End of life options act is crafted in a way that provides protections 

Editor’s note: this is a response to the April Access Press editorial, Consider rights of the disabled before allowing assisted […]

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Editor’s note: this is a response to the April Access Press editorial, Consider rights of the disabled before allowing assisted suicide. 

by Rebecca Thoman, M.D.  

As a physician and director of the campaign to pass the Minnesota End-of-Life Options Act (SF1813//HF 1930), I appreciate your thoughtful editorial comments. The End-of-Life Options Act, Introduced by Rep. Mike Freiberg and Sen. Dr. Kelly Morrison, would allow terminally ill adults the option to request and receive medication they can self-ingest for a peaceful death if their suffering becomes intolerable. I recognize that the history of abuse, neglect and trauma inflicted on adults and children with disabilities contributes to mistrust of the medical system and can make this conversation fraught with emotion.  

The original legislation upon which the Minnesota bill is modeled, crafted in Oregon more than two decades ago, was designed to account for concerns about the potential abuse of vulnerable populations. That’s why medical aid in dying is driven strictly by the patient and only the patient. Some of the major criteria include: 

  1. To qualify, a terminally ill adult must have a six-month prognosis (same as for hospice enrollment). 
  2. They must have full decision-making capacity understanding the risks and benefits of their treatment options and be able to give informed consent of their own volition. Substituted judgment (such as from guardians or healthcare proxies) is not allowed. 
  3. The request must be documented once in writing (which is submitted to the state department of health) and 2 verbal requests must be made to two different physicians or nurse practitioners of the patient’s choice who must document the request in the medical record. 
  4. Disability, advanced age or chronic disease in the absence of a six-month prognosis do not qualify a patient for medical aid in dying. 
  5. The individual must be able to self-ingest the medication (by swallowing, use of a gastric or rectal tube). Injections and infusions are explicitly forbidden, as is coercion which carries a criminal penalty.  

And, no one, including health care providers, is required to participate. As with reproductive healthcare or gender-affirming healthcare, providers may act in accordance with their own conscience. 

Concerns about the potential for abuse were first raised before the Oregon law was enacted in 1997. But now, with 25 years of experience from Oregon (and decades of experience from the other authorizing states), we don’t need to speculate. Data shows that the laws work as intended. In fact, Disability Rights Oregon hasn’t received a single complaint of abuse related to the state’s Death with Dignity Act. Annual reports from Oregon, Washington, California, Colorado and Vermont show that the vast majority of individuals who chose medical aid in dying were enrolled in hospice and died from cancer, heart or lung disease, or a progressive neurologic disorder like ALS. 

The movement for end-of-life options shares basic values with those of the disability rights movement: autonomy, dignity and self-determination. Our goal is to empower people at the end of life through conversations, advance care planning, and expanding end-of-life options. I welcome further discussion. 

Thoman is director for Doctors for Dignity, which is part of Portland, Oregon-based Compassion & Choices. Compassion & Choices fights for the rights of people at the end of their life and pushes back against those who seek to strip those rights away. Learn more at https://www.compassionandchoices.org/ 

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Mental Wellness