Update 100, Volume 36, Number 1 (2022-1)

Dear Update Reader:
As you can see, the Patients Rights Council’s Update is in a different format.  This is due to a number of factors, including the “supply chain crisis,” that makes it virtually impossible to get the supplies for the previous format.  Rather than waiting until that is resolved, this format will be used to get important information to you.

Suicide Tourism
From Arizona to Switzerland
In Mid-March the deaths of two healthy, affluent health-care professionals were reported in newspapers around the world.  Lila Ammouri, a 54-year-old a palliative care doctor, and her sister, 49-year-old registered nurse, Susan Frazier, had traveled from Phoenix, Arizona to Switzerland after paying $11,000 each to a clinic where their lives were ended.

Friends and co-workers at Aetna Health thought, at first, that the women must have met with foul play since they had indicated they were going on holiday and would be returning on Feb. 13.  However, it was later determined that they began inquiries about death clinics in 2019.  They had originally planned to go to Switzerland to end their lives in early 2020.  But the pandemic put a pause on that.

The clinic, which carried out the deaths does not require that a person have a severe or life-threatening illness. According to Philip Nitschke, who acts as a broker of sorts for such deaths, “Switzerland is unique because you don’t have to be sick to have VAD [Voluntary Assisted Dying].”  In Switzerland, it is not a crime to help a person die — if that assistance is given for a non-malicious purpose.” [The Daily Beast.com, 4/2/22]

Nitschke explained that the sisters had decided they were “tired of life and it was time to go.” Prior to leaving for their planned deaths, the wealthy sisters had made arrangements for disposition of their property with Ammouri putting her million-dollar Arizona home in an “interfamily trust,” also known as a “living trust,” which allows family members, friends or even business partners to receive the property without having to go through probate to prove they are rightful heirs to an estate.  [Daily Mail.com, 3/28/22]

Friends and family contacted the Phoenix Police Department to investigate the deaths but were told they could not open a case since it was outside their jurisdiction.  And, a spokesperson for the Basel, Switzerland Public Prosecutor’s Office said that the sisters’ deaths did not result in a criminal investigation since it was strictly performed through legal means.

Ironically, or maybe predictably, the tragedy of such deaths has led some to call for expansion of legalized assisted suicide in the United States.  As one newspaper stated, “American sisters’ assisted suicide in Switzerland spurs calls for more US states to adopt aid-in-dying laws.” [Independent, 3/23/22]

From Anywhere to Oregon
Oregon was the first state to pass a law permitting doctors to prescribe a lethal overdose of drugs to patients who were diagnosed as having a “terminal illness.”  The law went into effect in 1997 and has been considered the model for all other states where similar laws were proposed and were passed.  Oregon is always said to contain “safeguards” that protect patients.

One such “safeguard” was a requirement that a patient accessing the law be an Oregon resident. But, like other so-called “safeguards,” the residency requirement eventually was called a “barrier” that needed to be removed.

A federal lawsuit (Gideonse v. Brown) was filed by Compassion & Choices (formerly known as the Hemlock  Society) challenging that residency requirement.  The suit alleged that the residency requirement violated the U.S. Constitution’s guarantee of equal protection.  The court ruled that the Oregon law’s residency requirement was unconstitutional and, in a settlement reached on Monday, March 28, 2022, the Oregon Health Medical Board agreed to stop enforcing the residency requirement.

According to the Notice of Settlement, the state “decided it would not apply or otherwise enforce the residency requirement under the Act.” [CNN.com, 3/29/22]

Compassion and Choices immediately announced that similar suits to remove residency requirements could be filed in states that currently have laws permitting assisted suicide.

What does this mean?

It means that residents in any state who have been diagnosed — or misdiagnosed — as being “terminally ill” can travel to Oregon to obtain a prescription for a lethal dose of drugs. ______________________________________________________

What is meant by “terminally ill”?

In states where laws have transformed the crime of assisted suicide into a “medical treatment” as well as in proposed legislation to permit assisted suicide (using such labels as “death with dignity,” “aid-in-dying” or similarly benign words) have included a requirement that patients must be “terminally ill” or have a “terminal disease” to be eligible to receive the drug overdose to end their lives.  Furthermore, the definition of terminal illness is generally such as that in Oregon’s law which states that “‘terminal disease’ means an incurable and irreversible disease that has been medically confirmed and will, within reasonable judgement, produce death within six months.” [ORS 127.800 1.01 (12)].

Most people think of someone diagnosed with a “terminal disease” is bedridden and in terrible pain.  However, the reality is far different.

In the most recent official Oregon report, released in February, 2022, “terminal diseases” which patients were diagnosed included anorexia (an eating disorder) and arthritis.   In the previous year the “terminal diseases which made a person eligible for “death with dignity” included diabetes, arthritis, complications from a fall and other conditions which are generally not thought of as “terminal.” [The full Oregon official reports are available at: https://www.patientsrightscouncil.org/site/oregon]

How could individuals with such conditions be diagnosed as having a terminal disease?  Why were they prescribed the drugs to end their lives?

Note that while the “terminal condition is to be incurable and irreversible,” it can be controllable.  For example, Type 1 diabetes is controllable with insulin, but if the diabetic does not take insulin, death will occur within six months.  Thus, such an individual is eligible for a prescription for death in Oregon.

Whenever, reading the language of a law or a proposed bill, it is as important to understand what is not in it, as well as that which is.

Briefing Book (Part One)

This is Installment One of suggestions to help you discuss assisted suicide with others.

When was the last time you heard someone discussing assisted suicide?

The vast majority of people are totally unaware that the crime of assisted suicide has been transformed into a “medical treatment” in ten states and the District of Columbia.  And there are efforts in all remaining jurisdictions to legalize it.

Those who promote assisted suicide work constantly.   They are well-meaning.  But their good intentions do not protect people from the deadly content of their proposals.

They constantly seek out ways to gain acceptance for their agenda.  When met with a roadblock, they don’t give up.  They work even harder.  They are committed.  They talk with friends, colleagues and others.  They work to change hearts and minds.

Between the passage of Oregon’s “Death with Dignity Act” in 1994 (which went into effect in 1997) and the end of 2019, hundreds of similar bills were introduced.  But it took until 2008 for the second assisted-suicide bill to pass in Washington State.   Several other states followed, yet it was slow going for those who were seeking to change the law in every state.

Hawaii had tried to pass such a law many times since 1998.  After another loss in 2017, they proclaimed, “We will retool, reboot, and start over,” until every state has a law permitting every American “to choose from the full range of end-of-life options without interference from the government or the church.”(1)  Their hard work paid off.  In April 2018, the “Our Care, Our Choice Act” was signed into law.  It went into effect on January 1, 2019.

Virtually any proposal to legalize assisted suicide is described as a “choice.”  But is this really about choice?

Some doctors actually suggest to patients that they should consider “death with dignity” for the sake of loved ones.

For example, when an Oregon woman accompanied her seriously ill husband to the doctor, she thought they’d be getting badly needed help.  But the “help” that she heard the doctor suggest was frightening.  “I overheard the doctor giving my husband a sales pitch for assisted suicide.” She heard the doctor tell her husband about how good it would be if he chose to end his life:  “Think about what it will spare your wife. We need to think of her.” (2)

Few advocates of assisted suicide are open about its impact.  An exception to this is a statement by Derek Humphry (the cofounder of the Hemlock Society, now called Compassion & Choices).  Soon after the Oregon law went into effect, Humphry wrote, “[I]n the final analysis, economics, not the quest for broadened individual liberties or increased autonomy, will drive assisted suicide to the plateau of acceptable practice.” (3)

States that have legalized assisted suicide declare deaths that take place after taking the drugs prescribed for the purpose of ending life are not to be considered suicide for any purpose.  Thus, the decision about whether to cover the cost of the prescribed drugs is left up to the insurance companies.

An official Oregon web site explains: “The DWDA [Death with Dignity Act] does not specify who must pay for the services.  Individual insurers determine whether the procedure is covered under their policies (just as they do with any other medical procedure).” (4)

There is no question that a prescription for a deadly overdose of drugs is much less expensive than treatment for a serious illness.  This has led insurance plans – both private and governmental – to cover the cost of “death with dignity.”

If a patient has medical insurance, there is no guarantee that the insurance will cover treatment.  Instead, it can decide to cover the lethal prescription instead of treatment that a patient needs and wants.

When opponents of assisted suicide point out that pressure could be put on vulnerable people to end their lives, they are often met with derision.  One of the most blatant examples is a comment made by renowned British neurosurgeon Henry Marsh.  During an interview to promote his latest book, he called such concerns “grotesque.”

He said, “They [opponents of assisted suicide] argue that grannies will be made to commit suicide.”  But then he added, “Even if a few grannies get bullied into it, isn’t that the price worth paying for all the people who could die with dignity?” (5)

Marsh’s comments were outside of the usual rhetoric of those who promote doctor-assisted suicide.  However, there is no question that, in reality, the elderly and others are at risk of being bullied into “death with dignity.”

Between 1994 and the end of 2019, laws transforming the crime of assisted suicide into a “medical treatment” had passed in nine jurisdictions. (6)  (In addition, a 2009 Montana court decision permitted doctors to use the patient’s request as a defense against charges of assisted suicide.) Due to the pandemic and the slowdown of activity in legislatures across the country, no new assisted suicide bills passed in the U.S in 2020.

However, in 2021, that changed.  New Mexico passed an assisted-suicide bill.  That law adds new elements.  For the first time an assisted-suicide law permits not only physicians but also advance practice nurses and nurse practitioners to replace physicians as lethally prescribing and consulting clinicians. (7)

The New Mexico law, as well as other laws and proposals avoid calling assisted suicide what it is.  They avoid the term “suicide.”  Yet that is exactly what it is.  And we must calmly refer to it for what it is.

This must be done to help people think but, at the same time, we must remember that we are not trying to win a debate.  We are working to help individuals think.

Additional developments are proposals that a patient could qualify for assisted suicide via telemedicine.  If passed, such a law would permit a health care provider to prescribe the lethal prescription without any in-person contact with the patient.

  1. Peg Sandeen, “The Will of the People Was Thwarted When Assisted Dying Bill Failed,” Civil Beat (Hawaii), May 2017.
  2. Kathryn Judson, “Assisted Suicide? ‘I was afraid to leave my husband alone again with doctors and nurses.’” Hawaii Free Press,” Letter to the Editor, February 15, 2011.
    3. Derek Humphry and Mary Clement, Freedom to Die, St. Martin’s Press (New York, 1998), p. 313. (Emphasis added.)
  3. Oregon Public Health Division, “Frequently Asked Questions About the Death with Dignity Act,” Response to question, “Will insurance cover the cost of participation in the Act?” (Available at: (https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/faqs.aspx#insurance) Last accessed August 19, 2021.
  4. Matt Rudd, “The Doctor Will See You Now: Henry Marsh gives Matt Rudd his prescription for a beleaguered NHS,” The Sunday Times (London), April 23, 2017. (Emphasis added.)
    See also: Zosia Chustecka, “Renowned Neurosurgeon on Assisted Dying and His ‘Suicide Kit,’” Medscape, April 27, 2017.
  5. Oregon (1994) took effect in 1997, Washington (2008), Colorado (2016), Vermont (2013), California (2015), District of Columbia (2016), Hawaii (2018) took effect 2019, Maine (2019), New Jersey (2019).
  6. The “Elizabeth Whitefield End-of-Life Options Act” (HB 47) was signed into law on April 8, 2021.

Installment Two of the Briefing Book will appear in the next Update.

The Patients Rights Council is a human rights group formed to promote and defend the right of all patients to be treated with respect, dignity and compassion and to resist attitudes, programs and policies which threaten the lives of those who are medically vulnerable.  To those ends, the PRC compiles well-documented and up-to-date information on a whole range of end-of-life issues, including health care advance directives, futile care policies, health care reform, and prescribed suicide.

The Update is available by mail to the general public; suggested minimum donation is $25.00 [U.S.] a year.  Add $3.00 for foreign postage.

Executive Director: Rita Marker, J.D.
Assistant Director: Jason Negri, J.D.
Consultant: Wesley J. Smith, J.D.

Patients Rights Council
P.O. Box 760
Steubenville, OH 43952 USA

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