Memorandum to Congress and the President of the United States: Reject DC Act 21-577

Margaret Dore, Esq. MBA &
DC Councilmember Yvette Alexander
To view a print version, click here and here.
  • Stop Assisted Suicide;
  • Stop Euthanasia;
  • Prevent Legal Elder Abuse;
  • Preserve Government Transparency and Integrity; &
  • Don't Let the District of Columbia Become Corrupt Like Oregon.
By Maragaret Dore, Esq., MBA, January 12, 2016

I.  INTRODUCTION

I am an attorney in Washington State where assisted suicide and euthanasia are legal.[1] Our law is based on a similar law in Oregon. Both laws are similar to Act 21-577 (“The Act”).[2]

The Act is a deceptively written law that legalizes physician-assisted suicide and euthanasia, on a voluntary and non-voluntary basis. The Act applies to persons who reside in the District of Columbia, which includes members of the House and the Senate, and the President of the United States. “Eligible” persons may have years or decades to live.

The Act is a recipe for elder abuse in which adult children are allowed to administer the lethal drug to their parents and perpetrators are legally protected. Purported government oversight and patient protections are a sham. Even if you are for the concept of assisted suicide and euthanasia, the Act is the wrong law and must be rejected.

II. DEFINITIONS

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

The American Medical Association (AMA) 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.”[3] The AMA gives this example:
[A] physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide.[4]
“Assisted suicide” is a general term in which the assisting 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.[5]

B. Withholding or Withdrawing Treatment Is Not Assisted Suicide or Euthanasia

Withholding or withdrawing treatment (“pulling the plug”) is not assisted suicide or euthanasia if the purpose is to withhold or remove burdensome treatment, as opposed to an intent to kill the patient. More importantly, withdrawing treatment will not  necessarily cause a patient’s death. Consider this quote from Washington State regarding a man removed from a ventilator:
[I]nstead of dying as expected, [he] slowly began to get better.[6]
III. FEW STATES ALLOW ASSISTED SUICIDE

Physician-assisted suicide was legalized in Oregon and Washington State, in 1997 and 2008, respectively.[7]  These laws also legalize euthanasia.[8] Just three other states have enacted similar laws.  (Vermont, California and Colorado).

In the last six years, five states have strengthened their laws against assisted suicide:  Arizona, Louisiana, Georgia, Idaho and Ohio.[9]

Last year, the New Mexico Supreme Court overturned a lower court decision recognizing a right to physician aid in dying, meaning physician-assisted suicide.[10] Physician-assisted suicide is no longer legal in New Mexico.

IV. THE ACT APPLIES TO PEOPLE WITH YEARS OR DECADES TO LIVE

The Act applies to persons with a “terminal disease,” meaning those predicted to have less than six months to live.[11]  Such persons may actually have years or decades to live.  This is true for three reasons:

A. Treatment Can Lead to Recovery

In 2000, Oregonian Jeanette Hall was given a terminal diagnosis of six months to a year to live, which was based on her not being treated for cancer.[12] Hall made a settled decision to use Oregon’s law, but her doctor convinced her to be treated instead.  In a 2016 declaration, she states:
This July, it will be 16 years since my diagnosis.  If [my doctor] had believed in assisted suicide, I would be dead.[13]
B. Predictions of Life Expectancy Can Be Wrong

Patients may also have years to live due to misdiagnosis and because predicting life expectancy is not an exact science. Consider John Norton, diagnosed with ALS (Lou Gehrig’s disease) at age 18 or 19. [15] He was told that he would get progressively worse (be paralyzed) and die in three to five years.[16] Instead, the disease progression stopped on its own.[17] 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.[18]
C. If the District of Columbia Follows Oregon’s Interpretation of “Terminal Disease,” Assisted Suicide and Euthanasia Will Be Legalized for Chronic Conditions Such as Insulin Dependant Diabetes

The Act defines “terminal disease,” as follows:
“Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within 6 months.[19]
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.[20]
In Oregon, this nearly identical definition is interpreted to include chronic conditions such as “chronic lower respiratory disease” and “diabetes mellitus” (better known as diabetes).[21] Oregon doctor, William Toffler, explains:
In Oregon, people with chronic conditions are “terminal,” if without their medications, they have less than six months [to] live. (Emphasis added).[22]
Dr. Toffler elaborates:
This is significant when you consider that a typical insulin-dependent 20 year-old-year will live less than a month without insulin.
Such persons, with insulin, are likely to have decades to live; in fact, most diabetics have a normal life span given appropriate control of their blood sugar. (Emphasis and spacing changed).[23]
If the Act is not rejected and the District of Columbia follows Oregon’s interpretation of “terminal disease,” assisted suicide and euthanasia will be legalized for people with chronic conditions such as insulin dependent diabetes. As noted by Dr. Toffler, such persons can have “decades to live.”[24]

V. HOW THE ACT WORKS

The Act has an application process to obtain the lethal drug, which includes a lethal drug request form with two required witnesses.[25] One of the witnesses is allowed to be the patient’s heir who will financially benefit from the patient’s death. The Act also features patient protections such as a second doctor and a requirement that the patient be capable. These protections, however, are unenforceable or illusory.

Once the lethal drug is issued by the pharmacy, there is no oversight. No witness, not even a doctor is required to be present at the death.

VI. THE ACT

A. Act 21-577 Applies to a Person Who “Resides” in the District of Columbia

Act 21-577 applies to a person over the age of 18 who resides in the District of Columbia.[27] The Act does not define “resides.”[28] Dictionary definitions include “to dwell . . . for a considerable time.”[29]

Some members of Congress and the Senate, and certainly the President of the United States, dwell for a considerable time in the District of Columbia. The Act applies to these persons as well as to members of the public, who reside in the District of Columbia.

B. The Act Creates a New Path of Elder Abuse, Which Is Legal
1. Elder abuse is a pervasive problem, which includes the financial exploitation and murder of older adults
Elder abuse is a problem in the District of Columbia and throughout the United States.[30]   Perpetrators are often family members who start out with small crimes, such as stealing jewelry and blank checks, before moving on to larger items or to coercing victims to change their wills or to liquidate their assets.[31] Victims may even be murdered.[32] Amy Mix, of the AARP Legal Counsel of the Elderly, states:
[Perpetrators] are family members, lots are friends, often people who befriend a senior through church . . . .  We had a senior victim who had given her life savings away to some scammer who told her that she’d won the lottery and would have to pay the taxes ahead of time. . . .  The scammer found the victim using information in her husband’s obituary.[33]
Elder abuse is prevalent in part because victims do not report it.  The D.C. Department of Human Services states:
Typically, the abuser is a relative, frequently an adult child of the victim....
Some don’t want to report their own child as an abuser.[34]
2. “Even if a patient struggled, ‘who would know?’
The Act has no required oversight at the death.[35] In addition, the drugs used for assisted suicide and euthanasia are water and alcohol soluble, such that they can be administered to a restrained or sleeping person without consent.[36] Alex Schadenberg, Executive Director for the Euthanasia Prevention Coalition, puts it this way:
With assisted suicide laws in Washington and Oregon [and with the Act], 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. . . . Even if a patient struggled, “who would know?” (Emphasis added).[37]
C. Death Certificate Requirements Protect Perpetrators
1. The death certificate “shall” list a medical condition as the cause of death, which will prevent prosecution for murder as a matter of law
The Act says:
The cause of death listed on a death certificate shall identify the qualified patient’s underlying medical condition . . . . (Emphasis added).[38]
The significance of requiring a medical condition to be listed as the cause of death is that it creates a legal inability to prosecute: The official legal cause of death is a medical condition (not murder) as a matter of law.
2. The death certificate will not disclose the manner of death, which will create an official legal cover up
The Act mandates that the manner of death (a lethal drug) not be disclosed on the death certificate. The Act states:
The cause of death listed on a death certificate shall identify the qualified patient’s underlying medical condition consistent with the International Classification of Diseases without reference to the fact that the qualified patient ingested a covered medication.  (Emphasis added).[39]
The significance is an official legal cover up.

D. The Act Merely Requires That Actions Be Taken in “Accordance” With the Act

Perpetrators are also protected by the Act, § 16, which states:
Actions taken in accordance with this act do not constitute suicide, assisted suicide, mercy killing, or homicide. (Emphasis added).[40]
The Act does not define “accordance.”[41] Dictionary definitions include “in the spirit of,” meaning “in thought or intention though not physically.”[42] So, if a participant in a patient’s death has a thought or intention to comply with the Act, but does not do not do so, that’s enough to prevent the death from being treated as a suicide, assisted suicide, mercy killing, or homicide.[43]

For an example of how “accordance” is interpreted in practice, see Section E below.

E. If the District of Columbia Follows Washington State, Perpetrators Will Be Protected Simply Because the Act Was “Used

The Act states:
The cause of death listed on a death certificate shall identify the qualified patient’s underlying medical condition . . .
[and]
Actions taken in accordance with this act do not constitute suicide, assisted suicide, mercy killing, or homicide.[44]
Washington State’s law has similar language, as follows:
[T]he patient’s death certificate . . . shall list the underlying terminal disease as the cause of death. [and]
Actions taken in accordance with this chapter do not, for any purpose, constitute suicide, assisted suicide, mercy killing, or homicide under the law.[45]
In Washington State, this similar language requires the death certificate to list a natural death without regard to whether there was compliance with patient protections. The only relevant inquiry is whether Washington State’s law was “used.” Washington State’s “Death Certificate Instructions for Medical Examiners, Coroners and Prosecuting Attorneys,” state:
If you know the decedent used [Washington State’s law], you must comply with the strict requirements of the law when completing the death record:
1. The underlying terminal disease must be listed as the cause of death.
2. The manner of death must be marked as “Natural.”
3. The cause of death section may not contain any language that indicates that                       [Washington’s law] wasused, such as:
a. Suicide
b. Assisted suicide
c. Physician-assisted suicide
d. Death with dignity
e. I-1000 [Washington’s law was passed by I-1000
f. Mercy killing
g. Euthanasia
h. Secobarbital or Seconal
i. Pentobarbital or Nembutal (Emphasis added; spacing changed.)[46]    
If the District of Columbia follows Washington State’s example, death certificates will list a natural death without disclosing the actual cause of death simply because the Act was “used.” Perpetrators and other participants in a patient’s death will be legally protected regardless of whether there was compliance with patient protections.

F. The Act Allows an Adult Child to Administer the Lethal Drug to His or Her Parent
1. Generally accepted medical practice  allows a doctor or a person acting under the direction of a doctor, such as a family member, to administer medication
Generally accepted medical practice allows a doctor or a person acting under the direction of a doctor to administer medication to a patient.[47]

A person acting under the direction of a doctor to administer medication may be a healthcare professional or a non-medical person.[48] A common example of a non-medical person is a mother in a home setting who administers medication to her sick child, pursuant to a doctor’s prescription.[49]   Another common example is an adult child in a home setting who administers prescription medication to his or her parent.[50] This is normal medical practice.
2. The Act describes prescribing the lethal drug as part of a doctor’s medical practice
The Act describes a doctor’s prescribing the lethal drug as part of his or her medical practice. The Act states:
[T]he attending physician’s practice shall not be primarily or solely composed of patients requesting a covered medication [the lethal drug].[51]
With prescribing the lethal drug part of a medical practice, the patient’s adult child acting under the direction of the doctor is allowed to administer the lethal drug to the patient.  An adult child, acting pursuant to a doctor’s prescription, is allowed to administer the lethal drug to kill his or her parent.
3. Allowing someone else to administer the lethal drug to a patient is euthanasia
Allowing an adult child to administer the lethal drug is euthanasia under generally accepted medical terminology.  AMA Code of Ethics, Opinion 2.21, states:
Euthanasia is the administration of a lethal agent by another person to a patient . . . .  (Emphasis added).[52]
II. PURPORTED GOVERNMENT OVERSIGHT IS A SHAM
A. Mandatory Review of “Each Death” by the Office of the Chief Medical Examiner Is a Sham
The Act provides for review of “each death” by the Office of the Chief Medical Examiner.  The Act states:
The Office of the Chief Medical Examiner shall review each death involving a qualified patient who ingests a covered medication [lethal drug] and, if warranted by the review, may conduct an investigation. (Emphasis added).[53]
The Act, however, has no mechanism for the Office of the Chief Medical Examiner to know when a death under the Act has occurred:  (1) the death certificate will not disclose it; (2) healthcare providers who dispense the lethal drug are required to report it to the Department of Health, not the Office of the Chief Medical Examiner; and (3) required rule making concerns notice to the Department of Health, not the Office of the Chief Medical Examiner.[54, 55, 56]

With no mechanism to inform the Office of Chief Medical Examiner that a death under the Act has occurred, the purported mandatory review of “each death” by the Office of the Chief Medical Examiner is a sham.
B. The Office of the Chief Medical Examiner Has No Power to Determine the Cause of Death
Under D.C. Code § 2-711(f), the Office of Chief Medical Examiner is charged with conducting an inquiry in which the Medical Examiner “shall” determine the cause of death.[57] The Act, however, limits the power of the Office of Chief Medical Examiner to conducting a review and investigation, with the investigation to constitute the inquiry.[58] The Office has no power to determine the cause of death under the Act.

For this reason also, the purported mandatory oversight by the Office of Chief Medical Examiner is a sham.

C. If the District of Columbia Follows Oregon’s Interpretation of “Not a Public Record,” the Department of Health Will Be Insulated from Review by Law Enforcement; Annual Reports Will Be Unverifiable
1. Information about individual cases will not be available from the Department of Health
The Act charges the Department of Health with issuing an annual statistical report based on data in patient medical records.[59] The Act also states:
The information collected by the Department pursuant to this act shall not be a public record and may not be made available for inspection by the public under the Freedom of Information Act of 1976, effective March 25, 1977 (D.C. Law 1-96; D.C. Official Code § 2-2-531 et seq.), or any other law. (Emphasis added).[60]
Oregon’s law has a similar provision, as follows:
Except as otherwise required by law, the information collected shall not be a public record and may not be made available for inspection by the public.  (Emphasis added).[61]
In Oregon, this similar provision is interpreted by the State of Oregon to bar release of information about individual cases, including to law enforcement.  Oregon’s website states:
[T]he Act specifically states that information collected is not a public record and is not available for inspection by the public (ORS 127.865 (2)).  The protection of confidentiality conferred by the Death with Dignity Act precludes the Oregon Health Authority [which oversees Oregon’s Department of Health] from releasing information that identifies patients or participants . . . .
[C]ase-by-case information will not be provided . . . . (Emphasis added)[62]
Consider also this e-mail from Alicia Parkman, Mortality Research Analyst for the Oregon Health Authority, which states:
We have been contacted by law enforcement  . . . in the past, but have not provided identifying information of any type. (Emphasis added).[63]
The significance is a near complete lack of transparency. If the District of Columbia follows Oregon’s example, there will be a similar lack of transparency in which even law enforcement will have no access to information about individual cases under the Act.
2. Patient identities will not be recorded in any manner by the Department of Health; source documentation will be destroyed
Oregon’s website describes the data collection protocol for its annual reports, as follows:
The identity of participating physicians is coded, but the identity of individual patients is not recorded in any manner. Approximately one year from the publication of the Annual Report, all source documentation is destroyed. (Emphasis added).[64]
Alicia Parkman, Mortality Research Analyst for the Oregon Health Authority, makes a similar representation as follows:
To ensure confidentiality, our office does not maintain source information on participants. (Emphasis added).[65]
The significance is that Oregon’s annual reports are unverifiable via Oregon government sources. If the District of Columbia follows suit, its annual reports will also be unverifiable.
D. The Act Can Be Read as Preventing Disclosure of Information Collected by the Department of Health under “Any Law”
The District of Columbia Act can be read as preventing disclosure of information collected by the D.C. Department of Health, under “any law.” The Act states:
The information collected by the Department pursuant to this act . . . may not be made available for inspection . . . under the Freedom of Information Act . . ., or any other law. (Emphasis added).[66]
If so, the Department of Health will be an agency beyond review, not only by law enforcement, but arguably by the courts and political authority. This fits the definition of “shadow government,”
A government run by an unelected bureaucracy, or a state within a state.[67]
VIII. COMPASSION & CHOICES

The Act’s passage is being spearheaded by the suicide promotion group, Compassion & Choices. In Oregon, this organization has used Oregon’s law to disable and displace the Department of Health as the entity overseeing that law.
A. Compassion & Choices is the Former Hemlock Society; Its Mission Is to Promote Suicide
Compassion & Choices was formed in 2004 as the result of a merger/takeover of two other organizations.[68] One of these organizations was the former Hemlock Society, originally formed by Derek Humphry.[69]

In 2011, Humphry was the keynote speaker at Compassion & Choices’ annual meeting here in Washington State.[70] He was also in the news as a promoter of mail-order suicide kits.[71] This was after a depressed 29 year old man used one of the kits to kill himself.[72] Compassion & Choices’ newsletter, promoting Humphry’s presentation, references him as “the father of the modern movement for choice.”[73]  Compassion & Choices’ mission is to promote suicide.
B. In Oregon, Compassion & Choices, a Non-Governmental Entity, has Largely Displaced the Department of Health as the Agency Overseeing Oregon’s Law
1. In Oregon, Compassion & Choices is the fox in the chicken coop reporting to the farmer what’s happening in the coop
In 2008, the Editorial Board for The Oregonian, which is Oregon’s largest newspaper, urged Washington State voters to reject its then pending assisted suicide measure.[74] The Editorial Board stated:
Oregon’s physician-assisted suicide program has not been sufficiently transparent. Essentially, a coterie of insiders run the program, with a handful of doctors and others deciding what the public may know. (Emphasis added).[75]
Four days later, Oregon doctors Kenneth Stevens and William Toffler published a follow up piece agreeing with the Editorial Board.[76] They also stated:
The group promoting assisted suicide, so-called "Compassion and Choices (C&C)", are like the fox in the proverbial chicken coop; in this case the fox is reporting its version to the farmer regarding what is happening in the coop.
Members of C & C authored and proclaim they are the stewards of Oregon's assisted suicide law. They call it "their law". They have arranged and participated in 3/4ths of Oregon's assisted suicide cases. . . .
In 2006, C&C's attorneys intimidated the Oregon Department of Human Services (DHS) to change to euphemisms in referring to Oregon's assisted suicide law. The limited DHS reports of assisted suicides is another indication of this organization's influence. Information that is damaging to the "good public image" of Oregon's assisted suicide law is hidden or glossed-over in the DHS reports. . . .[77]
2. In Oregon, the police officer was not able to get case information from the State; he obtained it from Compassion & Choices
In 2010, a man contacted me wanting to know if his father had died under Oregon’s Act.  I referred him to an Oregon attorney, Isaac Jackson, who asked the police to investigate.  Jackson’s declaration states:
The officer’s report describes how he determined that the [father’s] death was under Oregon’s assisted suicide law due to records other than from the State of Oregon.[78]
Jackson also states:
The officer’s report . . . describes that he was unable to get this information from the Oregon Health Authority, which was not willing to confirm or deny whether the deceased had used the [law].[79]
I also read the officer’s report.  According to the report, Compassion & Choices provided the records necessary for the officer to determine that the decedent had died under Oregon’s law. As noted by Jackson, the State had been unwilling to provide this information.

In Oregon, Compassion & Choices, a non-governmental entity, has largely displaced the Department of Health as the agency overseeing Oregon’s law.

IX. OTHER CONSIDERATIONS
A. The Act’s Felony for Undue Influence Is Illusory and Unenforceable
The Act has a felony for undue influence, which is not defined and has no elements of proof. The Act states:
A person who, without authorization of the patient, willfully coerces or exerts undue influence on a patient to request or ingest a covered medication [lethal dose] with the intent or effect of causing the patient’s death is punishable as a class C felony. (Emphasis added).
As noted previously, the Act also allows the patient’s heir to be one of two witnesses on the lethal drug request form. In the context of a will, this same situation is used to prove undue influence.[82]

How do you prove that undue influence occurred when the Act does not define it and the Act allows conduct normally used to prove it? You can’t. The felony for undue influence is illusory and unenforceable.
B. The Swiss Study:  Physician-Assisted Suicide Can Be Traumatic for Family Members
In 2012, a European research study addressed trauma suffered by persons who witnessed legal physician-assisted suicide in Switzerland. The study found that one out of five family members or friends present at an assisted suicide was traumatized. These people,  experienced full or sub-threshold PTSD (Post Traumatic Stress Disorder) related to the loss of a close person through assisted suicide.[84]
C. My Clients Suffered Trauma in Oregon and Washington State
In Oregon and Washington State, I have had two cases where there was trauma suffered in connection with legal assisted suicide.

In the first case, one side of the family wanted my client’s father to take the lethal dose, while the other side did not. The father spent the last months of his life caught in the middle and torn over whether or not he should kill himself. My client, his adult daughter, was severely 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. My client was told that his father had two suicide parties, that at the first party, his father had refused to take the lethal drug and that at the second party, his father took the lethal drug while intoxicated on alcohol. The person who related this information later changed his story.

My client, although he was not present at the death, was traumatized over the incident, and also by the sudden loss of his father.
D. Pain is Not the Issue
The Oregon and Washington laws, and their progeny such as the District of Columbia Act, are sold as necessary to stop physical pain.

Official statistics for Oregon and Washington (such as they are) do not make this claim. Consider, for example Oregon’s most recent annual report for 2015, which says that 37 people who ingested the lethal drug had had a concern about "inadequate pain control or concern about it.”(Emphasis added).[86] There is no claim that any one of these 37 people actually had pain.[87]

Note also that this was 37 people out of approximately 34,000 deaths in Oregon.[88] Pain is not the issue.

X. CONCLUSION

The Act legalizes assisted suicide and euthanasia for persons who reside in the District of Columbia. Such persons include members of Congress and the Senate, and the President of the United States. They include members of the public who already put up with terrible abuse from adult children or strangers, but who at least cannot be legally killed to get an inheritance, at least not yet.

If the Act is not rejected, new legal paths of elder abuse will be created with the most obvious problem being the complete lack of oversight at the death. Even if the patient struggled, who would know?  Another big problem is the Act’s reach to people with years or decades to live, who with passage of the Act will be encouraged to throw away their lives.

Finally, there is the major systemic problem in which  purported government oversight is a sham. The Act must be rejected to preserve transparency and integrity in government. The Act must also be rejected to prevent the District of Columbia from becoming corrupt like Oregon.

Respectfully submitted this 12th day of January 2017.

Margaret Dore, Esq., MBA

Endnotes: 
[1]  I am an elder law and appellate attorney licensed to practice law in Washington State since 1986. I am also a former Law Clerk to the Washington State Supreme Court and a former Chair of the Elder Law Committee of the American Bar Association Family Law Section. I am president of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia.  My CV can be viewed at this link: https://choiceisanillusion.files.wordpress.com/2017/01/dore-cv.pdf.  See also www.margaretdore.com and www.choiceillusion.org
[2]  A copy of Act 21-577, pp A-5 to A-15, can be viewed at https://choiceisanillusion.files.wordpress.com/2017/01/appendix-a-5-to-a-15-dc-act-21-577.pdf
[3]  AMA Code of Medical Ethics, Opinion 2.211, Physician-Assisted Suicide, attached here at A-16.
[4]  Id.
[5]  Id., Opinion 2.21, Euthanasia, attached here at A-17.
[6]  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?,” The Seattle Weekly, 01/14/09; article attached here at A-18, quote at A-20.
[7]  In 1997, Oregon’s law was passed as Ballot Measure 51; it had originally been passed in 1994 as Ballot Measure 16, but did not go into effect at that time.  Washington’s law was passed by Initiative 1000 in 2008 and went into effect in 2009.
[8]  The Washington and Oregon laws are sold as limited to physician-assisted suicide in which a patient self-administers the lethal dose. In Washington’s law, however, “self-administer” is specially defined to allow someone else to administer the lethal dose, which is euthanasia.  See Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009.  (Attached here at A-29 to A-31).  For an online version, go here. Oregon’s law also legalizes euthanasia, but with different language.
[9]  See: Associated Press, “Brewer signs law targeting assisted suicide,” Arizona Capitol Times, 04/30/14, attached here at A-24 (“The proposal was prompted by a difficult prosecution stemming from a 2007 assisted suicide”); Associated Press, “La. assisted-suicide ban strengthened,” The Daily Comet, 04/24/12, attached here at A-25); Georgia HB 1114 (attached here at A-26); Margaret Dore, “Idaho Strengthens Law Against Assisted Suicide,” Choice is an Illusion, 07/04/11, attached here at A-27 (”Governor Butch Otto signed Senate law 1070 into law.  The law explicitly provides that causing or aiding a suicide is a felony”); and Ohio HB 470, which can be viewed at this link: https://choiceisanillusion.files.wordpress.com/2016/12/ohio-assisted-suicide-hb470.pdf
[10]  Morris v. Brandenburg, 376 P.3d 836 (2016).  (Excerpt attached here at A-28).
[11]  The Act, § 2(16), attached here at A-6.
[12]  Affidavit of Kenneth R. Stevens, JR., MD, ¶¶ 3-7, attached here at A-33 to A-39.
[13]  Declaration of Jeanette Hall, ¶ 4, attached  here at A-40.
[14]  See e.g., Jessica Firger, “12 million Americans misdiagnosed each year, CBS NEWS, 4/17/14 (attached at here A-41); and Nina Shapiro (attached here at A-18 to A-20).
[15]  Affidavit of John Norton, August 15, 2012, attached here at A-42 to A-44c, ¶3.
[16]  Id., ¶1.
[17]  Id., ¶4.
[18]  Id., ¶5.
[19]  The Act, § 2(16), attached here at A-6.
[20]  Or. Rev. Stat. 127.800 s.1.01(12), attached here at A-47.
[21]  These conditions are listed in Oregon State reports concerning its law.  See, for example, report excerpts attached here at A-53 & A-54.
[22]  Declaration of William Toffler, MD,¶ 4, attached here at A-45 to A-46.
[23]  Id. at A-46.
[24]  Id.
[25]  The form can be viewed in the Act at §3(c), attached here at A-7 & A-8.
[26]  See the Act attached here at A-8.
[27]  The Act, §2(13)(“‘Patient’ means a person who has attained 18 years of age, resides in the District of Columbia . . .”)  Attached here at A-6.
[28]  See the Act in its entirety, which can be viewed at this link: https://choiceisanillusion.files.wordpress.com/2017/01/appendix-a-5-to-a-15-dc-act-21-577.pdf
[29]  See Dictionary.com  (Reside: “To dwell permanently or for a considerable time”). (Emphasis added). Synonyms include “lodge” and “stay.”  See appendix here at A-32.
[30]  See e.g., Kathryn Alfisi, “Breaking the Silence on Elder Abuse,” Washington Lawyer, February 2015, excerpts attached here at A-55 to A-56, and Met Life Mature Market Institute, Broken Trust: Elders, Family and Finances,” March 2009, at https://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf
[31]   Met Life Mature Market Institute, supra
[32]   Id., p. 24; and Yanan Wang, “This 80-year-old ‘Black Widow,’ who lured lonesome old men to horrible fates, is out of prison again,” Washington Post, 03/21/16, at https://www.washingtonpost.com/news/morning-mix/wp/2016/03/21/this-80-year-old-black-widow-who-lured-lonesome-old-men-to-horrible-fates-is-out-of-prison-again/?utm_term=.09b3c1de0823
[33]  Kathryn Alfisi, supra, quote here at A-56.
[34]  “Adult Abuse,” D.C. Department of Human Services, 07/23/15, available here at A-57.
[35]   See the Act in its entirety, which can be viewed at this link: https://choiceisanillusion.files.wordpress.com/2017/01/appendix-a-5-to-a-15-dc-act-21-577.pdf
[36]  The drugs used for assisted suicide in Oregon and Washington State include  Secobarbital and Pentobarbital (Nembutal), which are water and alcohol soluble, such that they can be injected without consent. See "Secobarbital Sodium Capsules, Drugs.Com, at http://www.drugs.com/pr/seconal-sodium.html and http://www.drugs.com/pro/nembutal.html  See also Oregon’s government report, page 6, attached here at A-53 (listing these drugs).
[37]  Alex Schadenberg, Letter to the Editor, “Elder abuse a growing problem,” The Advocate, Official Publication of the Idaho State Bar, October 2010, page 14, available at http://www.margaretdore.com/info/October_Letters.pdf
[38]  The Act, § 6(h).  Attached here at A-10.
[39]  Id.
[40]  Act, § 16(b), attached here at A-14.
[41]  See the Act in its entirety, which can be viewed at this link: https://choiceisanillusion.files.wordpress.com/2017/01/appendix-a-5-to-a-15-dc-act-21-577.pdf
[42]  Definitions are attached here at A-76 and A-77. 
[43]  “Mercy killing” is another name for euthanasia.  See here at A-58.
[44]  The Act, §§ 6(h) & 16(b), attached here at pages  A-10 & A-14, respectively.
[45]  RCW 70.245.040(2) and 180(1), available at http://app.leg.wa.gov  (Excerpts can be viewed here at A-78).
[46]  Washington State Department of Health “Instructions for Medical Examiners, Coroners, and Prosecuting Attorneys: Compliance with the Death with Dignity Act.”  (Attached here at A-78).
[47]  Dr. Kenneth Stevens testifies:
Generally accepted medical practice allows a doctor, or a person acting under the direction of a doctor, to administer prescription drugs to a patient. Common examples of persons acting under the direction of a doctor, include: nurses and other healthcare professionals who act under the direction of a doctor to administer drugs in a hospital setting; parents who act under the direction of a doctor to administer drugs to their children in a home setting; and adult children who act under the direction of a doctor to administer drugs to their parents in a home setting. (Emphasis added). 
Declaration of Dr. Kenneth Stevens, MD, 01/06/16, here at A-62, ¶10.
[48]  Id.
[49]  Id.
[50]  Id.
[51]  The Act, § 2(1), attached here at A-5.
[52]  AMA Code of Medical Ethics, Opinion 2.21, Euthanasia, attached here at A-17.
[53]  The Act, § 6(i)(1), attached here at A-10.
[54]  Again see the Act, § 6 (h), here at A-10, which states: "The cause of death listed on a death certificate shall identify the qualified patient’s underlying medical condition . . .  without reference to the fact that the qualified patient ingested a covered medication."
[55]  The Act, § 2(6), states “‘Department’ means the Department of Health.”  (Attached here at A-6).  The Act, § 6, also states:
(e) Within 30 days after a health care provider dispenses a covered medication [lethal drug], the attending physician shall file with the Department a copy of the information required by section 7 on a form created by the Department.
(f) Within 30 days after a patient ingests a covered medication [lethal drug], or as soon as practicable after the a (sic) health care provider is made aware of a patient’s death resulting from ingesting the covered medication [lethal drug], the health care provider shall notify the Department of a patient’s death.  (Emphasis added).
Attached here at A-10.
[56]  See the Act, § 15(a)(1) & (2) regarding the issuance of mandatory rules to develop the form “required by section 7" and to facilitate the collection of data “required by section 7."  Section 7 requires attending physicians to notify the Department of Health, not the Office of the Chief Medical Examiner.
[57]  D.C. Code § 2-711(f) states:
When an inquiry is conducted by the Office of the Chief Medical Examiner, the Medical Examiner shall determine the cause of death, and complete, sign, and return the medical certification portion of the death certificate to the funeral director within 48 hours after taking charge of the case.  (Emphasis added).  (Attached here at A-79. 
[58]  The Act, § 6(i)(2), attached here at A-10. states:
The review required by paragraph (1) of this subsection shall not constitute an inquiry for the purposes of section 12 of the Vital Records Act of 1981, effective October 8, 1981 (D.C. Law 4-34; D.C. Official Code § 7-211); provided, that an investigation authorized by paragraph (1) of this subsection shall constitute an inquiry for the purposes of the Vital Records Act of 1981, effective October 8, 1981 (D.C. Law 4-34; D.C. Official Code § 7-211).  (Emphasis added).
[59]  The Act, §§ 8 (a) & (b), attached here at A-11.
[60]  The Act, § 17, attached here at A-14.
[61]  ORS 127.865 s.3.11, attached here at A-81.
[62]  Oregon Data Release Policy, copy attached here at A-70.
[63]  E-mail from Alicia Parkman to Margaret Dore, January 4, 2012, attached here at A-63.
[64]  Oregon Health Authority, Frequently Asked Questions, attached here at A-71.
[65]  E-mail from Alicia Parkman to Margaret Dore, 01/04/12,  attached here at A-63
[66]  The Act, § 17, attached here at A-14.
[67]  https://en.wikipedia.org/wiki/Shadow_government
[68]  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.”).  Accord. Compassion & Choices Newsletter attached  here at A-21 and available at https://choiceisanillusion.files.wordpress.com/2016/10/humphry-keynote.pdf
[69]  Id.
[70]  Compassion & Choices Newsletter, regarding Humphry’s October 22, 2011 speaking date, at https://choiceisanillusion.files.wordpress.com/2016/10/humphry-keynote.pdf
[71]  See Jack Moran, "Police kick in door in confusion over suicide kit,” The Register-Guard, September 21, 2011 (“"A spotlight was cast on the mail-order suicide kit business after a 29-year-old Eugene man committed suicide in December using a helium hood kit. The Register-Guard traced the $60 kit to [the company, which] has no website and does no advertising; clients find [the] address through the writings of Humphry.") (Emphasis added). (Attached here at A-22 & A-23).
[72]  Id.
[73]  Compassion & Choices Newsletter, at https://choiceisanillusion.files.wordpress.com/2016/10/humphry-keynote.pdf
[74]  The Oregonian Editorial Board, “Washington state's assisted-suicide measure: Don't go there,” The Oregonian, September 20, 2012, available at http://www.oregonlive.com/opinion/index.ssf/2008/09/washington_states_assistedsuic.html
[75]  Id.
[76]  Kenneth Stevens MD and William Toffler MD, “Assisted suicide: Conspiracy and control,” The Oregonian, September 24, 2008.  (Attached here at A-91 and avialable at http://www.oregonlive.com/opinion/index.ssf/2008/09/assisted_suicide_conspiracy_an.html
[77]  See also Dr. Stevens’ follow up article, revised 3/18/15, attached here at A-92 to A-95.
[78]  Isaac Jackson, Declaration of Testimony, ¶ 8, 09/18/12, attached here at A-66.
[79]  Id.  Jackson’s entire affidavit is attached here at A-65 to A-70.
[80]  The Act, § 14(b), attached here at A-13.
[81]  Id, § 3, attached  here at A-8.
[82]  See e.g., Washington State’s probate statute: 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."  (Attached here at A-87)
[83]  “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 http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf  (Cover page attached  here at A-72)
[84]  Id.
[85]  To protect the privacy of the persons involved, I am not identifying which case occurred in which state.
[86]  Attached here at A-53
[87]  See the report in its entirety, here at A-48 to A-54.
[88]  See report here at A-50, footnote 1.