Saturday, May 23, 2015

SB 128: The Promise of Patient Choice and Control is False; the Potential Cost is Enormous.

This is a memo to the California State Senate. To view the original hard copy version, please click here.  To view the attachments, click here. A web version below.

Thank you for your interest. Please tell your Senators to vote NO on SB 128.

Margaret Dore. Esq., MBA


I am an attorney in Washington State where physician-assisted suicide is legal.[1] Our law is modeled on a similar law in Oregon. Both laws are similar to the proposed bill, SB 128.[2]

SB 128 seeks to legalize both physician-assisted suicide and euthanasia, which it terms “aid-in-dying.” The term, aid-in-dying, is traditionally a term for euthanasia.[3] “Eligible” patients may have years, even decades, to live.

The bill is also promoted as assuring patient choice and control, which is false. I urge you to reject this measure. Do not make Washington and Oregon’s mistake.


A.  Compassion & Choices Is a Successor Organization to the Hemlock Society.

Passage of SB 128 is being spearheaded by the suicide/euthanasia advocacy group, Compassion & Choices (“C & C”). C & C was formed in 2004 as the result of a merger/takeover of two other organizations.[4] One of these organizations was the former Hemlock Society, originally formed by Derek Humphry.[5]

In 2011, Humphry was in the news as a promoter of mail-order suicide kits.[6] This was after one of the kits was used by the depressed son of a federal judge, to kill himself.[7] Later that year, C & C celebrated Humphry as the keynote speaker for its annual meeting.[8]

 B.  Physician-Assisted Suicide; Assisted Suicide; and Euthanasia.

The American Medical Association 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.”  “Assisted suicide” is a general term in which the aiding person is not necessarily a physician.  “Euthanasia,” by contrast, is the direct administration of a lethal agent with the intent to cause another person’s death.[10]

The American Medical Association rejects physician-assisted suicide and euthanasia, stating they are:
[F]undamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.[11]
C. Withholding or Withdrawing Treatment is Not Assisted Suicide or Euthanasia.

Withholding or withdrawing treatment (“pulling the plug”) is not assisted suicide or euthanasia. The purpose is to withhold or remove burdensome treatment, i.e., as opposed to an intent to kill the patient.[10] More importantly, the patient does not necessarily die. Consider this quote from an article in Washington state regarding a man removed from a ventilator:

[I]nstead of dying as expected, [he] slowly began to get better.[12]

D. Most States Have Rejected Assisted Suicide and/or Euthanasia.

The vast majority of states to consider legalizing assisted suicide and/or euthanasia have rejected it.[13] In the last four years, four states have strengthened their laws against assisted suicide. These states are: Arizona, Idaho, Georgia and Louisiana.[14] In another state, Minnesota, that state’s assisted suicide law was recently clarified.[15] Just last week, there was a conviction.[16]


A. “Eligible” Patients May Have Years, Even Decades, to Live.

SB 128 applies to “terminal” patients, meaning those predicted to have less than six months to live. Such persons may, actually have years, even decades, to live, i.e., unless the bill passes and they commit suicide or are euthanized thereunder. This is true for at least three reasons:
1. If California follows Oregon’s interpretation of “terminal disease,” assisted suicide and euthanasia will be legalized for persons with chronic conditions such as diabetes.
SB 128 states:
“Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within six months.[18]
Oregon’s law has a nearly identical definition, as follows:
“Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.[19] 
In Oregon, this nearly identical definition is interpreted to include chronic conditions such as insulin dependent diabetes.[20]  Oregon doctor, William Toffler, explains: 
Our law applies to "terminal" patients who are predicted to have less than six months to live.  In practice, this idea of terminal has recently become stretched to include people with chronic conditions . . . .  Persons with these conditions are considered terminal if they are dependent on their medications, such as insulin, to live.[21] 
If California enacts SB 128 and follows Oregon’s interpretation of “terminal disease,” assisted suicide and euthanasia will be legalized for people with chronic conditions such as diabetes.  Dr. Toffler states:  
Such persons, with treatment, could otherwise have years or even decades to live.[22]
          2. Predictions of life expectancy can be wrong.

Patients may also have years to live because predicting life expectancy is not an exact science.[23] Consider John Norton who was diagnosed with ALS. He was told that he would get progressively worse (be paralyzed) and die in three to five years. Instead, the disease progression stopped on its own. In a 2012 affidavit, at age 74, he states:
If assisted suicide or euthanasia had been available to me in the 1950's, I would have missed the bulk of my life and my life yet to come.
Affidavit of John Norton, ¶ 5.

          3. Treatment can lead to recovery.

Consider also Oregon resident, Jeanette Hall, who was diagnosed with cancer in 2000 and wanted to do assisted suicide.  Her doctor convinced her to be treated instead.[25]  In a 2013 affidavit, she states:
This last July, it was 13 years since my diagnosis.  If [my doctor] had believed in assisted suicide, I would be dead.[26]
B. If SB 128 Is Enacted, There Will Be Pressure to Expand its Reach.

In Washington State, our law went into effect in 2009.  Since then, we have had informal “trial balloon” proposals to expand it to non-terminal people.  For me, the most disturbing proposal was in the Seattle Times, which is our largest paper.  A column suggested euthanasia as a solution for people without funds for their old age, which could be any of us (say if the company pension plan went broke).[27]  Moreover, this would be non-voluntary or involuntary euthanasia.

Meanwhile, in Oregon, this year’s legislative session featured a bill to expand eligibility.[28]

If SB 128 is enacted in California, it’s not unlikely that there will be a similar push for expansion.

C. How the Bill Works.

SB 128 has an application process to obtain the lethal dose, which includes a formal lethal dose request form.

Once the lethal dose is issued by the pharmacy, there is no oversight.[29] No doctor is required to be present.[30] The death is not required to be witnessed.[31]

 D. Patient Choice Is Not Assured.

1. No witnesses at the death.

SB 128 does not require witnesses at the death.[32] Without disinterested witnesses, the opportunity is created for someone else to administer the lethal dose to the patient without his consent.[33] Even if he struggled, who would know? This situation is especially significant for people with money. People v. Stuart, 67 Cal.Rptr.3d 129, 143 (2007), states:
Financial considerations [are] an all too common motivation for killing someone.
Without disinterested witnesses, the patient’s control over the time, place and manner of his death is not guaranteed.

          2.  Adding witnesses will not fix the problem.

Requiring disinterested witnesses at the death would protect against overt murder.  Generally, however, witnesses are not much of a safeguard.  Many wills are properly witnessed and nonetheless set aside for undue influence, fraud, etc.

          3.  Someone else is allowed to speak for the patient.

Patients signing the lethal dose request form are required to be “competent.”[34] This term is, however, specially defined to allow someone else to speak for the patient during the lethal dose request process, i.e., as long as the speaking person is “familiar with the patient’s manner of communicating.”  SB 128 states:
“Competent” means that. . . the individual has the ability to make and communicate an informed decision to health care providers, including communication through a person familiar with the individual’s manner of communicating . . . (Emphasis added).[35]
Being familiar with the patient’s “manner of communicating” is a very minimal standard.  Consider, for example, a doctor’s assistant who is familiar with a patient’s “manner of communicating” in Spanish, but she, herself, does not understand Spanish.  That, however, would be good enough for her to speak for the patient during the lethal dose request process.

Proponents may counter that not just anyone can speak for the patient, that a translator is required. This is only, however, if the lethal dose request form is in English and the patient speaks another language.[36] If the form is in the patient’s language, no translator is required.[37] Regardless, someone else is allowed to speak for the patient as long as she is familiar with the patient’s “manner of communicating.”  This person could be the doctor’s janitor or practically anyone at all.  The patient’s choice and control are not assured.

          4. There is no right to be told of feasible alternatives for cure or to extend life.

SB 128 says that patients have the right to be informed of feasible alternatives to the lethal dose.[38] The bill also says that the attending physician is to ensure that the patient is making an informed decision, by discussing:
The feasible alternatives or additional treatment opportunities, including, but not limited to, comfort care, hospice care, palliative care, and pain control.  (Emphasis added). [39]
The listed items ("comfort care, hospice care, palliative care, and pain control") all have to do with death and dying.

With this situation, the patient’s right to be told of feasible alternatives is limited to those having to do with death and dying. This is due to the rule of statutory construction, ejusdem generis, Latin for "of the same kind," which is summarized in the footnote below.[40] Moreover, with the patient’s right to be told of feasible alternatives limited to death and dying, patients have no right to be told of feasible alternatives for cure or to extend life.  Once again, patient choice and control is not assured.

          5.  Individual "opt outs" are not allowed.

SB 128 does not allow patients to opt out of its provisions.  § 443.10(a) states:
A 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 aid-in-dying medication, is not valid.  (Emphasis added).
So much for the patient’s choice and control.
6. If California follows Washington State, prosecutors will be required to treat deaths as natural if the act was “used,” without even a hint of the true cause of death.  There will be no recourse for patients or their families. 
SB 128 states that the cause of death on the patient’s death certificate “shall be the underlying terminal disease.”[41]  SB 128 also states:
Actions taken in accordance with this part shall not, for any purposes, constitute suicide, assisted suicide, mercy killing, homicide, or elder abuse under the law.[42]
In Washington State, similar language is interpreted to require the death certificate to reflect a natural death if Washington’s act was “used” (not complied with). Moreover, there must not be even a hint that the actual cause of death was assisted suicide or euthanasia. The Washington State Department of Health, “Instructions for Medical Examiners, Coroners and Prosecuting Attorneys: Compliance with the Death with Dignity Act,” states:
Washington’s Death with Dignity Act (RCW 70.245) states that “the patient’s death certificate . . . shall list the underlying terminal disease as the cause of death.”  The act also states that, “Actions taken in accordance with this chapter do not, for any purpose, constitute suicide, assisted suicide, mercy killing, or homicide, under the law.”
If you know that the decedent used the Death with Dignity Act, you must comply with the strict requirements of the law when completing the death record: . . .
2. The manner of death must be marked as
3. The cause of death section may not contain any language that indicates that the Death with Dignity Act was used, such as:
a.  Suicide
b.  Assisted suicide
c.  Physician-assisted suicide
d.  Death with Dignity
e.  I-1000
f.  Mercy killing
g.  Euthanasia
h.  Secobarbital or Seconal
i.  Pentobarbital or Nembutal.  (Emphasis added).

With the death required to be treated as “Natural” simply because the act was used, there is no criminal recourse if the patient was pressured into taking the lethal dose, or even outright murdered via the lethal dose.  The Medical Examiner, the Coroner and the Prosecutor must certify the death as Natural without any indication of the true cause of death: It’s the perfect crime.

If California adopts a similar interpretation based on SB 128's similar language, there will be a similar situation.  Patients will be unprotected under the law no matter how egregious the facts of the particular case.

E. SB 128 Legalizes Euthanasia.

1. Euthanasia is not prohibited.

SB 128 appears to prohibit “euthanasia,” which is another name for mercy killing.[43]  SB 128 states:
Nothing in this part may be construed to authorize a physician or any other person to end an individuals’s life by lethal injection, mercy killing, or active euthanasia.[44]
This prohibition is, however, defined away in the next sentence.  SB 128 states:
Actions taken in accordance with this part shall not, for any purposes, constitute . . . mercy killing, [another word for “euthanasia”], homicide, or elder abuse under the law.[45]
 2. Standard medical practice allows someone else to administer the lethal dose to  the patient, which is euthanasia under generally accepted medical terminology.
Generally accepted standard medical practice allows prescription medication to be administered by the patient, by a medical professional or by a lay person acting under the direction of a medical professional.[46] Common examples of the last category are parents who administer prescription medication to their children and adult children who administer prescription medication to their parents.[47]

Under SB 128, physicians write prescriptions for aid-in-dying medication, which the patient may “self-administer,” “take” and/or “use.”[48] There is, however, no language making these methods of administration mandatory.[49] With this situation, standard medical practice prevails, which allows another person to administer the lethal dose to a patient. This is euthanasia under generally accepted medical terminology.  The AMA Code of Ethics, Opinion 2.21, states:
Euthanasia is the administration of a lethal agent by another person to a patient .... [50]
SB 128 legalizes euthanasia.

F. Purported Patient Protections are Illusory.
1. There is no requirement that a doctor or anyone else comply with a patient’s “rescission” of the request.
SB 128 provides that a patient may, at any time, rescind her request for the lethal dose.[51] There is, however, no provision that a doctor or anyone else is bound by the rescission.[52]  The protection is illusory.
2. The provision making undue influence a felony is too vague to be unenforced. 
SB 128 imposes criminal liability for undue influence, as follows:
Knowingly coercing or exerting undue influence on an individual to request medication for the purpose of ending his or her life . . . is punishable as a felony.[53] 
This provision does not define undue influence or provide elements of proof.[54]

In California’s Welfare and Institution’s Code, factors supporting a determination of undue influence include a victim’s illness and the fact that the person influencing the victim is a health care professional.[55] This scenario is, however, specifically allowed by SB 128, which says that an “attending physician” is to “counsel” (influence) a terminally ill person.[56]

How do you prove undue influence when the bill prohibiting undue influence allows conduct normally used to prove undue influence? It’s hard to say.

When reasonable people must guess at the meaning of a statute, which is the case here, statutes have been found to be unconstitutionally vague. People v. Acosta, 226 Cal.App.4th 108, 116-117, 171 Cal.Rptr.3d 774 (2014), states:
A statute which . . . forbids . . . the doing of an act in terms so vague that men of common intelligence must necessarily guess at its meaning and differ as to its application violates the due process requirement of adequate notice.  (Internal punctuation removed). 
The purported liability is, regardless, illusory.


A.  Elder Abuse is a Large and Uncontrolled Problem.

In 2009, the MetLife Mature Market Institute released a landmark study on elder financial abuse.[57] The estimated financial loss by victims in the United States was $2.6 billion per year. In 2011, Met Life released another study, which described how financial abuse can be catalyst for other types of abuse.  Consider this example:
A woman barely came away with her life after her caretaker of four years stole money from her and pushed her wheelchair in front of a train.[58]
B.  Legalization of Assisted Suicide and/or Euthanasia will Create New Paths of Elder Abuse.

In California, preventing elder abuse is official state policy.[59]  If assisted suicide and euthanasia are legalized pursuant to SB 128, new paths of abuse will be created against the elderly, which is contrary to that policy.  Alex Schadenberg, chair for the Euthanasia Prevention Coalition, International, states:
With assisted suicide laws in Washington and Oregon [and with SB 128], 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. . . . [E]ven if a patient struggled, “who would know?”[60]
Consider also, the Thomas Middleton case in which physician-assisted suicide was part of an elder abuse fraud.  Click here for more information.

C. Any Study Claiming that Oregon’s Law is Safe, is Invalid.

In 2011, the lack of oversight over administration of the lethal dose in Oregon, prompted State Senator Jeff Essmann, of Montana, to make this observation: the Oregon studies claiming that assisted suicide is safe are invalid.  He stated:
[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 [taken on a voluntary basis].
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.[61]
D. Assisted Suicide and Euthanasia can be Traumatic for Family Members as well as Patients.

1. The Swiss study.

In 2012, a study was released in Switzerland, addressing trauma suffered by persons who witnessed an assisted suicide.  The study found that 1 out of 5 family members or friends present at an assisted suicide were traumatized.[63]  These persons:
[E]xperienced full or sub-threshold PTSD [Post Traumatic Stress Disorder] related to the loss of a close person through assisted suicide.[64]
2. My cases involving the Oregon and Washington assisted suicide laws.

I have had two clients whose fathers signed up for the lethal dose.[65] In the first case, one side of the family wanted the father to take the lethal dose, while the other did not. He spent the last months of his life caught in the middle and traumatized over whether or not he should kill himself. My client, his adult daughter, was also 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 father refused to take the lethal dose when it was delivered (“You’re not killing me.  I’m going to bed”), but then he took it the next night when he was high on alcohol. The man who told this to my client later recanted. My client did not want to pursue the matter further.

E.  In Oregon, Other (Conventional) Suicides Have Increased with Legalization of Physician-Assisted Suicide; the Financial Cost is Enormous; the Cost to California Could be Enormous.

In Oregon, physician-assisted suicide has been legal for 17 years.[66]  Usage has been small, but steadily increasing.[67] Last year, the highest year yet, there were 105 deaths.[68] 

In Oregon, this legalization and steady increase in the number of physician-assisted suicides, is statistically correlated with an increase in other (conventional) suicides. Please consider the following:
  • Oregon's assisted suicide act went into effect “in late 1997.”[69]
  • By 2000, Oregon's conventional suicide rate was "increasing significantly."[70]
  • By 2007, Oregon's conventional suicide rate was 35% above the national average.[71]
  • By 2010, Oregon's conventional suicide rate was 41% above the national average.[72]
This documented increase in conventional suicides, correlated with a steady increase in physician-assisted suicides, is consistent with a suicide contagion in which the legalization and promotion of physician-assisted suicide has encouraged the conventional suicides.

It is well known that suicide is contagious. A famous example is Marilyn Monroe’s suicide, which was followed by “a spate of suicides.”[73]  A contagion is more likely to occur when there is excessive graphic publicity about a suicide.[74]

The apparent suicide contagion in Oregon makes sense given what's been happening there, in which media reports and relentless advocacy by Compassion and Choices has been focused on Oregon’s physician-assisted suicide law and the people using it, most recently, Brittany Maynard.[75]

The significance of increased conventional suicides from a financial perspective is that they can cost a lot of money. People don't always succeed and can be left injured or disabled, requiring hospitalization or long term care. Sometimes suicidal people take other people with them, for example, during a "suicide by cop." This is when a suicidal person threatens the police or civilians in order to be killed by the police.

Consider, Californian, Andy Williams, who at age 15 decided that he wanted to be killed by the police.[76] He went to school with a gun, killed two schoolmates and wounded 13 others.[77] As of 2013, he was reported as incarcerated and facing his first parole hearing at age 65.[78]  A very expensive suicide indeed.

In Oregon, the financial cost of conventional suicides is “enormous.”[79]  An Oregon government report states:

In 2010 alone, self-inflicted injury hospitalization charges exceeded 41 million dollars; and the estimate of total lifetime cost of suicide in Oregon was over 680 million dollars.[80]

Oregon is the only state where there has been legalization of assisted suicide long enough to have statistics over time. The enormous cost of increased (conventional) suicides in Oregon, positively correlated to physician-assisted suicide legalization, is a significant factor for this body to consider regarding SB 128, which seeks to legalize physician-assisted suicide in California. The cost to California could be enormous.


SB 128 seeks to legalize assisted suicide and euthanasia in California. “Eligible” persons are not necessarily dying and may have years, even decades, to live. Patient choice and control is not assured. The cost to California could be enormous. Don’t make Washington and Oregon’s mistake. I urge you to reject SB 128.


[1]  I have been licensed to practice law in Washington State since 1986.  I am a former Law Clerk to the Washington State Supreme Court and the Washington State Court of Appeals.  I am a former Chair of the Elder Law Committee of the American Bar Association Family Law Section.  I am also President of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia.  For more information, please see, and
[2]  SB 128, as amended 04/14/15, can be viewed at this link:
[3]  See, for example, this link to the 1989 “Model Aid-in-Dying Act,” with the letters, “euthan,” for “euthanasia,” at
[4]  See Ian Dowbiggin, A Concise History of Euthanasia 146 (2007)(“In 2003, [the] Hemlock [Society] changed its name to End-of-Life Choices, which merged with Compassion in Dying in 2004, to form Compassion & Choices”).
[5]  Id.
[6]  Randi Bjornstad, “Suicide Kits Sell Death by Mail,” The Register-Guard, March 20, 2011 (“For $60, they blew his life apart”), which can be viewed here:
[7]  Id.
[8]  See Compassion & Choices newsletter (featuring Humphry) at
[9]  The AMA Code of Medical Ethics, Opinion 2.211 - Physician-Assisted Suicide, which can be viewed at
[10] Cf. AMA Code of Ethics, Opinion 2.21 - Euthanasia, which can be viewed at .
[11]  AMA Code of Ethics, Opinions 2.211 and 2.21, supra at footnotes 9 & 10.
[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?, Seattle Weekly, January 14, 2009. The quote is at page A-19, at this link:
[13]  See tabulation at
[14]  See
[15]  See State v. Melchert-Dinkel, 844 N.W.2d 13 (Minn. 2014).
[16]  Associated Press, “Right-to-Die Group Convicted of Assisting Minnesota Suicide,” May 14, 2015, at .
[17]  SB 128, § 443.1(o) The section is at page A-2, at this link: link:
[18]  Id.
[19]  Or. Rev. Stat. 127.800 s.1.01(12), which can be viewed at this link:
[20]  See, for example, the most recent annual report for Oregon’s law (listing “chronic lower respiratory disease" and “diabetes mellitus” as qualifying underlying illnesses).  See quotes at pages A-33 & A-34, at this link:
[21]  Letter to the Editor, William Toffler MD, New Haven Register, February 24, 2014, ¶2.  (Attached at A-35).  (I verified the content with him).  To view letter, go here: 
[22]  Id.
[23]  Compare Terminal Uncertainty supra at footnote 12.
[24]  Affidavit of Kenneth Stevens, MD, para. 3-7, at ; Affidavit of Jeanette Hall, para 4, at
[25]  Id.
[26]  Jeanette Hall Affidavit, para 4, at
[27]  See Jerry Large, “Planning for old age at a premium,” The Seattle Times, March 8, 2012 (“After Monday’s column, . . . a few [readers] suggested that if you couldn’t save enough money to see you through your old age, you shouldn’t expect society to bail you out.  At least a couple mentioned euthanasia as a solution.”) (Emphasis added). To view, go here:
[28]  Oregon House Bill 3337 (“Modifies definition of ‘terminal disease’ in Oregon’s Death with Dignity Act”).  See
[29]  See SB 128 in its entirety, at link:
[30]  Id.
[31]  Id.
[32]  Id.
[33] The drugs used for assisted suicide in Oregon and Washington, Secobarbital and Pentobarbital (Nembutal), are water soluble, such that they can be injected without consent, for example, to a restrained or sleeping person.  See "Secobarbital Sodium Capsules, Drugs.Com, at and  See also Oregon’s report, listing these drugs under the heading, “DWDA process,” which can be found at page 5 of this link:
[34]  SB 128 § 443.1(m).  (“Qualified” patients are required to be “competent”).
[35]  SB 128, § 443.1(d).
[36]  See SB 128, § 443.9.
[37]  Id.
[38]  SB 128, § 443.5(a)(2)(E).
[39]  Id.
[40]  Where a law lists specific classes of persons or things and refers to them in general, the general statements only apply to the same kind of persons or things specifically listed.  Example: if a law refers to automobiles, trucks, tractors, motorcycles and other motor-powered vehicles, "vehicles" would not include airplanes, since the list was of land-based transportation.
[41]  See SB 128, § 443.7(b) (“The cause of death listed on the death certificate of an individual who uses aid-in-dying medication shall be the underlying terminal disease”).
[42]  § 443.15, second sentence.
[43]  See (defining “mercy killing” as euthanasia).
[44]  SB 128, § 443.15.
[45]  Id.
[46]  Professional opinion of Kenneth Stevens, MD, May 17, 2015.
[47]  Id.
[48]  See SB 128, §§ 443.1(b)(stating that a patient may choose to “self-administer” the lethal dose); 443.1(i)(4)(stating that the patient may decide not to “take” the lethal dose); 443.5(a)(2)(D)(regarding the possibility that the patient may “not take it”); 443.5(a)(6)(A)(referring to the patient when he or she “takes” the lethal dose); 443.7(b)(regarding a patient who “uses” the lethal dose); and 443.9 (regarding the lethal dose request form, using the word, “take”).
[49]  See SB 128 in its entirety
[50]  AMA Code of Ethics, Opinion 2.21 - Euthanasia, which can be viewed at .
[51]  SB 128, § 443.4(a) states: "A qualified individual may at any time rescind his or her request for aid-in-dying medication without regard to the qualified individual’s mental state."
[52]  See SB 128 in its entirety.
[53]  SB 128, § 443.14(b), states in full:  "Knowingly coercing or exerting undue influence on an individual to request aid-in-dying medication for the purpose of ending his or her life or to destroy a rescission of a request is punishable as a felony."
[54]  Id.
[55]  California’s Welfare and Institutions Code, § 15610.70(a).
[56]  SB 128, § 443.5(a)(6).
[57]  See
[58]  Available at
[59]  See e.g., “The California People’s Law Library: Abuse and Neglect of Elderly Persons.”
[60]  Alex Schadenberg, Letter to the Editor, Elder abuse a growing problem, The Advocate, October 2010, page 14, available at
[61]  See link to hearing transcript for SB 167, February 10, 2011,
[62]  “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 .
[63]  Id.
[64]  Id.
[65] These cases are described in my article, Margaret Dore, "Preventing Abuse and Exploitation:  A Personal Shift in Focus" (An article about elder abuse, guardianship abuse and assisted suicide), The Voice of Experience, ABA Senior Lawyers Division Newsletter, Vol. 25, No. 4, Winter 2014, available at
[66]  Oregon report for 2014, page 1, line 1 (law “enacted in late 1997").
[67]  Id., p.1, see graph.
[68]  Id.
[69]  Id., page 1, line 1.
[70]  See Oregon Health Authority News Release, September 9, 2010, at ("After decreasing in the 1990s, suicide rates have been increasing significantly since 2000").  See also page A-72 at this link:
[71]  Id.
[72]  See page A-77 at this link:
[73]  See Margot Sanger-Katz, “The Science Behind Suicide Contagion,” The New York Times, August 13, 2014, at and
[74]  See id. and “Recommendations for Reporting on Suicide,” The National Institute of Mental Health.  See also “Preventing Suicide: A Resource for Media Professionals, World Health Organization, at
[75]  Consider also the case of Lovelle Svart, whose decision to use Oregon’s act was featured in a three-month-long media series in the Oregonian, which is Oregon’s largest paper. The series conclusion featured her death in which online viewers were invited “to hear and see when [she] swallowed the fatal dose.” (See article at this link:
Such graphic coverage is a well known factor of suicide contagion.
[76]  Rebecca Jacobson, “School Shooter: ‘My Grand Plan Was Suicide by Cop,’” PBS Newshour, February 18, 2013, available at the second page of this link:
[77]  Id.
[78]  Id.
[79]  See 2012 report excerpt at page A-78, at this link:
[80]  Id.