Source: https://www.choiceillusion.org/p/the-oregon-washington-assisted-suicide.html
Timestamp: 2019-04-22 03:06:55+00:00

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This article was originally published as, Margaret Dore, "Death with Dignity": A Recipe for Elder Abuse and Homicide (Albeit Not by Name)," 11 Marquette Elder's Advisor 387, 2010.* The updated version below is current as of May 28, 2011.
Death with Dignity Acts in Oregon and Washington authorize physicians to write life-ending prescriptions for their patients. Oregon’s Act went into effect thirteen years ago. Washington’s Act was passed as a citizen’s initiative in 2008 and went into effect in 2009. Both Acts are touted as providing "choice" and "control" for end-of-life decisions. During Washington’s election, the "For Statement" in the voters’ pamphlet declared: "Only the patient – and no one else – may administer the [lethal dose]." Washington’s Act, however, does not say this anywhere. In fact, neither Act even requires the patient’s consent when the lethal dose is administered. These problems and other problems are discussed below.
When signing a will, having an heir act as one of the witnesses can support a finding of undue influence. Washington’s probate code, for example, states that when one of two witnesses is a taker under the will, there is a rebuttal presumption that the taker/witness "procured the gift by duress, menace, fraud, or undue influence."
Other states have similar laws. Consider Burns v. Kabboul, which states: "[i]t will weigh heavily against the proponent [of the will] on the issue of undue influence when the proponent was . . . present at [its] dictation . . . ." The lethal dose request process, which allows an heir to act as a witness on the request form, does not promote patient choice. It invites coercion.
In Washington, patients signing the lethal dose request form are required to be "competent." In Oregon, patients are required to be "capable." Regardless of the term used, this is a relaxed standard in which someone other than the patient is allowed to speak for the patient. For example, the Washington Act states: "‘Competent’ means . . . a patient has the ability to make and communicate an informed decision . . . , including communication through persons familiar with the patient’s manner of communicating . . . ."
There is no requirement that the person speaking for the patient be a designated agent such as an attorney-in-fact. The person could be an heir or a new "best friend." Regardless, without a requirement of strict competency, both Acts set the stage for undue influence by heirs and others who will benefit from the patient’s death.
[My patient’s cancer specialist] asked me to be the "second opinion" for his suicide . . . I told her that assisted-suicide was not appropriate for this patient and that I did NOT concur . . . [A]pproximately two weeks later my patient was dead from an overdose prescribed by this doctor . . . .
Both acts imply that patients administer the lethal dose to themselves. There is, however, nothing in either Act that requires this. There is no language that "only" the patient can administer the lethal dose to himself.
The Washington Act instead states that the patient may "self-administer" the dose. In an Orwellian twist, the term "self-administer" does not mean that administration will necessarily be by the patient. "Self-administer" is instead defined as the patient’s "act of ingesting." The Washington Act states: "‘Self-administer’ means a qualified patient’s act of ingesting medication to end his or her life . . ." (Emphasis added).
In other words, someone else putting the lethal dose in the patient’s mouth qualifies as proper administration because the patient will thereby "ingest" the dose. Someone else putting the lethal dose in a feeding tube or IV nutrition bag will also qualify because the patient will thereby "absorb" the dose, i.e., "ingest" it.
Oregon’s Act does not use the term "self-administer." Official forms for both Acts also refer to administration as "ingestion," "ingesting," and other forms of the word "ingest." See, for example, Washington's "Attending Physician's After Death Reporting Form." With administration defined as mere ingestion, someone else is allowed to administer the lethal dose to the patient.
Intentionally killing an incompetent or unaware person, or intentionally killing some other person without his consent, is homicide. Both Acts, however, allow this result as long as the action taken is "in accordance with" the Act. For example, Washington’s Act states: "Actions taken in accordance with this chapter do not, for any purpose, constitute . . . homicide, under the law."
Proponents sometimes argue that "only" the patient can administer the lethal dose because both Acts prohibit mercy killing and active euthanasia (another name for mercy killing). This argument is word play. The prohibition against mercy killing and euthanasia is defined away in the next sentence. For example, the Washington Act states: "Nothing in this chapter authorizes . . . mercy killing, or active euthanasia. Actions taken in accordance with this chapter do not, for any purpose, constitute . . . mercy killing [also known as ‘euthanasia’] . . . ."
Proponents may also argue that patient consent is required because patients may rescind the request for the lethal dose "at any time." A provision that a patient "may" rescind is not, however, the same thing as a right to give consent when the lethal dose is administered. Consider, for example, a patient who obtained the dose on a "just-in-case" basis without consenting to taking it. If such patient would later become incompetent, be sedated, or simply be sleeping, he would not have the ability to rescind. Without the right to consent, someone else could, nonetheless, administer the lethal dose to him. Without the right to consent, the patient’s promised control over the "time, place, and manner" of his death is an illusion.
If, for the purpose of argument, the Acts do not "allow" a patient’s death without his consent, patients are, nonetheless, unprotected from this result due to the lack of required witnesses at the death. Without witnesses, the opportunity is created for someone other than the patient to administer the lethal dose to the patient without his consent. Even if he struggled, who would know? The lethal dose request would provide the alibi.
This scenario would seem especially significant for patients with money. A California case, People v. Stuart, states: "[F]inancial considerations [are] an all too common motivation for killing someone . . . ."
In Washington, a further alibi is provided by a reporting requirement that medical examiners, coroners, and even prosecuting attorneys treat the death as "natural." Any death certificate not complying with this requirement is to be rejected by the Washington State Registrar. In Oregon, the Act and official forms do not explicitly require that the death to be treated as natural. This is, however, the implication of § 127.880 § 314, which states: "Actions taken in accordance with [the Act] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law." Under local practice, the deaths are treated as natural.
Neither Act defines undue influence or provides elements of proof. Undue influence is also a traditionally equitable concept "not susceptible of precise definition . . . ." For example, in Washington, the test for undue influence consists of multiple nonexclusive factors. With this situation, the "crime" of undue influence appears too undefined and/or vague to be enforced.
These statistics can be explained by older persons with money feeling a "duty to die" so as to pass on funds to their heirs. The statistics are also consistent with elder abuse. A recent MetLife Mature Market Institute Study states that "[e]lders’ vulnerabilities and larger net worth make them a prime target for financial abuse . . . [v]ictims may even be murdered by perpetrators who just want their funds and see them as an easy mark."
The statistics, which also show some poor people dying, are consistent with the "Barbara Wagner" scenario. Wagner was an indigent resident of Oregon who had lung cancer. The Oregon Health Plan refused to pay for a drug to possibly extend her life and offered to pay for her suicide instead. Unable to afford the drug, she was steered to suicide. Moreover, it was the Oregon Health Plan, an Oregon government agency, doing the steering.
In both Washington and Oregon, the official reporting forms include a check-the-box question with seven possible "concerns" that contributed to the lethal dose request. These concerns include the patient’s feeling that he was a "burden." The prescribing doctor is instructed: "Please check ‘yes,’ ‘no,’ or ‘don’t know’ depending on whether or not you believe that a concern contributed to the request."
In other states, a person being described as a "burden" is a warning sign of abuse. For example, an Idaho Adult Protection Services information document describes the following "warning sign": "Suspect behavior by the caregiver . . . [d]escribes the vulnerable adult as a burden or nuisance." The recommendation is that when such "warning signs" exist, a report should be made to law enforcement and/or to the local adult protective services provider. Washington and Oregon, by contrast, instruct its doctors to check a "burden" box.
Washington and Oregon promote the idea that its citizens are burdens, which justifies the prescription of lethal drugs to kill them. Washington’s and Oregon’s Acts do not promote patient "control," but officially sanctioned abuse of vulnerable adults.
Neither state’s Act allows patients to opt out of its provisions. The Washington Act states that any provision that affects whether a person may make or rescind a lethal dose request "is not valid." Oregon’s Act has a similar provision. So, if a person knows he gets talked into things, and he doesn’t want to get talked into requesting the lethal dose, committing suicide and/or facilitating his own homicide, he is not allowed to make legal arrangements to try and prevent it. So much for personal "choice" and "control."
By signing the lethal dose request form, the patient takes an official position that if he dies suddenly, no questions should be asked. He will be unprotected against others in the event he obtains the dose on a "just-in-case" basis or changes his mind and decides that he wants to live. This would seem especially important for older people with money. There is, regardless, a loss of control.
Both Acts apply to adults determined by an "attending physician" and a "consulting physician" to have a disease expected to produce death within six months. But, what if the doctors are wrong? This is the point of a 2009 Seattle Weekly article. The article states: "Since the day [the patient] was given two to four months to live, [she] has gone with her children on a series of vacations. . . . ‘[w]e almost lost her because she was having too much fun, not from cancer’ [her son] chuckles."
Death with Dignity Acts in Oregon and Washington State are not about patient "choice" and "control." These laws instead enable heirs, other people and even government agencies to pressure or steer people to an early death, or even cause that death. What was previously "homicide" is now "death with dignity." Elderly persons with money, i.e., the middle class and above, appear to be especially at risk. Don’t let physician-assisted suicide come to your state.
 Wash. Rev. Code Ann. § 70.245.010(3) (emphasis added). The Oregon Act has similar language. See Or. Rev. Stat. § 127.800 § 1.01(3)(stating "‘[c]apable’ means . . . a patient has the ability to make and communicate health care decisions . . . , including communication through persons familiar with the patient’s manner of communicating . . . ." (Emphasis added).
 Id. For a discussion of new "best friends" and other signs of elder financial abuse, see MetLife Mature Market Institutions, Study: Broken Trust: Elders, Family, and Finances: A Study on Elder Financial Abuse Prevention, March 2009, at 22-23.
 See e.g., Mont. Code Ann. § 28 2-407(2) (defining undue influence as "taking an unfair advantage of another’s weakness of mind"); Burns v. Kabboul, 595 A.2d at 1162 (describing "weakened intellect" as a factor for undue influence).
 Both Acts contain provisions requiring that a determination of whether a patient is acting "voluntarily" be made in conjunction with the lethal dose request, not later. See Wash. Rev. Code Ann. §§ 70.245.020(1), 70.245.030(1), 70.245.040(1)(a)(d), 70.245.050, 70.245.120(3)(4), 70.245.220; Or. Rev. Stat. §§ 127.805 § 2.01(1), 127.810 § 2.02(1), 127.815 § 3.01(1)(a)(d), 127.820 § 3.02, 127.855 § 3.09(3), 127.855 § 3.09(4), 127.897 § 6.01.
 Neither Act defines "ingest." See Wash. Rev. Code Ann. §§ 70.245.010-904 and Or. Rev. Stat. §§127.800-995. Dictionary definitions include "to take(food, drugs, etc.) into the body, as by swallowing, inhaling, or absorbing" (emphasis added). Webster’s New World College Dictionary, www.yourdictionary.com/ingest (last visited May 28, 2010).
 Or. Rev. Stat. § 127.875 § 3.13 (stating "[n]either shall a qualified patient’s act of ingesting medication to end his or her life in a humane and dignified manner have an effect upon a life, health, or accident insurance or annuity policy." (Emphasis added)).
 Wash. Rev. Code Ann. § 70.245.180(1); Or. Rev. Stat. § 127.880 § 3.14 (stating that "[n]othing in [this chapter] shall be construed to authorize . . . mercy killing or active euthanasia. Actions taken in accordance with [this chapter] shall not, for any purpose, constitute . . . mercy killing [also known as ‘euthanasia’] . . . ." (Emphasis added)).
 See e.g. Oregon's Annual Report for 2010 ("Of the 65 patients who died under DWDA in 2010, most (70.8%) were over age 65 years; the median age was 72 years. As in previous years, most were white (100%), well-educated (42.2% had a[t] least a baccalaureate degree) . . ."
 Id. (stating that these "‘warning signs’ should . . . serve as indicators that a problem may exist and a report should be made to law enforcement or to the local Adult Protection service provider.").
 Wash. Rev. Code Ann. § 70.245.160(1) (stating that "[a]ny provision in a contract, will, or other agreement, whether written or oral, to the extent the provision would affect whether a person may make or rescind a request for medication to end his or her life in a humane and dignified manner, is not valid." (Emphasis added)).
 Or. Rev. Stat. § 127.870 § 3.12(1) (stating "[n]o provision in a contract, will, or other agreement, whether written or oral, to the extent the provision would affect whether a person may make or rescind a request for medication to end his or her life in a humane and dignified manner, shall be valid." (Emphasis added)).
 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?

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