Friday, October 23, 2009

Discerning Coercion or Abuse Under the Death with Dignity Act.

Margaret Dore is a very new acquaintance. I posted a rebuttal to her article in Washington State Bar News; she called me and vigorously contested my points. And then she emailed me a number of times to make sure she had been clear and understood.

As someone who works to eliminate elder abuse, Dore's issue with the Death with Dignity Act in Oregon boils down to three main points, as I can discern:

1. a family member, perhaps one who is working to coerce their loved one into Death with Dignity, can act as one of two witnesses to the Death with Dignity document

Dore contends that allowing one of the two required witnesses to be a family member opens the door to elder abuse and coercion.

2. a patient, according to her interpretation of the Act, is not required to self-administer the lethal medication

The language regarding self-administration seems clear enough to me but Dore insists that "self-administration" is defined as "ingest" and therefor allows someone else to inject the medication into a feeding tube or to administer the medication in another way, perhaps for their own nefarious purposes. (See above link for more of our exchange.)

3. the act does not require that a witness be present at the time the lethal medication is ingested

Again, Dore insists that this opens the door for elder abuse. Her concern is that most abuse of the elderly is perpetrated by family members. A "loved one" who wishes to end the life of a patient can, without supervision, achieve that goal once the patient has received the medication. Dore contends that the Act serves as an alibi for the acting family member, that no investigation is likely if the patient has successfully fulfilled the qualifications for Death with Dignity and has received the lethal medication.

How this witnessing differs from the common practice of assigning a medical proxy is unclear to me.

Today Dore writes a letter to the ConcordMonitor:

Re "Doctors shouldn't facilitate suicide" (Monitor Opinion page, Oct. 16):

I am an attorney in Washington state, where assisted suicide was recently legalized via a citizens' initiative. Voters thought that they were voting for "choice." Our new law is instead a recipe for elder abuse. Your proposed assisted suicide bill, House Bill 304, has the same problem.

Under HB 304, someone else is allowed to talk for the patient during the lethal dose request process. This someone else could be an heir or new "best friend" who will benefit from the death. There are also no required witnesses at the death. Without disinterested witnesses, the opportunity is created for someone other than the patient to administer the lethal dose to him without his consent. Even if he struggled, who would know? The lethal dose request facilitated by the heir or new "best friend" would provide the alibi.

Don't make Washington's mistake. Protect yourself and your family. Keep assisted suicide out of New Hampshire.



Without betraying my private communications with Dore, I feel it necessary to say that no Death with Dignity advocate wishes to promote elder abuse or coercion. In fact, advocates state repeatedly that their efforts are to ensure patient and elder rights and choice at the end of life. My interpretation of the Act - and the state's, and voters' - is that necessary safeguards are in place to prevent coercion or elder abuse.

I am clearly not a lawyer, but I wonder if use of the Act removes motive from any nefariously acting family member. The patient must verbally state their desire for Death with Dignity, then restate it again within 15 days. The attending physician must determine that the patient is terminal and mentally competent and a consulting physician must concur. The request must then be made in writing. Someone other than the family member must also witness the signing. A period of 48 hours must pass before the prescription is written. The physician must deliver or see to the delivery of the prescription. Any doctor working in compliance of the Act must determine that no coercion or abuse is present and the Act states that both coercion and facilitation of the medication is prosecutable. The patient may at any time, whether mentally competent or not, choose not to use the prescription.

If a patient is determined qualified for Death with Dignity, is dying, and has stated repeatedly a wish to die, I wonder if this removes motive from a coercing or abusive family member? Getting to one's inheritance a few days, weeks, or months sooner is cause to act in this situation, at the threat of prosecution? According to Dore, we don't know because the Act, as she says, provides the coercing family member with an alibi.

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