Editor’s note: The following article deals with topics including depression, mental health and suicidal ideation. If you are, or someone you know is, struggling with such difficulties, resources include the 988 suicide and crisis lifeline and SAMHSA’s National Helpline at 1-800-662-4357.
Jean Swenson was an ambitious 28-year-old teacher working with at-risk youth in Minneapolis when her life changed forever.
As she drove a car full of teenagers in a drug rehab program back from an outing in 1980, she collided with a semitrailer. Swenson’s body was thrown into the windshield, the force of which broke her neck. Looking down to see her blood dripping on the floor of the vehicle, she realized that she could not move.
“I kept saying to myself, ‘Even though I walk through the valley of the shadow of death I will fear no evil, for you are with me,’” Swenson recalled of the painful minutes after the collision.
Swenson said she fell into a deep depression in the months after the accident. She found it difficult to accept that she would never play her piano again, cook for herself, or go to the bathroom without assistance.
“I wanted to die. I thought my life was over,” Swenson recalled.
Fortunately, Swenson said, physician-assisted suicide was not an option for her. She is now very grateful to be alive.
But if legislation for people diagnosed with a terminal condition passes in Minnesota and opens the door to potential expansion, assisted suicide could one day be an option for people like Swenson. Such legislation would be a tragedy, said Swenson, who is paralyzed from the neck down.
Canada, for example, now allows those with incurable illnesses or disabilities to take their lives. Some Canadian legislators have proposed to include people with mental illness in assisted suicide programs.
“It doesn’t stop here, but it expands,” Swenson said.
The Minnesota Catholic Conference (MCC), which represents the public policy interests of the state’s bishops, said in a recent action alert that the bill is “one of the most aggressive physician-assisted suicide bills in the country” and violates the teaching of the Catholic Church.
“As Catholics, we are called to uphold human dignity,” MCC wrote. “Legalization of assisted suicide works against this principle because death is hastened when it is thought that a person’s life no longer has meaning or purpose.”
The proposed legislation — HF1930/SF1813 — would allow anyone with a six-month terminal prognosis to come to Minnesota to get a prescription for a lethal drug. People who have disabilities are not included in the bill, but some warn that the legislation, if enacted, could soon expand to them as well.
Despite the opposition of pro-life leaders, many physicians, people with disabilities including Swenson and mental health experts, testimony and action taken by the House Health and Finance Policy Committee Jan. 25 appeared to signal that the legislation has momentum.
James Hamilton, a resident of St. Paul, has implored legislators to enact the bill before his small-cell lung cancer advances to a stage that will suffocate him.
“Death need not be this ugly. Were the law to allow it, I would choose to end my life before this disease riddles my body and destroys my brain,” Hamilton wrote in testimony to the House. “The time and manner of my death should be mine to decide.”
After a three-hour hearing, the committee passed the bill. The House Public Safety Committee is expected to discuss the issue once the legislative session begins Feb. 12. The committee will decide if the bill will continue its trajectory toward becoming law.
Committees in the Senate and the House must act favorably toward the bill by a March 22 deadline to keep the legislation in play.
Those who oppose the proposed legislation pointed to several concerning aspects of the bill.
Medical ethics
The proposal would not require doctors to prescribe a lethal dose of a drug to patients who meet all criteria for it. However, the bill states that doctors who refuse to provide a prescription for the lethal dose are required to refer a patient to a doctor who will.
Dr. Robert Tibesar, a pediatrician and member of St. Agnes in St. Paul, said in a Jan. 30 interview that he has been watching the proposed legislation and fears it would violate the conscience of ethical doctors.
“To say to someone, ‘Well I’m not going to harm you, but I’m going to send you to someone else who is going to harm you,’ still goes against our conscience. It still violates our covenant relationship with our patient,” said Tibesar, who is president emeritus of the Catholic Medical Association Twin Cities Guild.
Dr. Paul Post, a family medicine doctor who retired in 2019 after 37 years of practicing medicine in Chisago City, testified against the legislation at the hearing and said in an interview that referring patients to a doctor who will kill them is “just as serious” as prescribing the lethal dose.
“If you are making the referral, you are still involved in the act, so that doesn’t really take care of your freedom of conscience,” he said.
Tibesar and Post also expressed concern about a lack of sufficient mental health checks in the proposed legislation. The bill states that the physician who prescribes the medication is also the one who would refer the patient to a mental health specialist if he or she deems it necessary.
Tibesar suggested this system could allow biased and agenda-driven doctors to disregard signs of concern.
“It would not be a true evaluation of the patient’s mental health by an objective, unbiased medical expert in mental health,” said Tibesar. “It is just an … insincere effort to appease people who may have a concern.”
Dr. John Mielke, chief medical director at St. Paul-based Presbyterian Homes and Services with more than 40 years of experience caring for the elderly in Minnesota, said at a news conference held by the Minnesota Alliance for Ethical Healthcare before the House hearing that the legislation would “corrupt the physician’s ethics” by requiring the doctor to list on the death certificate the underlying diagnosis as the cause of death rather than assisted suicide. The alliance is MCC’s end-of-life care partner organization. It can be reached at ethicalcaremn.org.
Moreover, the bill would require doctors to determine a six-month-or-less prognosis for the patient to be eligible for assisted suicide. This prognosis, Mielke said, is virtually impossible to accurately determine. Patients outlive a six-month diagnosis in about 17% of cases, he said.
Dr. Paul Wojda, an associate professor of theology at the University of St. Thomas in St. Paul who specializes in healthcare ethics and has been following the issue, said in an interview Jan. 30 that if the bill passes into law there is a risk that doctors who oppose physician-assisted suicide will be terminated from their positions, or not hired, or simply not admitted to medical school.
“Healthcare professionals — mostly nurses but also it could include some doctors — are put into situations where they are asked or even required to do things that are contrary to their conscience. It leads to serious distress on their part,” said Wojda, who did not testify at the Jan. 25 House hearing.
Lack of oversight
Wojda also said the bill would require “really, really minimal” data to be recorded about the practice of physician-assisted suicide. The legislation would only require that data be collected on how many prescriptions doctors give for a lethal drug, how many patients take the prescribed doses and how many doctors are prescribing the doses.
Unlike Oregeon’s assisted suicide law, which served as a model for the proposed Minnesota legislation, no data on the race, age, gender, or self-reported motives would be collected of those who die in Minnesota.
Wojda said it is fanciful to think this would not lead to abuse.
“If I as a provider know that it is not going to be public information, then maybe I am a little less vigilant about it,” Wojda said.
Teresa Collett, a professor at the University of St. Thomas School of Law and director of the UST Prolife Center, testified at the hearing. In an interview, she said the lack of data collection under the proposed legislation is “absurd and terrible public policy.”
“We are going to know virtually nothing,” she said. “We are not going to know if it is being abused … we simply will not have the tools to detect why people are doing this.”
Potential for abuse
While it is illegal and would remain illegal under the proposed legislation for insurance companies to refuse a patient treatment in favor of them dying, cases of this happening in other states have nonetheless been documented. In 2017, the Washington Times in Washington, D.C., reported that an insurance company offered assisted suicide to a patient but not chemotherapy due to the cost of treatment.
“(The bill) is fraught with potential abuse,” Collett said.
Disability rights activists say that regardless of how the legislation expands, the bill as currently proposed is already working against people who have disabilities.
Kathy Ware — whose son Kylen Ware has quadriplegic cerebral palsy, epilepsy and autism — said that the proposal invalidates the worth of the lives of those with disabilities. At the Jan. 25 committee hearing, she advocated for greater resources and home health aides for the disabled, rather than making physician-assisted suicide an option for the terminally ill.
“Doctor- and practitioner-prescribed suicide will weaponize an already biased medical community even further against my son, Kylen, and his peers. We are already looked at as a burden to society and a drain on resources and finances,” Ware wrote in testimony to the Minnesota House.
Legislating physician-assisted suicide, according to Ware and other disability rights activists, would only intensify the stigma against those with disabilities.
Legislating despair
Collett said that if passed, the bill would “give way to despair.”
“I think, as a lawyer, as a matter of public policy, we should not be encouraging people to despair. We should instead be encouraging them, walking with them, and helping them find sufficient meaning to continue until natural death occurs,” Collett said in an interview.
“If avoidance of suffering is the highest good then the Passion makes no sense,” said Collett, who described her father-in-law’s final months of life as extremely important and valuable to her family. “There are things we learn from suffering that we cannot learn any other way.”
Isaac Wicker, a mental health therapist and a member St. Peter in North St. Paul, has worked with many patients who have struggled with suicidal ideation throughout his career. This legislation would be devastating to the mental health of those who already do not feel hope, he said.
“At an institutional level, we are saying that it is OK for you to die. We don’t need you; we don’t want you; we don’t care,” Wicker said in an interview. “That could be a really strong message not of empowerment but of rejection.”
The proposed legislation requires a prognosis of six months or less of life for one to qualify — the very period when profound personal and interpersonal healing can occur, Wicker suggested.
“The last six months of a person’s life, especially if the (family) system is aware that those are the last six months, that time can be very dynamic. A lot of healing can happen, a lot of reconnection and amends,” Wicker said.
Tibesar said that for Christians, the end of one’s life can be a time to find meaning in suffering in the light of Christ.
“It might actually be the holiest thing that person has ever done, to suffer well for those last days, weeks, months, whatever it takes. It might truly be their shining moment from a spiritual sense,” Tibesar said.
PHYSICIAN-ASSISTED SUICIDE
Under proposed physician-assisted suicide legislation HF1930/SF1813 in the Minnesota Legislature:
- If passed, a resident of any state could come to Minnesota to receive a dose of lethal medication
- The family of the person who will commit physician-assisted suicide does not have to be notified
- A doctor does not have to be present when the lethal dose is administered
- A physician who objects to the law would still be required to refer a patient to a doctor who will assist with their suicide
- A mental health evaluation is not required unless a physician deems it necessary
If the legislation passes, anyone will be able to come to Minnesota and obtain an assisted suicide if:
- The patient is over 18 years old
- The patient has a prognosis of six months or less to live
- The patient is deemed mentally fit
- The patient can administer the lethal dose themselves
Data that Minnesota will collect if the bill passes into law:
- How many lethal prescriptions were written
- How many doctors wrote these prescriptions
- How many people who were prescribed the medication took it
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