In a new article that appeared in The Voice of Experience newsletter of the American Bar Association, Washington State elder law attorney Margaret Dore explained how she got involved in the fight against legalization of assisted suicide. The ABA newsletter is only available to subscribers, but the article, Preventing Abuse and Exploitation: A Personal Shift in Focus. An article about guardianship, elder abuse and assisted suicide, also appears on Dore’s Choice Is An Illusion website.
Dore recounted some early experiences in handling guardianship cases involving elders. Initially, she worked within the system, but then things changed:
. . . I got a case involving a competent man who had been railroaded into guardianship. The guardian, a company, refused to let him out. The guardian also appeared to be churning the case, i.e., causing conflict and then billing for work to respond to the conflict and/or to cause more conflict. . . .
At this point, the scales began to fall from my eyes. My focus started to shift from working within the system to seeing how the system itself sometimes facilitates abuse. This led me to write articles addressing some of the system’s flaws. See e.g., Margaret K. Dore, Ten Reasons People Get Railroaded into Guardianship, 21 AM. J. FAM. L. 148 (2008), available at http://www.margaretdore.com/pdf/Dore_AJFL_Winter08.pdf.
Dore’s career as an elder law attorney brought new elements to the discussion of potential issues affecting elders who might be victimized. As Dore noted in her ABA article:
In 2011, Met Life released [a . . ] study . . . , which described how financial abuse can be catalyst for other types of abuse and which was illustrated by the following 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. After the incident the woman said, “We were so good of friends . . . I’m so hurt that I can’t stop crying.” [The study is available at www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf.]
Dore went on to connect the dots between elder financial abuse and assisted suicide:
In the United States, physician-assisted suicide is legal in three states: Oregon, Washington and Vermont. . . .
All three laws are a recipe for abuse. One reason is that they allow someone else to talk for the patient during the lethal dose request process. Moreover, once the lethal dose is issued by the pharmacy, there is no oversight over administration. Even if the patient struggled, who would know?
In this and other legal articles, Dore has brought new analysis and valuable insights to the public debate over legalization of assisted suicide. The majority of reported cases in Oregon and Washington involved people with education and resources. Unfortunately, an elder’s resources are no safeguard against abuse. In fact, Dore’s voice of experience would suggest that resources may instead be a motivation for it. – Diane Coleman
I admire the position and the good work of attorney, Margaret Dore, who explains to the legislatures the real problem of state-sponsored assisted suicide that will encourage the financial and medical abuse of the elderly and the disabled in our society and undermine the public good of the younger generations, as well.
While I believe the laws against physician assisted suicide are being attacked by the “right to die” crowd who have the money to influence the legislatures, I believe the more immediate problem for the elderly and disabled on Medicare/Medicaid is the epidemic of unilateral covert/overt DNR code status that is placed in the charts of the elderly/disabled without their informed consent.
If only more members of the American Bar Association (ABA) would encourage the ABA to take an individual stand on unilateral covert/overt Do Not Resuscitate Code Status (DNR) that I believe is an urgent problem today in the real world of US Medicine.
The ABA has already offered an opinion to the US Congress/Medicare that the law of the 1991 Patient Self Determination Act (PSDA) ALREADY allows CMS and private insurers to treat costs of medical treatment that is in opposition to a patient’s legal advanced directive under State Law as an “error” or as an “adverse event” and refuse reimbursement to the hospital/physician. Non beneficial over treatment of Medicare/Medicaid patients, mistakes, errors, and exceeding the Diagnosis Related Group Cap for the disease/cancer being treated is also treated as an “adverse event” that CMS and private insurers do NOT reimburse to the hospitals/physicians.
However, if Congress were to define the PSDA to clarify this position of CMS and the 1991 PSDA. would they have to define the discrimination that is prohibited in the 1991 PSDA? Would Medicare/Medicaid patients then have to be notified that their treatments in the hospital were not being reimbursed and that they were charity patients?
Is this why the unilateral DNR is epidemic in US Acute Care Hospitals today? —-because the US Congress won’t take a position — and because of the Balkanization of the implementation of the goals of the 1991 PSDA by the states?
I blame the ABA and the influential community of the Bioethicists for the epidemic of unilateral DNRs in US Acute Care Hospitals. Obviously, this epidemic has been possible because no case law has been made in the courts that defines the unilateral DNR as a crime or a tort when the purpose of the unilateral covert/overt(default) DNR is primarily to limit any further treatment that the hospital knows will NOT be reimbursed by CMS and private insurance. .
Obviously, the epidemic which is hidden from view by the noisy red herring of “medical futility” has been fed because there is no case law in our courts that defines the unilateral DNR for private gain as a crime or a tort.
The ABA has cooperated with the bioethicists to treat the unilateral DNR merely as an “ethics” violation. The “right to die” crowd who pushes physician assisted suicide gets the assistance of the ACLU —but private parties on Medicare/Medicaid can get no help in defending any “right to live” they may have under the law from the ACLU, can they? when they are victims of unilateral DNRs that hasten their deaths without their informed consent.
Physician, Muriel Gillick, on the Hastings Center “Over 65 Blog” has written recently that DNR Code Status has been problematic for hospitals, physicians, and patients for over 40 years in an article entitled “Pulling the Plug on DNR.”
I would hope that activists like attorney, Margaret Dore, will investigate unilateral covert and overt DNR Code status in their own states and report to the ABA and the Legislature.
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