No on ABX2-15: A Response to Comments Made at Recent Committee Hearings.

1.  New Mexico no longer allows physician-assisted suicide.

2.  Under ABX2-15, requiring the patient to meet alone with the doctor as a protection against undue influence, is not necessarily a safeguard.  See § 443.5(a)(4).  Consider, for example, if the doctor, himself or herself, has an interest in seeing the patient gone. For example, if the doctor botched the patient’s case and wants to eliminate the liability by eliminating the patient.

3. ABX2-15 protects patients by providing that doctors may be sanctioned by their licensing board or agency. See § 443.16(c). Doctors, however, are notoriously bad at policing themselves. For an extreme example, there is the case of Michael Swango MD, who thrill-killed his patients. When hospital administrators became aware of a potential problem, they simply let him go, leaving him free to get another job and start killing again.  See James B. Stewart, “ Blind Eye: How the Medical Establishment Let a Doctor Get Away with Murder,” 1999.

4.  Under ABX2-15, a bad doctor like Swango would be additionally aided by “blanket immunity.“ See Committee Staff Analysis for the Assembly Committee on Public Health and Developmental Services, p. 17 (“the bill provides blanket immunity for health care providers ... even in instances where their actions are grossly negligent”).

John B. Kelly: Second Thoughts Against ABX2-15

Assemblymember:

I [John Kelly, pictured here] -hope you will have second thoughts about legalizing assisted suicide in California. Now especially that the California Medical Association secured the removal of any liability clause from  AB2x 15, in the words of the committee staff’s analysis (see page 17), “wanton misconduct” and “gross negligence” will go unpunished.

The replacement clause, that professional licensing boards “may sanction” professional misconduct, is toothless. As we have seen across society, self-interested institutions cannot be trusted to police themselves. Please see the case of Wendy Melcher, who was illegally injected with lethal drugs by two Oregon nurses, completely outside the scope of the law. The nurses were not referred for prosecution, but were secretly dealt with by the state nursing board. The nurses continue to practice today. 

In important ways assisted suicide laws are like death penalty laws: innocent people inevitably lose their lives. A strong consensus is now emerging against the death penalty because mistakes (witness misidentification, false confession) and abuse of the system (prosecutorial and police misconduct) lead to wrongful convictions and executions.

Mistakes and abuse in the medical system are common. People who are misdiagnosed (see John Norton), people who would respond to more treatment (Jeanette Hall), or who would live years longer  (some participants in Oregon have lived almost 3 years after being judged “terminal”) will be led to tragically “choose” death. Assisted suicide programs have offered lethal drugs to patients with severe depression (Michael Freeland) and to people denied treatment (Barbara Wagner). And because not all families are loving or financially secure, innocent people will be bullied or worse by abusive families and beneficiaries.

The Financial Cost of ABX2-15 Could Be "Enormous."

Below please find a memo submitted to the California Assembly Finance Committee by Margaret Dore, Esq., on September 3, 2015. To view the original document as a pdf, please click here.
_________

I.  INTRODUCTION

ABX2-15 seeks to legalize physician-assisted suicide in California. In Oregon, which has a similar law, government reports show an increase in other (conventional) suicides and suicide attempts, the financial cost of which is “enormous.”

If California enacts ABX2-15, the financial cost could also be “enormous.”  ABX2-15 should be rejected.

II.  DISCUSSION

A.  In Oregon, Other (Conventional) Suicides Have Increased with the Legalization of Physician-Assisted Suicide.

In Oregon, physician-assisted suicide has been legal for 17 years.[1] According to the Oregon Health Authority, the number of physician-assisted suicides has been small, but is steadily increasing.[2] This increase is statistically correlated with an increase in other (conventional) suicides.  Consider the following:

∙Oregon's assisted suicide act went into effect “in late 1997.”[3]

∙By 2000, Oregon's conventional suicide rate was "increasing significantly."[4]

∙By 2007, Oregon's conventional suicide rate was 35% above the national average.[5]

∙By 2010, Oregon's conventional suicide rate was 41% above the national average.[6]

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 of physician-assisted suicide has encouraged other suicides.

ABX2-15 Talking Points

By Margaret Dore, Esq., MBA

INTRODUCTION

On August 17, 2015, proponents unveiled Bill No. ABX2-15, which seeks to legalize "aid in dying," a term that means assisted suicide and euthanasia.

"Assisted suicide" means that a person assists another person's suicide.  If a physician is involved, the practice may be called "physician-assisted suicide." "Euthanasia" means the direct administration of a lethal agent with the intent to cause another person's death.

ABX2-15, is in substance an old bill (SB 128) that failed due to a lack of support. A detailed analysis of ABX2-15 can be viewed by clicking here and  here.

TALKING POINTS

1.  ABX2-15 Is a Recipe for Elder Abuse. 

• The patient's heir, who will financially benefit from his/her death, is allowed to actively participate in signing the patient up for the lethal dose. See memo, p. 6. This fact alone does not meet the "stink test."

HTML Version: Vote "NO" on ABX2-15.

Below, find an html version of Margaret Dore's legal/policy memo opposing ABX2-15. To view the original memo, click here.  If the memo is too large for your computer, click here and here to view it as two smaller documents.

MEMORANDUM

TO THE CALIFORNIA STATE ASSEMBLY

VOTE "NO" ON ABX2-15.  (NO ASSISTED SUICIDE)

UPDATED AUGUST 26, 2015

* * *

OVERVIEW

ABX2-15, the “End of Life Option Act,” seeking to legalize physician-assisted suicide in California is a recipe for elder abuse. The bill is not limited to people who are dying. Indeed, “eligible” persons can have years, even decades, to live.

In Oregon, which has a similar law, that state’s Medicaid program uses coverage incentives to steer people to suicide. If ABX2-15 is enacted, California’s Medicaid program, as well as private insurers, will be able to engage in this same conduct. Do you want this to happen to you or your family?

The bill has a myriad of other problems.  Please vote “No” on ABX2-15.

Updated Materials Against ABX2-15

To view a new materials against ABX2-15, click here and here for a memo and its appendix as separate documents.

Overview 

ABX2-15, the “End of Life Option Act,” seeking to legalize physician-assisted suicide in California is a recipe for elder abuse.  The bill is not limited to people who are dying.  Indeed, “eligible” persons can have years, even decades, to live.

In Oregon, which has a similar law, that state’s Medicaid program uses coverage incentives to steer people to suicide.  If ABX2-15 is enacted, California’s Medicaid program, as well as private insurers, will be able to engage in this same conduct.  Do you want this to happen to you or your family?

The bill has a myriad of other problems.  Please vote “No” on ABX2-15.

California's ABX2-15: Governor Not Impressed; Bill Is But A "New Number With the Same Song."

By Margaret Dore, Esq., MBA

On August 17, 2015, the deceptively named Compassion & Choices unveiled its "new" deceptively named End of Life Option Act to great fanfare in a press credentialed only press conference.

Governor Jerry Brown has already weighed in that the present special session "is not the appropriate venue to consider the issue."

The new bill, ABX2-15, is in substance an old bill (SB 128) that was unable to make it out of committee.

ABX2-15 has some new provisions and puts some of the old bill's provisions in a different order. ABX2-15 is in substance the same bill as the old bill. Key points include:

• ABX2-15 applies to patients with a "terminal disease." In Oregon, which has a similar law, such persons include young adults with chronic conditions such as insulin dependent diabetes and chronic lower respiratory disease. People living with HIV/AIDS, who are dependent on their medication to live, also qualify as "terminal." Such persons can have years, even decades, to live. 

• Once a person is "labeled 'terminal,' an easy justification can be made that his or her treatment or coverage should be denied in favor of someone more deserving."[1] In Oregon, where assisted suicide is legal, patients are not only denied coverage for treatment, they are offered assisted suicide instead.[2] Well known cases are Barbara Wagner and Randy Stroup.[3]

• The bill remains a recipe for elder abuse in which the patient's heir, who will financially benefit from his or her death, is allowed to actively participate in signing the patient up for the lethal dose. This fact alone does not meet the "stink test." 

• Once the lethal dose is issued by the pharmacy, there is no oversight. Not even a witness is required at the death. If the patient struggled, who would know?

• The death certificate is required to be falsified to reflect a natural death. The significance is a lack of transparency and an inability to prosecute for murder even in a case of outright murder for the money.

ABX2-15 is but a new number with the same song. Don't be fooled.

To view a detailed legal/policy analysis of ABX2-15, please click on the following links: Executive summary and index; Memo; and Appendix/Attachments.

* * *

[1] Opinion Letter by Richard Wonderly MD and Attorney Theresa Schrempp, available athttps://choiceisanillusion.files.wordpress.com/2012/07/schrempp_wonderly_opn_ltr1.pdf

[2] Id.
[3] Id.

Memo to the California State Assemblymembers: Vote "No" on SB 128.

The original pdf version of this memo has an executive summary and index, which can be viewed here. The attachments can be viewed here.

I. INTRODUCTION.

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

Enactment of SB 128 will create new paths of elder abuse. “Eligible” patients will include people with years, even decades, to live.  

I urge you to reject this measure. Do not make Washington’s and Oregon’s mistake.

California's Prohibition Against Assisted Suicide Is Constitutional

Margaret Dore, Esq., MBA

A California trial court has upheld the constitutionality of that state's criminal statute prohibiting assisted suicide, which states:

Every person who deliberately aids, or advises, or encourages another to commit suicide, is guilty of a felony.

Penal Code § 401

The court's reasoning is contained in a 19 page "Ruling on Demurrer," filed on July 24, 2015. The ruling uses the term, "Aid in Dying" to mean physician-assisted suicide.  The term also means euthanasia. The court states in part:

Since "Aid in Dying" is quicker and less expensive, there is a much greater potential for its abuse, e.g,, greedy heirs-in-waiting, cost containment strategies, ímpulse decision-making, etc. Moreover, since it can be employed earlier in the dying process, there is a substantial risk that in many cases, it may bring about a patently premature death. For example, consider that a terminally ill patient, not in pain but facing death within the next six months, may opt for “Aid in Dying”' instead of working through what might have been just a transitory period of depression. Further, "Aid in Dying" creates the possible scenario of someone taking his life based upon an erroneous diagnosis of a terminal illness illness, which was, in fact, a mis-diagnosis that could have been brought to light by the passage of time. After all, doctors are not infallible.

"Big Business" and Assisted Suicide

By Margaret Dore, Esq., MBA*

Assemblyman Roger Hernandez was recently quoted as concerned that big business would use California's assisted suicide proposal, SB 128, to "guide people in that direction," meaning early death via a lethal overdose.

This is a valid concern.

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 128, which seeks to legalize assisted suicide and euthanasia in California.

In Oregon, it is well documented that Oregon's Medicaid program uses coverage incentives to steer people to suicide.  See Affidavit of Oregon doctor, Ken Stevens, pp 3-4 at https://maasdocuments.files.wordpress.com/2014/08/dr-stevens-affidavit_001.pdf  With legal assisted suicide, private health plans have this same ability.  Dr. Stevens states:

If assisted suicide is legalized in [your state], your government health plan could follow a similar pattern.  Private health plans could also follow this pattern.  If so, these plans would pay for you and/or your family to die, but not to live.  (Emphasis added).

Id, ¶16.

Dr. Stevens also notes that the mere presence of legal assisted suicide steers people to suicide, which was the case with his patient Jeanette Hall.  Her cancer treatment was fully covered, but with the existence of Oregon's law, she nonetheless became adamant that she would kill herself.  Dr. Stevens convinced her to be treated instead.  (Affidavit, ¶¶ 5-9).  She is alive today, fifteen years later.

As for Assemblyman Hernandez's specific "big business concern," in 2013, a Montana State Senator made a similar observation:

I found myself wondering, Where does all the lobby money come from?  If it really is about a few terminally ill people who might seek help ending their suffering, why was more money spent on promoting assisted suicide than any other issue in Montana?

Could it be that convincing an ill person to end their life early will help health insurance companies save a bundle on what would have been ongoing medical treatment?  How much would the government gain if it stopped paying social security, Medicare, or Medicaid a few months early? [it could actually be years earlier].  How much financial relief would pension systems see?  Why was the proposed law to legalize assisted suicide [SB 220] written so loosely?  Would vulnerable old people be encouraged to end their life unnecessarily early by those seeking financial gain? 

http://www.montanansagainstassistedsuicide.org/2013/06/beware-of-vultures-senator-jennifer.html

Finally, there is the expansion issue. In Washington State, we have had informal "trial balloon" proposals to expand our law to non-terminal people. For me, the most disturbing one was in the Seattle Times, which is our largest paper. A column suggested euthanasia as a solution for people without funds in their old age, which could be any of us, say if the company pension plan went broke.**

Assemblyman Hernandez is right to be concerned about what could happen to his constituents if SB 128 is passed.

Don't let California make Washington and Oregon's mistake.  Urge your legislators to vote "NO" on SB 128.

///
               
* Margaret Dore is a former Law Clerk to the Washington State Supreme Court and the Washington State Court of Appeals.  She is a former Chair of the Elder Law Section of the ABA Family Law Committee.  She also worked for a year with the United States Department of Justice.  She is president of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia.  To learn more, see www.margaretdore.com and www.choiceillusion.org

**  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). https://choiceisanillusion.files.wordpress.com/2014/10/jerry-large_001.pdf

SB 128 Defeated!

SB 128 Defeated!

The bill did not have the votes to go forward in Committee, and is reportedly dead for the year.

Special thanks to Nina Rhea, Mike Hodas and everyone else who went the extra mile to defeat the bill.

THANK YOU!

Margaret Dore