‘Everybody dies’: how a decision in California could affect the right-to-die movement in Minnesota

REUTERS/Max Whittaker
In mid-September, the California legislature passed a right-to-die bill, which has been lying on Gov. Jerry Brown’s desk ever since.

The fate of even serious discussion about a right-to-die law in Minnesota currently lies in the hands of what may seem like an unlikely character: California Gov. Jerry Brown. 

True, a bill was presented to a Senate committee last spring by a handful of DFL senators. But the bill — the Minnesota Compassionate Care Act — was presented in an informational hearing only, meaning there was no vote by the committee. The idea of presenting the bill, according to Sen. Chris Eaton, DFL-Brooklyn Center, was “to get the conversation started.”

Yet the conversation supporting what is often referred to as assisted suicide often seems as if it’s being conducted in whispers. The loudest, most organized activity isn’t among supporters of the right-to-die bill, in fact. It’s by Minnesota Citizens Concerned for Life (MCCL), which opposes the legislation. At this point, it is highly unlikely that the Compassionate Care Act will be a topic of discussion in Minnesota’s 2016 legislative session.

That’s where California’s Brown figures in the picture. In mid-September, the California legislature passed a right-to-die bill, which has been lying on Brown’s desk ever since. He has three choices: sign it, veto it, leave it unsigned. If he leaves it unsigned, it would become law in mid-October, meaning California would become the sixth state where physicians are allowed to hasten the death of some terminally ill patients.

More important, legalization in California would create a new round of national media attention on this issue, which would create momentum in other states toward passing assisted dying laws. 

Is ‘right-to-die’ the new ‘freedom-to-marry’?

Start with this: The phrase “assisted suicide” is considered misleading — and politically loaded — among proponents of “end of life” choices. 

“Suicide is a terribly tragic event,” said Rebecca Thoman, who for years was a volunteer with the Minnesota Chapter of Compassion & Choices. She  helped organize Compassion & Care chapters in across both Iowa and Minnesota. “A suicide represents somebody not receiving the mental health treatment they needed. … Aid in dying represents an end-of-life choice by an individual.”  

Sen. John MartyState Sen. John Marty

By any name, where does the issue stand in Minnesota?

Sen. John Marty, DFL-Roseville, was among the handful of DFLers who took leadership  in presenting Minnesota’s right-to-die bill in May. He compares the issue to same-sex marriage.

“Over time you will see an attitudinal change,” Marty said. “When you look back just 10 years, you see how much attitudes changed on same-sex marriage. The more people think about this, the more they’ll see it as an issue of personal choice.” 

What’s different about this issue and same-sex marriage is that for years, the American public has supported right-to-die legislation at much higher levels. A Gallup Poll in May showed 68 percent support the idea. The issue has support, according to the poll, across all age and political spectrums. Indeed, public support for physician-assisted dying dates back nearly two decades.

Well-organized opposition

As shown repeatedly, politicians don’t necessarily respond to public opinion (hello, Sunday liquor sales). Instead, special-interest groups — especially well-organized ones — have big voices in public policy. 

In this case, that’s the MCCL, which has fought the legalization of abortion dating back to 1968. Now it’s stepping front and center in opposing end-of-life legislation; when Sen. Eaton asked for a statewide conversation on the issue, the MCCL was more than happy to oblige.

MCCL Executive Director Scott Fischbach says that the organization has held 50 meetings across the state over the summer and that there has been as much passionate opposition to aid in dying as there’s been around opposition to abortion.

MCCL executive director Scott Fischbach
MCCL Executive Director Scott Fischbach

Fischbach says that the Compassionate Care Act, which is based on Oregon’s landmark right-to-die law, is loaded with dangers, ranging from financial pressures on the poor to end their lives prematurely, to a lack of safeguards, to psychological burdens on physicians. The discussion should not be about assisted suicide, Fischbach said, but about more resources for hospice care and mental health treatment.

Those associated with Compassion & Choices don’t disagree with Fischbach that more should be invested in palliative and hospice care. But they also say that the Minnesota bill is, in fact, filled with myriad safeguards.

Under the proposed law, a person wishing to hasten his or her own death would need to meet the following criteria: The attending physician would have to determine that the person has less than six months to live; the person would have to be assessed as competent (no signs of depression, mental illness or dementia); the person would have to make two written requests to a physician for prescription of lethal drugs within 15 days; and the person would have to be able to administer the lethal dosage by him or herself. 

The notion that low-income people would feel more pressure than those of higher income is not borne out by statistics in Oregon, where assisted dying has been legal since 1997. Statistics there show that most who request assisted dying measures are white, well educated and from middle- to upper-middle-class backgrounds. (The number of requests in Oregon is minuscule. Last year, for example, about 33,000 people died in Oregon. Of that number, about 100 people died as a result of physician assisted aid.)

Physicians, too, would have choice in this matter. Under the proposed Minnesota law, physicians would not be required to prescribe life-ending drugs, but would be obliged to refer their patients to physicians who would write the needed prescription.

How the notion of a ‘natural death’ has changed

So, given these safeguards, why have the American Medical Association and statewide medical organizations traditionally opposed life-ending drugs? 

“I think that aiding dying makes us face our limitations,” said David Plimpton, a retired Minnesota physician who is on the board of directors of the Minnesota Chapter of Compassion & Choices. “As physicians, we’re afraid of death. Death is failure. We’re warriors against death. Death is evil. Life is good.”

But, Plimpton says, the whole notion of “natural death” has been stood on its ear by modern medical practices, which have extended life, though not necessarily quality of life. He argues, in a quiet voice, that dying aids would make medical practices “patient-centered” in a way that currently does not exist.

Plimpton also points out that attitudes among physicians are changing. For example, after years of opposing aid in dying, the California Medical Association took a “neutral” position on the subject prior to the recent legislative action in California. He also notes that the American Medical Student Association has come out in favor of patient choice in this matter.

Laws lag changing attitudes 

But if attitudes are changing, the process likely is going to be slow, for aid in dying represents political risk. When an organization such as the MCCL stands in opposition, there are a significant number of politicians, especially within the Republican Party, who will listen closely. The organization may not be huge — it claims 70,000 members in Minnesota — but its members show up at such events as party caucuses, meaning conservative pols must listen or lose endorsement.

But Fischbach says that “the political opposition will be bipartisan.” He says that national polling doesn’t show support for physician assisted suicide so much as it reflects a national desire “for more caring” for those in pain and nearing the end of life.

The Minnesota Chapter of Compassion & Choices has been around since 2000 quietly urging support for aid in dying. Janet Conn, president of the organization, believes momentum is increasing not only in Minnesota but across the nation.

State Sen. Chris Eaton
State Sen. Chris Eaton

“We’re doing more speaking than we’ve ever done and we’re passing out more literature,” Conn said. “There’s a lot more conversation about end-of-life issues than we’ve seen before. There are more articles, more books. People are seeking a peaceful end to the dying process.”

But Conn also admits that opponents are more visible. “People who oppose anything often are real vocal and really organized,” Conn said. “Part of our job is to show legislators that we’re here and we represent a large majority. … You wouldn’t think it would fall along party lines. Everybody dies.”

Wherever this is going in Minnesota, it’s likely going slowly. Again, look to the California process. In 1992, Californians, via the petition process, had a chance to vote on the issue and overwhelmingly rejected “Californians Against Human Suffering.” In ensuing years, physician assisted suicide was frequently introduced in the state legislature and always defeated.

But the political tone changed dramatically in California in 2014 when Brittany Maynard, a young California woman with terminal brain cancer, moved to Oregon so she could have “the right to die on my own terms.” Her highly public decisions were especially powerful in California where the law that would allow physicians to assist in the suicide of some people sits on the governor’s desk.

By contrast, the discussion is in the early stages in Minnesota. Eaton says she believes her bill was the first ever introduced in the state Legislature.

Comments (13)

  1. Submitted by Pat Berg on 09/30/2015 - 11:50 am.

    No signs of depression?

    What – do they expect people to be *cheerful* about having such a miserable quality of life that they’d rather die?

    How about no signs of *severe* depression. Because I’m pretty sure any competent mental health professional would be able to tell the difference between a low level of depression that would be expected under these circumstances v.s. such severe depression that the person isn’t capable of responsible decision making.

    Let’s try to get our *politicians* to make some responsible decisions for a change.

  2. Submitted by Frank Phelan on 09/30/2015 - 02:05 pm.

    One Mile X One Inch

    Opinion polls have consistently showed broad support for the death penalty. But when alternatives are offered, such as life without parole, support proves to be a mile wide and an inch deep.

    We also saw this with the voter restriction amendment. Once there was a debate, the overwhelming 80% support it enjoyed plummeted and even reversed.

    Support for this may prove to be similar. it sounds simple in the abstract, but the devil is always in the details.

  3. Submitted by Rachel Kahler on 09/30/2015 - 02:22 pm.

    Depression

    I would have to agree with Pat, above. It’s possible, even likely, that people who are looking at a maximum of 6 months of life left are going to be somewhat depressed. Maybe even severely depressed.

    But, honestly, if a person has less than 6 months to live and requests medication that can ease death (twice), how much does it matter if they’re not depressed, depressed a little bit, or weeping daily? For many terminal illnesses, the process of dying is painful in a lot of ways, including mentally and emotionally. How necessary is it to be not depressed about dying when you’re making the choice to make it go less painfully? Is it a punishment to depressed people that they get to suffer all of the bad stuff for longer because they’re depressed? In 6 months, are we going to counsel and medicate them to happiness in order that they might be considered competent enough to die?

    I get the safeguards, but I also don’t understand why certain safeguards are put in place, and not others. For example, while I don’t necessarily see a problem with people considering the financial situation of their families when choosing to ease their death, I do have a concern about the level of pressure by the families themselves. But then, I’ve seen elder abuse with my own eyes. You don’t need to be dying to have horrible relatives sucking every last bit of blood, soul, and money from you.

  4. Submitted by Bradley Williams on 09/30/2015 - 04:50 pm.

    Assisted suicide is a homicide in Montana

    Your source has done you a disservice. Assisted suicide is a homicide in Montana. Our MT Supreme Court ruled that if a doctor is charged with a homicide they might have a potential defense based on consent. The Court did not address civil liabilities. No one in Montana has immunity from civil or criminal prosecution. Does that sound legal to you? Oregon model bills have been rejected by our legislature in 2011, 2013 and 2015 because of gaping loopholes that allow exploitation of elders and people with disabilities of all ages. Passage would have established dangerous public policy.

    By Oregon and Washington law all family members are not required to be contacted. A single heir is allowed to initiate and execute the lethal process without a witness, thus eviscerating intended safe guards. Everyone involved in the lethal process gets immediate immunity. A witness is not required to confirm the dose was self-administered so if they struggled and changed their mind who would ever know?

    In addition these laws prohibit investigations or public inquiries leaving no recourse for surviving family members who were not contacted. Does that sound like good public policy to you? This is a very dangerous public policy that allows for the exploitation of elders and people with disabilities of all ages. However, it serves the health insurance corporations very well.
    All of these loopholes are embodied in California’s ABX2-15. A veto is in good order.
    Oregon and Washington should amend their initiative-sound-bite driven dangerous laws.
    Also note how the promoters of assisted suicide cling to their verbally engineered polls that claim a majority is in favor. I polled thousands of Montanans one-on-one as I served 60 days at fair booths across the state. Once folks knew about the loopholes in all of the Oregon model bills, 95% were not for them. So much for their verbally engineered polls.
    There were a few people (about 2%) that believed in the survival of the fittest who remained in favor of legalizing assisted suicide even after learning how these bills are written and can be administered to expand the scope of abuse. Their reasoning was that if one cannot control their family then their life should be cut short. 98% do not agree with that. Do you?

    • Submitted by Rachel Kahler on 10/01/2015 - 09:09 am.

      Lots of claims

      And very little explanation. What are the loopholes? Why would health insurance corporations be happy if their clients (who often pay premiums in return for very little) die? And, should we always resist those we don’t like (e.g., health insurance corporations)? Is it reasonable or is it spite? Don’t get me wrong, my opinion on health insurance companies (for and non profit) is pretty low, but even a broken clock is right twice a day.

      Further, on the one hand, you say that the current laws don’t actually make any of this legal, and on the other hand, you say that the current laws do all kinds of bad things. Which is it?

      Forgive me for my skepticism, but you must realize that commenters here frequently question a lot of stuff and ask for verification. Humor me, please.

  5. Submitted by Kent Fralish on 09/30/2015 - 08:37 pm.

    Sense?

    It’s OK to euthanize man’s best friend so he does not suffer, but humans must suffer to die?

  6. Submitted by Phil Dech on 09/30/2015 - 09:16 pm.

    Depression

    Why do people assume that when a person is faced with a dismal prognosis, it MUST be depression? Could it be a clear-eyed assessment of what the next few months will bring? Could that be why physicians, who have seen it all, elect for less life-prolonging treatment and extraordinary measures than their nonmedical peers? Why, in Oregon, is it the MORE educated people who take advantage of the law?

  7. Submitted by James Hamilton on 10/01/2015 - 07:51 am.

    If I am competent to complete

    a living will, why am I not competent to decide how and when my life will end?

    I have no problem with ensuring that the decision is free of coercion. Aside from that, my reasons for making an end of life decision are no one’s business but mine. They are not my wife’s, my son’s, or my siblings’ concern and not their decision.

    I have witnessed the slow deaths of two parents and one brother to date. All, I believe, would have opted for a quick and painless death rather than the slow, drug-addled declines they experienced, knowing the end was coming and impatient for its arrival. None of them died an easy death, despite the best efforts of hospice personnel and family members. Emphysema, a slowly leaking and irreparable aneurysm, and lung cancer do not lend themselves to easy deaths, as those who have witnessed such deaths can testify.

    MCCL and others who would impose their values on me and my end should simply butt out.

  8. Submitted by Rod Loper on 10/07/2015 - 07:51 am.

    Yes

    I don’t want any of them near my bedside.

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