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Appeal from a Former Palliative Care Doctor: Advocate for End-of-Life Choices Bill

In 2008, following more than ten years of deliberation, the residents of Washington state approved a law to legalize medical aid in dying by a significant 16% margin. This initiative garnered support from the majority of voters in 30 out of 39 counties, showcasing a bipartisan endorsement from both conservative and liberal factions. The legislation closely mirrors the law enacted in Oregon in 1994, which has since been adopted in 10 other states and the District of Columbia.

During my tenure as a hospice and palliative medicine practitioner in Washington at that time, I vocally opposed and voted against the measure. My stance aligned with the concerns and viewpoints currently expressed by opponents in Minnesota. I firmly believed in the efficacy of hospice and palliative care in alleviating physical, emotional, and spiritual distress for individuals. I harbored apprehensions that the introduction of medical aid in dying could inadvertently influence healthcare providers and potentially patients to opt for this option against their personal convictions. Additionally, I feared that terminally ill patients might opt for medical aid in dying instead of receiving hospice care.

Subsequent events proved my apprehensions unfounded. Over the years, I closely monitored the outcomes of the laws in Washington and Oregon. I personally cared for three patients who chose this alternative, and I interacted with numerous families whose loved ones opted for medical aid in dying. It became evident that certain individuals nearing the end of life encounter suffering that transcends conventional palliative measures. In some instances, the standard doses of pain-relieving medications proved insufficient or led to unconsciousness, making it challenging for families to bid farewell to their loved ones. Importantly, there have been no reported cases of abuse or coercion. The utilization of medical aid in dying was infrequent, accounting for less than one in 200 deaths, with the vast majority of cases occurring within hospice care settings.

The proposed legislation in Minnesota, modeled after the established laws in Washington and Oregon, mandates that adults diagnosed with a terminal illness and a prognosis of six months or less to live must fulfill specific requirements. These include making two oral requests, submitting a written request, and undergoing thorough evaluation by two healthcare providers to ascertain eligibility, capacity to provide informed consent, and volitional decision-making. Notably, individuals lacking mental capacity, such as those afflicted with dementia, are ineligible. The law strictly prohibits any form of coercion, enforced through legal ramifications.

In both Washington and Oregon, the implementation of medical aid in dying has been characterized by judicious use, compassion, and careful consideration. Individuals who opted for this option did so in the face of imminent death due to conditions like cancer or ALS, with the support and consensus of their loved ones. Their decisions granted them comfort, control, and facilitated a peaceful transition.

As a hospice medical director, I bore witness to three patients who chose this path due to unmanageable suffering that surpassed the scope of our hospice’s interventions. Conversations with patients contemplating medical aid in dying revealed that open dialogue, devoid of guilt or legal repercussions, often led them to opt for hospice care as a means to address their distress.

Presently, as I confront my own terminal illness, I anticipate minimal and manageable suffering through hospice support. Reflecting on the positive impact of similar laws in 10 states and Washington, D.C., I advocate for Minnesotans to have the autonomy to make end-of-life choices. The proposed End-of-Life Options Act offers a voluntary choice without imposing obligations on healthcare professionals or patients. Upholding the principles of individual liberty and informed decision-making, this legislation empowers patients to align their healthcare preferences with their values and priorities.

After a decade of deliberation and drawing insights from states like Washington and Oregon, it is imperative for Minnesota legislators to grant residents the freedom to navigate their end-of-life journey. By passing the End-of-Life Options Act, Minnesota can embrace a future where individuals have the liberty to shape their final chapters in alignment with their personal beliefs. It is time to heed the voices of Minnesotans who advocate strongly for this legislation, promoting compassion and dignity in end-of-life care.

I implore the Minnesota legislature to demonstrate compassion and enact the End-of-Life Options Act this year. Let us usher in an era where Minnesotans have the agency to steer their end-of-life trajectory, mirroring the autonomy I desire for myself. It is high time for Minnesota to join the cohort of states recognizing the right to compassionate choices in the twilight of life.