A retired palliative medicine physician’s plea: Pass end-of-life options legislation

In 2008, after more than a decade of debate, Washington state voters enacted by a margin of 16% a law to legalize medical aid in dying. A majority of voters supported the initiative in 30 of 39 counties, demonstrating that it had support from both conservatives and liberals. The law is virtually identical to the law now being considered by the Minnesota Legislature. It is based on the law passed in Oregon in 1994 and implemented since then in 10 states and the District of Columbia.

As a practicing hospice and palliative medicine physician in Washington at the time, I spoke out and voted against the initiative. At the time, I shared the beliefs and concerns expressed today among opponents here in Minnesota. I believed that hospice and other palliative treatments could effectively ease every person’s physical, emotional and spiritual pain. I worried that doctors — and perhaps patients — might be subtly nudged to engage in medical aid in dying against their personal beliefs. I worried that dying patients would forego hospice in favor of medical aid in dying.

I was wrong. Over the years, I have closely watched the outcomes of the laws in Washington and Oregon. I helped care for three patients who chose the option. And I have interviewed several families whose loved one chose medical aid in dying. There are indeed individuals near life’s end who experience suffering that is beyond our capacity to alleviate. In some cases, the high doses of narcotics needed to alleviate the suffering are either inadequate or result in sedation to unconsciousness, leaving families in turmoil about how to say, “I love you” and “Goodbye.” There has been no evidence of misuse or coercion. Fewer than one in 200 deaths involved medical aid in dying, and virtually all are on hospice.

Under Minnesota’s proposed End-of-Life Options Act, which is modeled after the time-tested laws in Washington and Oregon, an adult must be diagnosed with a terminal illness and have a prognosis of six months or less to live. They must make two oral requests, submit a written request, and be fully evaluated by two clinicians who would determine eligibility, including whether the patient is capable of giving informed consent and acting of their own volition. Patients who lack mental capacity, such as those suffering with dementia, would not qualify. Any kind of coercion is strictly prohibited through criminal penalties.

In both Washington and Oregon, medical aid-in-dying has been implemented in this manner for decades: sparingly, and with compassion and thoughtfulness. Individuals who have chosen this option had complete agency in their decision-making, and they imminently faced terminal diseases such as cancer or ALS. Loved ones were involved, and the consensus was clear: This option brought comfort and control, leading to a peaceful dying process.

As a hospice medical director, I bore witness to three patients who opted for this path. Our hospice provided excellent care, yet their suffering was beyond the ability of our hospice teams to relieve. I also spoke with several patients who were considering medical aid in dying, and by being able to discuss it openly and without guilt or fear of legal prohibitions, they decided against the option because they concluded that hospice could manage their suffering.

Now, I am facing my own terminal illness. Fortunately, the suffering around my death is likely to be brief and manageable with hospice care. However, as someone with death on the horizon and having seen the positive impact of this law in 10 other states and Washington, D.C., I believe that Minnesotans should no longer be denied the opportunity to make their own end-of-life choices. Every American values life, especially those facing death. Indeed, that value sits atop our Declaration of Independence, right next to “liberty,” the right to decide for ourselves without government coercion.

The End-of-Life Options Act is just that — an option. No individual — doctor, nurse, pharmacist or patient — is required to participate. The American Medical Association’s Code of Medical Ethics states that physicians can provide medical aid-in-dying “according to the dictates of their conscience without violating their professional obligations.” The End-of-Life Options Act gives patients the freedom to make health care decisions that reflect their values and priorities.

After a decade of discussion, and now with the evidence from states like Washington, Oregon, and others, it is time for lawmakers to allow Minnesotans to have agency over their lives as we near our deaths. It is time to stop  forcing some to endure unnecessary terminal suffering. It is time to listen to Minnesotans who strongly support this legislation.

I urge the Minnesota legislature to take a compassionate stance and pass the End-of-Life Options Act  this year. Let us embrace a future where Minnesotans have the autonomy to choose the course of their own end-of-life journey, just as I wish to have for myself. It is time for Minnesota to join the ranks of states that acknowledge the right to all compassionate choices in the final chapters of our lives.