Source: https://www.choiceillusionnevada.org/2017/06/tell-legislators-to-say-no-to-assisted.html
Timestamp: 2019-04-24 16:36:55+00:00

Document:
To view a pdf version, click these links for the index, memo and appendix.
The issues addressed include why proposed patient protections ("safeguards") are unenforceable. See Section IX below.
I am an attorney in Washington State where assisted suicide is legal. Our law is based on a similar law in Oregon. Both laws are similar to SB 261, which seeks to legalize assisted suicide and euthanasia in Nevada.
SB 261 is stacked against the individual and recipe for elder abuse. If enacted, the bill will encourage people with years or decades to live to throw away their lives. I urge you to reject this measure.
This year, the South Dakota Legislature passed Senate Concurrent Resolution 11, opposing physician-assisted suicide. The vote was nearly unanimous.
Oregon and Washington State legalized assisted suicide via ballot measures in 1997 and 2008, respectively. In the fine print, these laws also allow euthanasia.
Elder abuse is a problem throughout the United States, including Nevada. Perpetrators are often family members who start out with small crimes, such as stealing jewelry and blank checks, before moving on to larger items or to coercing victims to change their wills or to liquidate their assets. Victims are sometimes murdered.
The bill has an application process to obtain the lethal dose, which includes a lethal request form with two required witnesses. One of the witnesses is allowed to be the patient’s heir who will financially benefit from the patient’s death.
When signing a will, having an heir act as a witness can support a finding of undue influence. Washington State’s probate code, for example, provides that when one of two witnesses receives a gift under a will, there is a presumption that the gift was procured “by duress, menace, fraud, or undue influence." The proposed bill, which allows an heir to act as a witness on the lethal dose request form, invites coercion.
SB 261 applies to persons with a “terminal condition,” meaning those predicted to have less than six months to live. Such persons may, in fact, have years or decades to live. This is true for three reasons.
“Terminal condition” means an incurable and irreversible condition that cannot be cured or modified by any known current medical therapy or treatment and which will, in the opinion of the attending physician, result in death within 6 months.
Such persons, with insulin, are likely to have decades to live; in fact, most diabetics have a normal life span given appropriate control of their blood sugar.
[T]he Nevada definition also applies to [patients] with chronic conditions such as insulin dependent diabetes. This is because treatments such as insulin do not reverse, cure or modify the underlying disease or condition. . . .
Patients, instead, are able to function [with treatment]. This is especially true with diabetes in which treatment with insulin can allow [patients] to live happy, healthy and productive lives.
If Nevada enacts SB 261, the bill as written will allow assisted suicide and euthanasia for people with chronic conditions such as insulin dependent diabetes. Such persons can have years or decades to live.
Eligible persons may also have years to live because predictions of life expectancy can be wrong.
Affidavit of John Norton, at A-18, ¶ 5.
If the bill is enacted, people like Jeanette Hall, with years or decades to live, will be encouraged to throw away their lives.
The bill does not require administration of the lethal dose to be voluntary. There is also no language requiring consent to administration. Without these requirements, patient choice and control is far from guaranteed.
The bill refers to the lethal dose as being “self-administered,” which is not a defined term. The term’s ordinary meaning, to administer to oneself, is a different concept than voluntary or consensual conduct. Consider, for example, a person already intoxicated on alcohol, who drinks another shot without being aware that it contains the lethal dose. He or she would be self-administering the lethal dose, but would not be engaging in voluntary or consensual conduct.
Without a requirement of voluntary and consensual conduct by the patient to administer the lethal dose, patient choice and control is not guaranteed.
C. "Even If a Patient Struggled, Who Would Know?"
With assisted suicide laws in Washington and Oregon [and with SB 261], 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).
The provisions of sections 3 to 26, inclusive, of this act are intended to provide the safeguards, procedures, written requirements and reporting functions to allow a safe framework for patients . . . . (Emphasis added).
The bill does not define “accordance.” Dictionary definitions include “in the spirit of,” meaning “in thought or intention.” With these definitions, a mere thought to comply with patient protections is enough. Compliance is not required.
For these reasons also, patient choice and control are not guaranteed.
The medical certificate of death of a patient who dies after self-administering a controlled substance that is designed to end the life of the patient in accordance with the provisions of sections 3 to 26, inclusive, of this act must be signed by the attending physician who shall specify the terminal condition with which the patient was diagnosed as the cause of death of the patient. (Emphasis added).
Death resulting from a patient self-administering a controlled substance that is designed to end his or her life in accordance with the provisions of sections 3 to 26, inclusive, of this act does not constitute suicide or homicide. (Emphasis added).
In Washington State, similar, albeit less wordy language is interpreted by the Washington State Department of Health to require the death certificate to list a terminal disease as the cause of death, without even a hint that the actual cause of death was assisted suicide or euthanasia. The only relevant inquiry is whether Washington’s act was “used.” Compliance with patient protections is not required.
1. The underlying terminal disease must be listed as the cause of death. . . .
If Nevada enacts the proposed bill and follows Washington State, death certificates will list a terminal condition without even a hint that the actual cause of death was assisted suicide or euthanasia. This will be without regard to whether there was compliance with patient protections. There will be an official legal cover up.
The significance of requiring a terminal 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 terminal condition (not murder) as a matter of law.
More to the point, a perpetrator will be let off the hook: The bill will create the perfect crime.
Oregon is not a valid case study due to a near complete lack of transparency regarding its law. Even law enforcement does not have access to the information collected. Source documentation is destroyed. The bottom line, Oregon’s official data cannot be verified.
The bill provides for data collection similar to Oregon in which patient names and other identifying patient data will not be provided to “oversight” authorities.” As with Oregon, there will be little, if any, ability to verify reported data. The proposed government oversight is a sham.
In Washington State and Oregon, I have had two cases where my clients suffered trauma due to legal assisted suicide. In the first case, one side of the family wanted the 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, his adult daughter, was severely traumatized. The father did not take the lethal dose and died a natural death.
In the other case, it’s not clear that administration of the lethal dose was voluntary. A man who was present told my client that his (my client's father) had refused to take the lethal dose when it was delivered, stating, "You're not killing me. I'm going to bed," but then he (the father) took it the next night when he was intoxicated on alcohol. The man who told this to my client subsequently changed his story.
It is unlawful for any person to: . . . .
As noted supra, the bill also allows a patient’s heir to be a witness on the lethal dose request form, which is a marker of undue influence in the context of a will.
How do you prove that undue influence occurred when the bill does not define it and the bill also allows conduct used to prove it in another context? You can’t. The felony for undue influence is illusory and unenforceable.
Passing SB 261 will encourage people with years or decades to live to throw away their lives. Elder abuse is already a problem. Passage of the bill will make it worse.
The bill is sold as voluntary, but does not even have a provision requiring administration of the lethal dose to be voluntary. Administration of the lethal dose is allowed to occur in private without a doctor or witness present. If the patient objected, or even struggled, who would know?
The death certificate will list a terminal condition as the cause of death. This will prevent prosecution for murder, no matter what the facts. The bill, if passed, will create the perfect crime.
I urge you to vote “No” on SB 261.
 SB 261 (First Reprint) is attached in the appendix at A-101 through A-126.
 The AMA Code of Medical Ethics, Opinion 5.7, attached in the appendix at A-5.
 Id, Opinion 5.8, “Euthanasia,” attached in the appendix at A-5 (lower half of the page).
 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; article in the appendix at A-6, quote at A-8.
 Id., 32 to 3 in the Senate; 67 to 1 in the House.
 Morris v. Brandenburg, 376 P.3d 836 (2016). (Excerpt attached in the appendix at A-12).
 See: Met Life Mature Market Institute, Broken Trust: Elders, Family and Finances,” March 2009, at https://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf; Geoff Dornan, “Working to stop senior exploitation,” Nevada Appeal, June 25, 2015, attached in the appendix at A-18 to A-19; and elder abuse info sheet, attached in the appendix at A-10.
 Yanan Wang, “This 80-year-old ‘Black Widow,’ who lured lonesome old men to horrible fates, is out of prison again,” The Washington Post, March 21, 2016. (Attached in the appendix at A-20 through A-22; quote at A-21).
 The bill’s lethal dose request form can be viewed at § 13, attached in the appendix at A-107 to A-108. The witness section can be viewed at A-108.
 SB 261, § 13, attached in the appendix at A-108.
 See SB 261 in its entirety, attached in the appendix at A-101 to A-126.
 Wash. Rev. Code Ann. § 11.12.160(2), attached in the appendix at A-11.
 SB 261, § 10, attached in the appendix at A-105, lines 23 to 27.
 Or. Rev. Stat. 127.800 s.1.01(12), attached in the appendix at A-27.
 See Declaration of William Toffler, MD, in the appendix at A-24 to A-25, ¶¶ 2-4.
 Id., in the appendix at A-25, ¶ 5.
 Id., ¶¶ 8 & 9.
 See Jessica Firger, “12 million Americans misdiagnosed each year,” CBS NEWS, 4/17/14, attached in the appendix at A-31, 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. (Excerpts attached in the appendix at A-6 to A-8).
 Affidavit of John Norton, attached in the appendix at A-17 to A-19.
 Id., ¶ 4, attached in the appendix at A-18.
 Affidavit of Kenneth Stevens, MD, attached in the appendix at A-31 to A-37; Jeanette Hall discussed at A-31 to A-32; Hall declaration attached in the appendix at A-38.
 Declaration of Jeanette Hall, ¶4, in the appendix at A-38.
 The bill uses the word “voluntary” in relation to a request for the lethal dose, not administration. See SB 261 in its entirety, attached in the appendix at A-104, line 16 to A-126, line 18.
After an attending physician prescribes a controlled substance that is designed to end the life of a patient, the attending physician shall, with the written consent of the patient, contact a pharmacist and inform the pharmacist of the prescription. After the pharmacist has been notified, the attending physician shall give the prescription directly to the pharmacist or electronically transmit the prescription directly to the pharmacist. (Emphasis added).
Attached in the appendix at A-110, lines 15-21.
 See SB 261, §§ 3-10, attached at A-104, line 44 to A-105, line 27.
 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.
 SB 261, § 10.5.4, attached in the appendix at A-105, line 43 to A-106, line 2.
 Id., § 22.1. The bill uses this same "accordance" language throughout its text.
 See “accordance” definition attached in the appendix at A-42, and “in the spirit” definition attached hereto at A-67.
 SB 261, § 1.3, attached in the appendix at A-104, lines 35-40.
 SB 261, § 22.1, attached in the appendix at A-113, lines 40 to 43.
 A copy of the Washington State Death certificate is attached in the appendix at A-43.
 See: “Declaration of Testimony” by Oregon attorney Isaac Jackson, dated September 18, 2012, attached in the appendix at A-45 to A-50 (regarding the run-around he got when he attempted to learn whether his client’s father had died under Oregon’s law - the Oregon Health Authority would neither confirm nor deny whether the father had died under the law); E-mail from Alicia Parkman, Oregon Mortality Research Analyst, to Margaret Dore, dated January 4, 2012, attached at A-51 to A-52 (law enforcement cannot get access to information); Excerpt from Oregon’s website at A-53 (patient identities “not recorded in any manner”); E-mail from Parkman to Dore, June 27, 2011, attached at A-55 to A-56 (“all source documentation” destroyed after one year); and the "Confidentiality of Death Certificates" policy issued by the Oregon Department of Human Resources Health Division, December 12, 1997, (clarifying that employees failing to comply with confidentiality rules “will immediately be terminated”), as published in the Issues in Law & Medicine, Volume 14, Number 3, 1998.
 See SB 261, §§ 20 & 20.5, attached in the appendix at A-112 & A-113.
 “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 attached in the appendix at A-57).
 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-60).
 Report excerpts at A-61 & A-62.
 Oregon Health Authority Report, attached in the appendix at A-63 & A-64.
 Attached in the appendix at A-65.
 Attached in the appendix at A-114.
Jeanette Hall shortly after she was talked out of assisted suicide in Oregon. Today, sixteen years later, she is thrilled to be alive.

References: v. 
 § 13
 § 13
 § 11
 § 10
 § 10
 § 22
 § 1
 § 22