness on the written request for the lethal dose. S.77 does not, however, prohibit an heir from procuring that request. An example of procuring would be: providing the written request to the patient; recruiting the witnesses; and supervising the signing. S.77, which allows an heir to procure the request, does not promote patient choice and control. It invites coercion.
S.77 allows the lethal dose to be picked up at the pharmacy by “an expressly identified agent of the patient.” S.77 does not prohibit an heir, or another person who will benefit financially from the death, from being this agent.
In Vermont, there are an estimated 3,750 cases of violence and abuse against elders each year. Nationwide, elder financial abuse is a crime growing in intensity, with perpetrators often family members. There are also victims reported murdered for their funds.
"[All] the protections end after the prescription is written. [The proponents] admitted that the provisions in the Oregon law would permit one person to be alone in that room with the patient. And in that situation, there is no guarantee that that medication is self administered.
So frankly, any of the studies that come out of the state of Oregon’s experience are invalid because no one who administers that drug . . . to that patient is going to be turning themselves in for the commission of a homicide."
In my law practice, I have had two clients whose parents signed up for the lethal dose.
In one case, one side of the family wanted the parent to take the lethal dose while the other did not. The parent spent the last months of his life struggling over the decision of whether or not to kill himself. My client, who was fearful that the other side of the family would use the lethal dose to kill the parent, who was no longer competent, was also torn and traumatized. The parent did not take the lethal dose and died a natural death.
In the other case, the parent reportedly refused to take the lethal dose at his first suicide party (“I’m going to bed. You’re not killing me”) and was high on alcohol the next night when he took the dose at his second party. The person who told this to my client subsequently recanted. My client did not want to pursue the matter further. As a lawyer who has worked on divorce cases, I couldn’t help but notice that if the parent's much younger wife had divorced him, he would have got the house. This way, she got everything.
If S.77 is enacted, patients affected by its passage will not necessarily be dying and may have years to live. S.77's assurance of patient choice and control is also untrue. The bill is instead a recipe for elder abuse. The most obvious problem is a complete lack of oversight over administration of the lethal dose. No doctor, not even a lay witness is required. Even if the patient struggled, who would know?
Don’t make Washington’s mistake. Reject S.77.
 People v. Stuart, 67 Cal. Rptr. 3rd 129, 143 (2007).
 Oregon’s physician-assisted suicide act was passed as Ballot Measure 16 in 1994 and went into effect after a referendum in 1997.
 § 5281(a)(2) states: "'Capable' means that a patient has the ability to make and communicate health care decisions to a physician, including communication through persons familiar with the patient's manner of communicating if those persons are available."
 See S.77 in its entirety, at http://choiceisanillusion.files.wordpress.com/2013/05/s-77-senate-version-as-of-05-08-13.pdf.
 S.77 does not prohibit heirs, or other persons who benefit financially from the patient’s death, to talk for the patient during the lethal dose request process. See S.77 in its entirety.
 See § 5281(a)(6)(defining “interested persons,” including an heir) and § 5283(a)(4)(regarding “interested persons”).
 See S.77 in its entirety.
 Elder Abuse Public Education Campaign, Vermont Center for Crime Victim Services, at http://www.ccvs.state.vt.us/pub_ed/index.html (last visited April 29, 2013).
 See MetLife Mature Market Institute, Broken Trust: Elders, Family and Finances, A Study on Elder Abuse Prevention, March 2009, at http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf (last visited April 29, 2013); Miriam Hernandez, ‘Black Widows’ in court for homeless murders, March 18, 2008, ABC Local, http://abclocal.go.com/kabc/story?section=news/local&id=6027370 (last visited October 2, 2010) (elderly homeless men killed as part of an insurance scam); and People v. Rutterschmidt, 98 Cal.Rptr.3rd 390 (2009) (regarding this same case).
 Id. See also People v. Stuart, 67 Cal. Rptr. 3d 129, 143 (where daughter killed her mother with a pillow, “financial considerations [are] an all too common motivation for killing someone . . .”).
 Elder Abuse Public Education Campaign, supra at note 29.
A Helena judge has scheduled oral arguments for next month in the case. The lawsuit was filed in December. Since then, the Montana Legislature failed in efforts to either clarify that the practice is specifically legal or illegal. It was the second straight session where lawmakers couldn't agree on which direction to take the state.
This letter addresses assisted suicide and the windfall profit issue. By this, I mean the situation where people pay for health insurance, but don't use it much. Then, if assisted suicide is legal and they do get sick, the insurer can legally encourage them to kill themselves. If this occurs, there is financial gravy for the insurer.
Here in Washington State, her group was the leading force in a ballot measure campaign that legalized assisted suicide. Our law, like the House Version of S.77, contains coercive provisions, which make it less likely that patients will get their choices. For example, in both laws, there is no oversight when the lethal dose is administered. Even if the patient struggled, who would know?

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