Wednesday, February 13, 2019

Dore Memo Opposing HB 399 and SB 311

To view this memo and supporting documentation as a pdf, click here


I am an attorney in Washington State where assisted suicide is legal.[1] Our law is based on a similar law in Oregon.[2] Both laws are similar to the proposed bills, HB 399 and SB 311.[3]

The bills seek to legalize physician-assisted suicide and euthanasia as those terms are traditionally defined. The bills call these practices, “aid in dying.” If enacted, the bills will apply to people with years, even decades, to live.

The bills will also allow undue influence. A required falsification of the death record will provide cover for murder. I urge you to vote “No” on HB 399 and SB 311.


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.”[4] For example:
[T]he physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide.[5]
Assisted suicide is a general term in which an assisting person is not necessarily a physician. Euthanasia is the administration of a lethal agent “by another person.”[6]

B.  Withholding or Withdrawing Treatment 

Withholding or withdrawing treatment (“pulling the plug”) is not euthanasia if the purpose is to remove burdensome treatment, as opposed to an intent to kill the patient. More importantly, the individual will not necessarily die. 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.[7]

Persons assisting a suicide or euthanasia can have an agenda. Consider Tammy Sawyer, trustee for Thomas Middleton in Oregon. Two days after his death by legal assisted suicide, she sold his home and deposited the proceeds into bank accounts for her own benefit.[8] Consider also Graham Morant, convicted of counseling his wife to kill herself in Australia, to get the life insurance. The Court found:
[Y]ou counseled and aided your wife to kill herself because you wanted . . . the 1.4 million.[9]
Medical professionals too can have an agenda. Michael Swango, MD, now incarcerated, got a thrill from killing his patients.[10] Consider also Harold Shipman, a doctor in the UK, who not only killed his patients, but stole from them and in one case made himself a beneficiary of the patient’s will.[11]


A.  Last Year, Utah Passed a Law Making Assisted Suicide a 

Last year, Utah amended its manslaughter statute to clarify that aiding suicide is a felony.[12] The bill, HB 86, passed the legislature by a 2 to 1 margin.[13]

B.  Two Years Ago, Alabama Passed an Act Banning Assisted 

Two years ago, Alabama enacted an “Assisted Suicide Ban Act,” which renders any person who deliberately assists a suicide, guilty of a felony.[14] The vote to pass was nearly unanimous.[15]

C.  Five Other States Have Strengthened Their Laws Against 
      Assisted Suicide

In the last eight years, five other states have strengthened their laws against assisted suicide. These states are Arizona, Louisiana, Georgia, Idaho and Ohio.[16]

The bills have an application process to obtain the lethal dose, which includes a lethal dose request form.[17]

Once the lethal dose is issued by the pharmacy, there is no oversight.[18] No doctor, not even a witness, is required to be present at the death.[19]


A. Patients May Have Years, Even Decades, to Live
1. If Maryland follows Oregon, the bills will apply         to young adults with chronic conditions, such           as diabetes
The bills apply to persons with a terminal illness,which is expected to result in death within six months. The bills state:
“Terminal illness” means a medical condition that, within reasonable medical judgment, involves a prognosis for an individual that likely will result in the individual’s death within 6 months. (Emphasis added)[20]
Oregon’s law has a similar criteria, 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. (Emphasis added).[21]
In Oregon, this similar criteria is interpreted to include chronic conditions such as “diabetes mellitus,” better known as diabetes.[22] Oregon doctor, William Toffler, explains:
[P]eople with chronic conditions are “terminal” for the purpose of Oregon’s law if without their medications, they have less than six months to live.
This is significant when you consider that a typical [diabetic] insulin-dependent 20 year-old 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 added).[23]
If Maryland enacts the proposed bills and follows Oregon practice, assisted suicide and euthanasia will be legalized for people with chronic conditions such as insulin dependent diabetes.
2. Predictions of life expectancy can be wrong
Patients may also have years or decades to live because predictions of life expectancy can be wrong. This is true due to actual mistakes (the test results got switched) and because predicting life expectancy is not an exact science.[24]

Consider John Norton, diagnosed with ALS at age 18.[25] He was told that he would get progressively worse (be paralyzed) and die in three to five years.[26] Instead, the disease progression stopped on its own.[27] 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.[28]
           3. Treatment can lead to recovery

Consider also Jeanette Hall, who was diagnosed with cancer in 2000 and made a settled decision to use Oregon’s law.[29] Her doctor convinced her to be treated instead.[30] In a 2018 declaration, she states:
It has now been 18 years since my diagnosis. If [my doctor] had believed in assisted suicide, I would be dead. Assisted suicide should not be legal.[30]
 B.  Someone Else is Allowed to Administer the Lethal Dose to 
       the Patient

Generally accepted medical practice allows a doctor, or a person acting under the direction of a doctor, to administer prescription drugs to a patient.[31] Common examples of persons acting under the direction of a doctor, include parents who administer drugs to their children, and adult children who administer drugs to their parents.[32]

The proposed bills imply that only patients are allowed to administer the lethal dose.[33] This interpretation is contrary to generally accepted medical practice, as set forth above. This interpretation is also contrary to the bills’ definition of “self-administer,” which paradoxically allows someone else to administer the lethal dose to the patient. The bills state:
“Self-administer” means a qualified individual’s act of taking medication prescribed under §5-6A-07(a) of this subtitle. (Emphasis added.)[34]
The bills do not define “taking.”[35] Dictionary definitions include “consume as food, drink, medicine, or drugs.”[36] With this definition, someone else putting the lethal dose in a patient’s mouth qualifies as “self-administration” because the patient will be engaged in an act of taking the lethal dose, i.e., consuming it as “medicine, or drugs.” Someone else putting the lethal dose in a patient’s feeding tube will also qualify because the patient will again be engaged in an act of taking the lethal dose, i.e., consuming it as “medicine, or drugs.” Gas administration, similarly, will qualify because the patient will again be engaged in an act of taking, i.e., consuming the lethal dose as “medicine, or drugs.”

With “self-administer” defined as the act of taking, someone else is allowed to administer the lethal dose to the patient.

C.  The Death Certificate Will List a Terminal Illness as the             Cause of Death

The bills require, that for all record keeping purposes, deaths via “self-administration” of the lethal dose, be legally deemed from natural causes, specifically as the result of a terminal illness. The bills state:
For all legal rights and obligations, record–keeping purposes, and other purposes governed by the laws of the state, whether contractual, civil, criminal, or otherwise, the death of a qualified individual by reason of the self–administration of medication prescribed under this subtitle shall be deemed to be a death from natural causes, specifically as a result of the terminal illness from which the qualified individual suffered. (Emphasis added).[37]
The significance is a legal inability to prosecute criminal behavior, for example, in the case of an outright murder for the money. Even if the qualified individual was misled to think that he was drinking straight whiskey, to celebrate his surprisingly improved health, not the lethal dose, the legal cause of death will be from natural causes due to a terminal illness. This will include “all ... record-keeping purposes,” which would or will include the patient’s death certificate. The official legal cause of death will be certified as a terminal illness due to natural causes as a matter of law. Prosecution will not be possible, the bills will thereby create a perfect crime.

D. Dr. Shipman and the Call for Death Certificate Reform

According to a 2005 article in the UK’s Guardian newspaper, there was a public inquiry regarding Dr. Shipman’s conduct, which determined that he had “killed at least 250 of his patients over 23 years.”[38] The inquiry also found:
that by issuing death certificates stating natural causes, the serial killer [Shipman] was able to evade investigation by coroners.[39]
According to a subsequent article in 2015, proposed reforms included having a medical examiner review death certificates, so as to improve patient safety.[40] Instead, the instant bills move in the opposite direction to require a legal coverup in which doctors and other perpetrators will be able to kill patients with impunity.

E.  “Even If a Patient Struggled, Who Would Know?”

The proposed bills have no required oversight over administration of the lethal dose.[41] In addition, the drugs used are water and or alcohol soluble, such that they can be injected into a sleeping or restrained person without consent.[42] Alex Schadenberg, Executive Director for the Euthanasia Prevention Coalition, puts it this way:
With assisted suicide laws in Washington and Oregon [and with the proposed 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).[43]
 F. The Bills Allow Undue Influence 

In Maryland, the Court of Appeals has identified seven elements to be considered when determining whether undue influence exists in the context of a will.[44] These elements include the following:
(2) the will contains substantial benefit to the beneficiary; (3) the beneficiary caused or assisted in effecting execution of [the] will; . . . and (7) the testator was highly susceptible to the undue influence.[45]
In the proposed bills, however, these same factors reflect clearly permissible behavior. Undue influence, as that term is traditionally defined, is legalized by the proposed bills. Please consider the following:

         1.  The patient’s heir is allowed to actively participate in                 obtaining the patient’s death.

The bills allow an heir, who will benefit financially from the patient’s death, to actively participate in the lethal dose request process to obtain the death. Indeed, an heir is specifically allowed to be one of two witnesses on the patient’s lethal dose request form.[46]

In the context of a will, similar conduct can instead create a presumption of undue influence.[47]

                   2. The bills allow the patient to have
                       compromised health, a factor traditionally
                       used to support a finding of undue

Under the bills, a terminal illness creates “eligibility” for the lethal dose. In the context of a will, by contrast, a terminal illness is an indicator of compromised health, which can support a finding of undue influence.[48] Once again, the bills allows a factor normally used to prove undue influence as that term is traditionally understood.

                   3. The felonies for undue influence are
The bills create two felonies for “undue influence,” a term not defined in the bills.[49] The bills also specifically allow conduct normally used to prove undue influence (the active presence of an heir and compromised health) How do you prove undue influence when it’s not defined and the bills specifically allow conduct normally used to prove it? You can’t. The proposed felonies are unenforceable as a matter of law.


A.  The Swiss Study: Physician-Assisted Suicide Can Be 
      Traumatic for Family Members and Friends

In 2010, a European research study addressed trauma suffered by persons who witnessed legal physician-assisted suicide in Switzerland.[50] The study found that one out of five family members or friends present was traumatized, with the most severe mental health problems occurring 14 to 24 months post loss.[51] An article describing the study states that these people, 
experienced full or sub-threshold PTSD (Post Traumatic Stress Disorder) related to the loss of a close person through assisted suicide.[52]
B.  My Clients Suffered Trauma in Oregon and Washington              State

In Oregon and Washington State, I have had two cases where my clients and their family member patients suffered severe emotional trauma due to legal assisted suicide. In the first case, one side of the family wanted the father/patient 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. A man who was present told my client that his (my client's) father had refused to take the lethal dose when it was delivered, stating: "You're not killing me. I'm going to bed." The man also said that my client’s father took the lethal dose the next night when he (the father) was already intoxicated on alcohol. The man who told this to my client subsequently changed his story.

My client, although he was not present, was severely traumatized over the incident, and also by the sudden loss of his father. He also followed the pattern of the Swiss cases described above, becoming especially traumatized about a year and a half after the death.


The bills will apply to people with years or decades to live. Some assisting persons, including doctors and family members, will have an agenda for an inheritance or even to get a thrill from watching someone die. The lack of required oversight at the death, coupled with the required falsification of the death certificate will provide cover for overreaching and murder. Families and individuals will be traumatized.

I urge you to vote “No” on HB 399 and SB 311.

Respectfully Submitted,

Margaret Dore, Esq., MBA
Law Offices of Margaret K. Dore, P.S.
Choice is an Illusion, a nonprofit corporation
1001 4th Avenue, Suite 4400
Seattle, WA 98154
206 697 1217


[1] I am an elder law attorney licensed to practice law 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 also president of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia. For more information, please see and
[2] Margaret Dore, "'Death with Dignity': A Recipe for Elder Abuse and Homicide (Albeit not by Name)," Marquette Elder's Advisor, Vol. 11, No. 2, Spring 2010 (regarding the Washington and Oregon laws.
[3]  HB 399, which is currently identical to SB 311, is attached in the appendix, at pages A-1 through A-23.
[4] The AMA Code of Medical Ethics, Opinion 5.7, attached in the appendix at p. A-24.
[5] Id.
[6] Id., Opinion 5.8, attached in the appendix hereto at A-25.
[8], “Sawyer Arraigned on State Fraud Charges,”  attached in the appendix at A-29. 
[9] R v Morant [2018] QSC 251, Order, 11/02/18, p. 1 & p.11, ¶ 78, available at, attached in the appendix at A-30 and A-31.
[10] Charlie Leduff, “Prosecutors Say Doctor Killed to Feel a Thrill,” The New York Times, 09/07/2000, Excerpts attached in the appendix at A-32 to A-34. See also: CBSNEWS.COM STAFF, “Life in Jail for Poison Doctor, 07/12/00,
[11] David Batty, “Q & A: Harold Shipman,” The Guardian, 08/25/05, at, attached in the appendix, pages 35 to 37. See also Fiona Guy, “Healthcare Serial Killers: Doctors and Nurses Who Kill,” Crime Traveller, updated July 7, 2018, at
[13] HB 86 passed the House 51 to 18, and the Senate, 19 to 5. For more information, see and click “status.”
[14] See Alabama: Assisted Suicide Ban Act to Go Into Effect,” 
[15] Scroll down to view roll calls: 
[16] See: AP, “Brewer signs bill targeting assisted suicide,” Arizona Capitol Times, 04/30/14, AP, “La. assisted-suicide ban strengthened,” The Daily Comet, 04/24/12; Georgia HB 1114; “Idaho Strengthens Law Against Assisted Suicide,” at (”The bill explicitly provides that causing or aiding a suicide is a felony”); and Ohio §3795.04, Assisted Suicide, added by the 131st Ohio General Assembly, effective 03/21/17, 
[17]  See HB 399 (presently identical to SB 311), attached in the appendix at A-1 to A-23.
[18]  Id.
[19] Id.
[20] § 5-6A-01(S), attached in the appendix at page A-39
[21] Or. Rev. Stat. 127.800 s.1.01(12), attached in the appendix at A-38 & A-39.
[22] See the Oregon report excerpt, attached in the appendix at A-40 (listing diabetes as an underlying illness for the purpose of Oregon’s law).
[23] Declaration of William Toffler, MD, attached in the appendix at A-41 to A-45, ¶¶ 5 & 6.
[24] See: Jessica Firger, “12 million Americans misdiagnosed each year,” CBS NEWS, 4/17/14, attached in the appendix, at A-46; and 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. (Excerpts attached in the appendix at A-26 to A-28). 
[25] Affidavit of John Norton, attached in the appendix, at A-47 to A-49.
[26]  Id., ¶ 1.
[27] Id., ¶ 4.
[28] Id., ¶ 5.
[29] Affidavit of Kenneth Stevens, MD, attached in the appendix at A-50 to A-52; Jeanette Hall discussed at A-50 to A-51; Hall declaration attached in the appendix at A-53. 
[30]  Id.
[31] Declaration of Dr. Kenneth Stevens, MD, 01/06/16, at A-52, ¶¶ 9-10. 
[32] Id.
[33] See, for example, § 5-6A-01(p)(5), which states that a “qualified individual” means an individual who “has the ability to self-administer medication.”
[34] HB 399 (presently identical to SB 311), § 5-6A-01(R), attached in the appendix at A-7.
[35] See HB 399 (presently identical to SB 311) in its entirety, attached in the appendix at A-1 through A-23.
[36] The definition of “take” is attached in the appendix at A-54. 
[37]  § 5–6A–11(a), attached in the appendix at A-17, lines 6-12
[38] David Batty, supra, attached in the appendix at A-35.
[39] Id., attached in the appendix, page A-37, second paragraph, “What are its findings?”
[40] Press Association, “Death certificate reform delays ‘incomprensible,’The Guardian, January 21, 2015, attached in the appendix at pages A-60 and A-61
[41] See e.g., HB 399, attached in the appendix at pages A-1 to A-23.
[42] In Oregon, the drugs used include Secobarbital, Pentobarbital (Nembutal) and Phenobarbital. See the Oregon government report excerpt, attached in the appendix at page 36 (listing these drugs). Secobarbital and Pentobarbital are soluble in water and alcohol. See and Phenobarbital is soluble in alcohol. See
[43]  Alex Schadenberg, Letter to the Editor, “Elder abuse a growing problem,” The Advocate, Official Publication of the Idaho State Bar, October 2010.
[44] Geduldig v. Posner, 129 Md.App. 490, 510, 743 A.2d 247 (1999), quoting Moore v. Smith, 321 Md. 347, 353, 582 A.2d 1237 (1990).
[45]  All seven factors are set forth below:
(1) the benefactor [testator] and beneficiary are involved in a relationship of confidence and trust;
(2) the will contained substantial benefit to the beneficiary;
(3) the beneficiary caused or assisted in effecting execution of will;
(4) there was an opportunity to exert influence;
(5) the will contains an unnatural disposition;
(6) the bequests constitute a change from a former will; and
(7) the testator was highly susceptible to the undue influence.
Geduldig v Posner, at 510-11.
[46] See § 5-6A-03(b)(allowing one of two witnesses on the lethal dose request form to be an heir “entitled to any benefit on the individual’s death”) (attached in the appendix at A-8).
[47] Consider, for example, Washington’s probate statute, RCW 11.12.160, which creates a presumption of undue influence when one of two witnesses on a will is an heir). A copy of the statute is attached in the appendix at A-62.
[48] See Moore, 321 Md. at 354 (element No.7) and 356-7 (describing the testator’s compromised health in connection with his “susceptibility” to undue influence).
[49] § 5-6A-11(c)(3), attached in the appendix at A-17, and § 5-6A-16(b), attached in the appendix at A-22.
[50] “Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide,” B. Wagner, J. Muller, A. Maercker; European Psychiatry 27 (2010) 542-546, available at 
[51] Id.
[52] Id.