The American public has been clear for decades on one end-of-life care issue: People who are mentally capable and dying should have the option to request prescription medication from their doctor to peacefully end their suffering if it becomes unbearable.
The majority of Americans have supported this option, known as medical aid in dying, since the 1970s. However, until recent years it was considered too controversial for legislatures to tackle. Fortunately, recent events show this concern is no longer valid.
This past April, New Jersey became the fifth jurisdiction to pass medical aid in dying through the legislature in the last six years, after Hawaii (2018); Washington, D.C. (2017); California (2016); and Vermont (2013). In addition, citizen-led ballot initiatives authorized medical aid in dying in Colorado (2016), Washington state (2008) and Oregon (1994), and the courts in Montana (2009). In fact, Colorado voters approved medical aid in dying by a 30-point margin (65 percent to 35 percent), the largest number of “yes” votes of any ballot initiative in Colorado’s history. And this week, the Maine legislature approved the Maine Death with Dignity Act; the bill awaits Gov. Janet Mills’ signature.
Strong support among Minnesotans
Like people in other states, Minnesotans want their lawmakers to authorize this compassionate end-of-life option. A 2016 statewide survey demonstrated that two-thirds of Minnesota residents support the authorization of medical aid in dying. That same year, 68 percent of Minnesota State Fair-goers indicated support on the annual Minnesota State Fair Survey sponsored by the Minnesota House and Senate.
Growing public demand for medical aid in dying is also causing greater acceptance within medicine. Since 2015, 20 national and state medical societies, including the American Academy of Family Physicians and the American Academy of Neurology, have dropped their opposition and adopted either a supportive or neutral policy. After completing a two-year Task Force study, the Minnesota Medical Association withdrew its opposition to medical aid-in-dying legislation that included appropriate protections for physicians and patients.
[image_caption]Kim Callinan[/image_caption]Despite these facts and the strong leadership of state Sen. Chris Eaton and state Rep. Mike Freiberg in introducing the Minnesota End of Life Option Act, which would have authorized medical aid in dying, the 2019 legislative session ended last month without making progress on the bill.
Fortunately, House leadership has indicated a willingness to advance the conversation by holding an informational hearing during the interim. I encourage Minnesota lawmakers to use this opportunity to listen to constituents and evaluate the evidence and data from a combined 40 years of experience across 8 jurisdictions, rather than allowing misinformation and implausible “what if” scenarios to stall progress.
Important trends
The data will reveal three important trends:
1) Medical aid in dying laws protect patients: There has not been a single incidence of abuse or coercion in a combined 40 years.
2) Relatively few people (fewer than 1,500 in more than 20 years in Oregon, or less than 1 percent of annual deaths) will decide to use the law; however, large numbers of terminally ill people gain peace of mind simply knowing the option exists.
3) The implementation of medical aid-in-dying laws contribute to improved conversations between doctors and patients, better palliative care training and more effective use of hospice care.
Given the profound demographic shift in Minnesota with the number of adults in Minnesota doubling between 2010 and 2030, public demand for this compassionate option will continue to grow. No doubt, as more constituents and lawmakers watch their loved ones unnecessarily suffer at the end of life, Minnesota will eventually join other states and authorize it. Unfortunately, that is cold comfort for those terminally ill Minnesotans who want this option now.
While medical aid-in-dying legislation garners opposition from a vocal minority, the reality is that it offers lawmakers a rare trifecta: widespread public support, conclusive data that the option will protect patients and improve end-of-life care, and it costs next to nothing to implement. Minnesota can continue its legacy of leadership by becoming the first state in the Midwest to authorize medical aid in dying, because everyone should have the autonomy to make end-of-life decisions that are best for themselves and their families, no matter where they live.
Kim Callinan is the CEO of Compassion & Choices. She holds a master’s degree in public policy from Georgetown University.
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During my 34 years of practicing law, I regularly worked with many clients on their Wills and end of life plans. These discussions included a health care directive specifying what care was wanted in the event that the client, typically both a husband and wife, no longer could make a decision for him or her self and the client’s medical condition was terminal, or the client was permanently unconscious, or the client was completely dependent on others for care. In nearly ever case the client wanted no medical care to prolong life, the client wanted medication to be comfortable and free of pain, even if that hastened death, and the client wanted no artificial feeding or sustenance, especially no tube or intravenous feeding of food or fluids. This means that the client clearly wanted to be left free to die, and in fact free to die quickly.
My 34 years of experience clearly shows that people do not want life artificially extended and want to be free to die quickly and free from discomfort or pain. Medical aid to allow a painless and comfortable death is what my clients wanted.
My sentiments exactly and thanks for the post.
The problem is getting hospitals and health care providers to honor those DNR documents.
The hospitals do honor the DNR requests of the patient and family. The problem is when family members choose to escalate care and initiate life prolonging treatment and physicians won’t stand up to them for fear of litigation.
I support the “choice option” in this matter, it is similar in some ways to a woman’s right to choose.
It disgusts me that the option to force me to endure pain at the end of life is a religiously inspired effort to impose their faith beliefs on me.
I truly want the state to stay separate from religions.
Comparing “medial euthanasia” for terminal patients to abortion is like comparing “apples and oranges”. Would most people support euthanasia for a healthy, 20 year old whom wants to die ??? Of course not. But late term abortion, and even worse, the infanticide that the far left legislatures seems to believe is a “right”, is abhorrent, no matter which side your on. I’m not religious at all, but abortion discusts me, especially beyond twelve weeks.
What I find abhorrent is mischaracterization of the need for late term abortions and the false claim that anyone supports infanticide. .
It’s about dignity, avoiding unwanted and unnecessary suffering – not only for the person, but for loved ones. I speak not only for myself, but also my father who, at age 92, is in good health, but fears what may happen when medical aid in dying is not an option.
It’s about time.
Agreed.
But my understanding of Minnesota law–heavily influenced by right-to-lifers who oppose any patient deciding on her own to die without medical intervention–is that if a patient at any point is intubated for artificial food and liquid sustenance, that patient may not demand to have those tubes removed. In other words, in Minnesota we do not have the option of simply starving and dehydrating ourselves to death at the end of horribly painful agonies. Much less ask for medically-assisted death with dignity, an option now available in other states.
I really hope I’m wrong on that fact (which includes that the law overrules any will or end of life plans drawn up with an attorney).
The cruelty in this boggles the mind.
Medical killing? In a land where we don’t have a right to health care?
I don’t think so.
I couldn’t agree more that it’s time to pass this legislation in Minnesota. As the article points out, even though few will use it, a legal option for medical aid in dying can bring tremendous peace of mind to people with a terminal diagnosis.
And who shall prescribe these medications? As a physician of 37 years I don’t know of any colleague who would sign on to do this. Good luck finding someone who will.
Unfortunately Paul, there are many doctors whom will do anything for both money and fame, under the guise of “helping patients”.
Physicians do not need to “sign on.” They simply need to fulfill their Hippocratic Oath of “do no harm.” Torturing a person before she dies is not medical practice and it should be a crime. Palliative care through the prevention and relief of suffering is what people want, even if that hastens death. Keeping people facing end of life in needless pain, discomfort and anxiety is inexorably cruel.
Jim, providing medical care is not torture. It is what physicians are trained to do. Why seek the advice of a physician otherwise. Patients and their families can elect to have care withdrawn at any time. Often it is the family wanting to continue intensive treatment (respirators, hemodialysis, chemotherapy, etc..) of a loved one who is unable to make the decision. Physicians comply with family wishes in futile situations because they understandably fear litigation. They are caught in the middle of a very difficult situation.
Physicians are facing increased scrutiny when prescribing opioids. With more physicians being employed by large organizations they will not be permitted to participate in these efforts. Do you think Mayo Clinic would allow their docs to participate in this? I doubt it. As I stated prior, good luck finding someone to do this.
Patients have the legal right to request, and physicians to provide, medication necessary to relieve pain, even at dosages that may prove lethal,
That may be so but physicians have the right to refuse care in non life threatening situations.
Mayo Clinic won’ allow their physicians to prescribe medical marijuana for the living, so how could one expect them to allow their physicians to help someone who has no relief of pain while their disease is terminal?
This is what Kim Callinan hasn’t told you:
The doctors writing these prescriptions are not doctors who routinely diagnose or treat any of these terminal conditions. In our legislature Ms. Kallinan heard a Washington anesthesiologist testify that she wrote 40 lethal prescriptions. Anesthesiologists don’t independently diagnose and treat cancer, ALS, or express prognoses about these conditions. In Washington, a psychiatrist even set up a fee-for-service end of life clinic. This is all legal under existing laws.
If even for doctors who possess the right qualifications, they are not following the law. In Washington, Oregon, and Colorado, the mandatory reports are not being filed. This means that many cases miss required documentation that the patient has been given informed consent and is competent to do so. People who should have capacity assessments are not being referred to a licensed psychologist or psychiatrist.
Ms. Callinan is aware of all this information, because it gets presented every hear in the state committee hearings that I attend with her.
Withholding that information from Minnesota readers is disingenuous at best and deceitful at worst.
I’m sure she is also quite aware of the misleading and false arguments you are raising here.
As an FYI, the action of the anesthesiologist is not condoned by the American Society of Anesthesiologists.
There are many sides to this story and most of them are painful. Alzheimers continues to challenge families and the medical community, both spiritually and financially. Hospice care could be helped by the introduction of entheogens for the right patients. We have a lot of work to do to recognize and deal with the realities that are right in front of us day to day.
“There has not been a single incidence of abuse or coercion in a combined 40 years.”
There hasn’t been any voter fraud either. How do the interviews go with a dead person as to whether or not they were coerced or abused?
Has anyone heard of “comfort care”?
Yes. As a retired nurse with National Certifications in Oncology & Hospice I am well aware of the limits
to “comfort care”. In the hospital based 10 bed
Hospice Unit I worked in I saw horrific deaths as
well as peaceful deaths. Medications only go so
far.
I firmly believe that a dying person should not be
forced to endure physical, psychological or
existential pain simply so we can wait it out
to the last breath. Death comes to each & everyone
of us; anything that lives, dies whether a blade of
grass or a human.
I’m in complete agreement with Aid in Dying.
There is no reason to hold on when what’s left
is prolonged dying, not living.
Recently we learned of the case of a German nurse named Niels Hoegel who enjoyed murdering patients. Over 85 were killed under his watch. The trust we provide to medical practitioners is important.
Medical aid in dying should not be allowed, legalized euthanasia serves no purpose in providing actual healthcare but rather increases the acute public risk of abuses such as the case of Hoegel. That risk far outweighs the benefits of allowing suicide by physician or other providers. Supporting choice itself would be to allow patients to commit to their line of actions while not requiring intervention or convenience by medical practitioners.
In any case it is disgusting and abhorrent that the left continues to push their “death” agenda while also supporting a ban on a “right to life”. This issue clearly isn’t about choice. The left is also supporting individual requirements to hold healthcare insurance, requirements to get shots, requirements to limit/seize/ban bearing arms that might otherwise expedite my so called right to die. This just illustrates further how hypocritical that current social policy platform is.
This is a disturbing development that Minnesota is considering medical aid in dying. I can see how the category for eligible patients would gradually expand from terminal illnesses with intractable pain to chronic but non-terminal illnesses, depression or mental illness, disabled people, and even children or babies. An overdose is also much cheaper than treatment. I can see how some patients are going to be pressured into this “option.” It’s happening in Europe now and I don’t want it here.
But forcing people to endure unyielding and unendurable pain is A OK in your book? Why is anyone so interested in another’s healthcare decisionmaking, particularly when they are so reticent in participating in its funding? In every one of the examples cited they answer is easy, consent is required, either by the party involved, or by the one granted such power (your example of parent’s randomly killing off children is nonsensical hyperbole, as I’m sure was its intent). The idea that allowing others to end THEIR life, if they so choose, is of any concern to anyone else, beyond their immediate familial and or social circle, is quite baffling. Why in the world should you, or I for that matter, get a vote?
Actually, in European countries where aid in dying is legal relatively few people actually choose it. Just knowing that it is available is usually enough.
“…medical aid in dying.”
Sounds so nice and antiseptic, almost compassionate.
But it is medical killing.
As a closing thought, assisted suicide (and that is what it is) is not the practice of medicine.
I have been suffering from Meniere’s Disease for nearly six years. In the last several months, my suffering has taken a significant turn for the worse, despite aggressive, painful treatments. My ability to walk safely is severely impaired and I fall frequently. The pressure in my ear is often unbearable. I can no longer drive, and I cannot tolerate noise. The sound of water running or meat frying makes me nauseated.
Several weeks of gentamicin injections seem to have made things worse, and my physician is starting to discuss brain surgery.
I’m not doing brain surgery. Despite the fact that I don’t have a terminal illness, I do have an incurable condition that has destroyed my quality of life and my dignity. I have spent the last two days researching end-of-life care and realize that most legislation in the United States limits it to terminally ill patients.
Those of us who have intolerable, incurable disabilities should have access to end-of-life care as well.