Source: https://mtaas.org/app/highly-documented-expose-of-euthanasia-monopolys-pitfalls-making-for-poor-public-policy/
Timestamp: 2019-04-25 23:46:39+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.
Both Acts have an application process to obtain the lethal dose, which includes a written request form with two required witnesses. One of these witnesses is allowed to be the patient’s heir, who will benefit from the death. Once the lethal dose is issued by the pharmacy, there is no supervision over its administration. The death is not required to be witnessed by disinterested persons. No one is required to be present.
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.
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.
Neither Act requires that the patient be competent, capable, or even aware when the lethal dose is administered. There is also no language requiring the patient’s consent at the time of administration. Without these requirements, when the lethal dose is administered, the Acts again set the stage for undue influence and worse.
[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 . . . .
In other words, the prescribing doctor asks multiple doctors to give the second opinion until one agrees to do so.
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.
In summary, someone other than the patient is allowed to administer the lethal dose. The Acts contain no requirement that the patient be competent, capable, or even aware when the lethal dose is administered. There is no requirement that the patient consent when the lethal dose is administered.
Under both Acts, physicians and pharmacists who participate in the lethal dose request process are required to complete official forms. The data collected is summarized in annual statistical reports, which are displayed on official web sites.
None of these official forms and reports ask about, or report on, patient competency, consent, or awareness at the time of administration, or whether the patient administered the lethal dose to himself. These factors are not relevant to compliance with either Act.
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.
Finally, proponents may argue that the Acts protect patients due to provisions that impose civil and criminal liability. None of these provisions penalize administration of the lethal dose without the patient’s consent.
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.
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.
Both Acts impose criminal, but not civil liability for undue influence in connection with the lethal dose request. Undue influence, as described in the Oregon and Washington Acts, does not appear capable of being criminally enforced.
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.
Both Acts also allow conduct that would generally provide proof of undue influence (allowing an heir to act as a witness on the lethal dose request form). How do you prove beyond a reasonable doubt that undue influence occurred when the Act prohibiting undue influence also specifically allows conduct used to prove undue influence? It’s hard to say. The purported criminal liability appears to be illusory.
As noted above, both Acts require annual statistical reports. Washington has generated two reports. In Oregon, there have been thirteen reports.
In Oregon and Washington, the annual reports do not track income or net worth. They do, however, show that the majority of people who have died under the Acts have been well-educated. Typically, people with this attributes would be those with money, i.e., the middle class and above. The statistics also show that the majority of persons dying have been age sixty-five or older.
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 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 . . . 25escribes 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.
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.
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.
This article is similar to shorter articles in the King County Bar Bulletin and the Washington State Bar News.
 Or. Rev. Stat. § 127.815 § 3.01(1)(k) (2009); Wash. Rev. Code Ann. § 70.245.040(1)(k) (West 2009).
 Or. Rev. Stat. §§ 127.800-995. Oregon’s physician-assisted suicide act was passed as Ballot Measure 16 in 1994 and went into effect in 1997. See act, available athttp://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx (last visited May 28, 2010).
 Wash. Rev. Code Ann. § 70.245.903. Washington’s Death with Dignity Act was passed as Initiative 1000 on November 4, 2008 and went into effect on March 5, 2009. See Washington State Dept. of Health, Ctr. for Health Statistics, Death with Dignity Act, available at http://www.doh.wa.gov/dwda/default.htm (last visited Jan. 10, 2010). The full text of the Act is available at http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245 (last visited Jan. 10, 2010).
 The voters’ pamphlet for Initiative 1000 can be viewed on the Washington State Secretary of State website, forprevious elections, athttp://wei.secstate.wa.gov/osos/en/PreviousElections/Pages/default.aspx. Click on the 2008 General Election and follow the prompts to view the voters guide for Initiative Measure 1000.
 See Wash. Rev. Code Ann. § 70.245.010-904 and Or. Rev. Stat. § 127.800-995.
 See Wash. Rev. Code Ann. §§ 70.245.030 and 70.245.220; see also Or. Rev. Stat. §§ 127.810 § 2.02, 127.897 § 6.01 (providing that one of two required witnesses on the lethal dose request form cannot be a patient’s heir or other person who will benefit from the patient’s death; the other witness may be an heir or other person who will benefit from the death).
 See generally Wash. Rev. Code Ann. §§ 70.245.010-904 and Or. Rev. Stat. §§ 127.800-995.
 Wash. Rev. Code Ann. § 11.12.160(2).
 Burns v. Kabboul, 595 A.2d 1153, 1163 (Pa. Super. Ct. 1991).
 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 “‘©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.
 Wash. Rev. Code Ann. § 70.245.040(1)(a); Or. Rev. Stat. § 127.815 § 3.01(1)(a).
 See supra at Introduction, note 5 and accompanying text. Seealso Wash. Rev. Code Ann. §§ 70.245.010-904 and Or. Rev. Stat. §§127.800-995.
 See Wash. Rev. Code Ann. §§ 70.245.010(7)(11)(12), 70.245.020(1), 70.245.090, 70.245.170, 70.245.220.
 Wash. Rev. Code Ann. § 70.245.010(12).
 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).
 Webster’s New World College Dictionary, supra note 27.
 See Or. Rev. Stat. §§ 127.800-995.
 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)).
 Supra notes 24-31 and accompanying text.
 Supra notes 19-20 and accompanying text.
 See Oregon Dep’t of Human Servs., Death With Dignity Actwebsite (last visited May 25, 2010); Washington State Dep’t of Health Ctr. For Health Statistics, Death with Dignity Act, available at http://www.doh.wa.gov/dwda (last visited Mar. 22, 2010).
 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)).
 Wash. Rev. Code Ann. § 70.245.100; Or. Rev. Stat. § 127.845 § 3.07. Wash. Rev. Code Ann. § 70.245.200; Or. Rev. Stat. § 127.890 § 4.02. Id.
 See Washington and Oregon Acts in their entirety. Wash. Rev. Code Ann. §§ 70.245.010-904; Or. Rev. Stat. §§ 127.800-995 (lacking a requirement that administration be witnessed by a disinterested party or anyone at all). People v. Stuart, 67 Cal. Rptr. 3d 129, 143 (Cal. App. 2007)(where daughter had killed her mother with a pillow).
 See Washington State Dep’t of Health, Instructions for Medical Examiners, Coroners, and Prosecuting Attorneys: Compliance with the Death with Dignity Act (last visited May 28, 2011).
 Or. Rev. Stat. §§ 127.800-995.
 See Washington and Oregon Acts in their entirety. Wash. Rev. Code Ann. §§70.245.010-904; Or. Rev. Stat. §§ 127.800-995.
 Mark Reutlinger, Washington Law of Wills and Intestate Succession, Washington State Bar Association 88 (2006).
 Supra notes 6-12 and accompanying text.
 Wash. Rev. Code Ann. § 70.245.150(3); Or. Rev. Stat. § 127.865 § 3.11(3).
 Washington has issued two reports.
 Oregon has generated thirteen annual reports, available here.
 Id.; see supra note 57.
 MetLife Mature Market Institutions, supra note 17, at 4, 24.
 See Susan Donaldson James, Death Drugs Cause Uproar in Oregon, ABC News, Aug. 6, 2008; and Katu.com, Letter Noting Assisted Suicide Raises Questions (July 30, 2008).
 See Attending Physician’s After Death Reporting Form, supra note 31, at question 7; see also Oregon’s Attending Physician Interview Form, Question 15.
 Sarah Scott, Adult Protection: Safeguarding Every Person’s Basic Human Right to a Safe and Decent Life, Regardless of Age, Regardless of Condition (excerpts here).
 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)).
 Kelly Bartlett, Letter to Editor in Response to Legalizing Suicide Draws in Others, Burlington Free Press, Dec. 9, 2008.
 70.245.050, 70.245.010(13); Or. Rev. Stat. §§ 127.815 § 3.01(a), 127.820 § 3.02, 127.800 § 1.01(12).
 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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