Four states, Oregon, Washington, Vermont and California, have statutes legalizing assisted suicide. Where assisted suicide is legal, an heir (someone who stands to inherit from the patient) or abusive caregiver may steer someone towards assisted suicide, witness the request, pick up the drugs and, since no disinterested witness is required at the death, even give the lethal dose. APS workers should be educated about these statutes so that can be alert to cases of coercion and abuse and, hopefully, prevent resulting harms to an older or disabled individual.
Although proponents claim that assisted suicide statutes contain safeguards to prevent coercion and abuse, the actual provisions are too weak to be effective. A short and clear analysis of the law’s provisions is provided by elder law attorney Margaret Dore in the article “Death With Dignity”: What Do We Advise Our Clients? https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm . Dore states:
The Act requires an application process to obtain the lethal dose, which includes a written request form with two required witnesses. The Act allows one of these witnesses to be the patient’s heir. The Act also allows someone else to talk for the patient during the lethal-dose request process, for example, the patient’s heir. This does not promote patient choice; it invites coercion. . . . Once the lethal dose is issued by the pharmacy, there is no oversight. The death is not required to be witnessed by disinterested persons. . . . With no witnesses present, someone else can administer the lethal dose without the patient’s consent. Indeed, someone could use an alternate method, such as suffocation. Even if the patient struggled, who would know? The lethal dose request would provide an alibi. This situation is especially significant for patients with money. (Citations omitted.)
The assisted suicide state reports are based on forms filed by the physician who issued the lethal prescription and the dispensing pharmacy, and do not enable identification of cases involving coercion or abuse. However, cases have come to light though mainstream media. The following are illustrative.
Thomas Middleton was diagnosed with Lou Gehrig’s disease, moved into the home of Tami Sawyer in July 2008, and died by assisted suicide later that very month. Middleton had named Sawyer his estate trustee and put his home in her trust. Two days after Thomas Middleton died, Sawyer listed the property for sale and deposited $90,000 into her own account. It took a federal investigation into real estate fraud to expose this abuse. Sawyer was indicted for first degree criminal mistreatment and first-degree aggravated theft, partly over criminal mistreatment of Thomas Middleton. But the Oregon state agency responsible for the assisted suicide law never even noticed. (Sawyer Arraigned on State Fraud Charges, KTVZ.com, Sept. 7, 2011. http://www.ktvz.com/news/Sawyer-Arraigned-on-State-Fraud-Charges/619440)
Kate Cheney, age 85, died by assisted suicide under Oregon’s law even though she had early dementia. Her physician had declined to provide the lethal prescription. Her managed care provider then found another physician to prescribe the lethal dose. The second physician ordered a psychiatric evaluation, which found that Cheney lacked “the very high level of capacity required to weigh options about assisted suicide.” Cheney’s request was denied, and her daughter “became angry.” Another evaluation took place, this time with a psychologist who insisted on meeting Cheney alone. Disturbingly, the psychologist deemed Cheney competent while still noting that her “choices may be influenced by her family’s wishes and her daughter, Erika, may be somewhat coercive.” Cheney soon took the drugs and died, but only after spending a week in a nursing home. (Erin Barnett, A family struggle: Is Mom capable of choosing to die? Oregonian, Oct. 17, 1999. Updated: http://www.oregonlive.com/health/index.ssf/2015/02/physician-assisted_suicide_a_f.html)
Kathryn Judson wrote of bringing her seriously ill husband to the doctor in Oregon. “I collapsed in a half-exhausted heap in a chair once I got him into the doctor’s office, relieved that we were going to get badly needed help (or so I thought),” she wrote. “To my surprise and horror, during the exam I overheard the doctor giving my husband a sales pitch for assisted suicide. ‘Think of what it will spare your wife, we need to think of her’ he said, as a clincher.” According to prescribing doctors, 40% of people who died by assisted suicide reported feeling like a burden on family and caregivers as a reason for requesting lethal drugs. (Kathryn Judson, Assisted Suicide? “I was afraid to leave my husband alone again with doctors and nurses,” Letter to the Editor, Hawai’I Free Press, February 15, 2011, accessed March 15, 2015, http://hawaiifreepress.com/main/ArticlesDailyNews/tabid/65/articleType/ArticleView/articleId/3647/Febru ary-2011-Letters-to-the-Editor.aspx.)