Analysis of 2019 Minnesota “End of Life Options Act”

                                               H.F. 2152, as introduced

This bill would transform Minnesota’s crime of assisted suicide[1] into a medical treatment. If passed, non-physicians could diagnose individuals as eligible for a lethal drug overdose.  The patient could be diagnosed and the massive overdose of drugs could be prescribed in less than a week. 

If the bill becomes law:

Non-physicians could diagnose a patient and prescribe the drugs to cause that patient’s death.

The bill permits a “health care provider,” defined as a person who is licensed, certified, registered or otherwise authorized or permitted to administer health care or to prescribe and dispense medication under the provider’s scope of practice.  That definition includes not only a doctor of medicine or osteopathic medicine but also a clinical nurse specialist or a nurse practitioner[2] who could diagnose (or misdiagnose) a patient as having a terminal illness and prescribe the lethal drugs.

Patients could be diagnosed as having a terminal illness and receive the drugs to end their lives almost immediately.

A patient could receive the diagnosis and, on the same day, make one oral request and a written request for the deadly drugs.

One oral request and one written request must be made to the health care provider[3] after the diagnosis is confirmed by a consulting health care provider.[4]  The consulting health care provider could be in the same practice as the attending health care provider.

There are no waiting periods between the diagnosis, the requests and the prescription.

The lethal drugs, when prescribed, could be delivered by mail or messenger service.

The drugs could be provided by the health care provider to the patient[5] or to someone designated by the patient or, by mail service or messenger service.[6]

Drugs for suicide could be prescribed for patients who could live for many years.

Proponents of the bill emphasize the requirement that a patient must be diagnosed with a terminal illness as if this were some sort of safeguard against abuse.   However, they avoid explaining that “terminal illness” is very broadly defined as an “incurable or irreversible illness that will, within reasonable medical judgment, result in death”[7] for a patient who has a prognosis of six months or less.[8]

However, a disease or condition can be incurable and irreversible but can be controllable, thus permitting the patient to live for many years.

There is documentation that, under Oregon’s assisted-suicide law, patients who could have lived for years, even decades, have died using legally prescribed lethal drugs.

According to the official Oregon report, released in February 2019, the “terminal diseases” that qualified some patients for the lethal overdose included diabetes, arthritis, arteritis, sclerosis, stenosis, kidney failure, and musculoskeletal system disorders.[9]

One such case was described by Dr. Charles Blanke, an oncologist and professor of medicine at Oregon Health and Science University, who acknowledges that he has written dozens of prescriptions for assisted suicide.[10]  He explained that one young woman who came to him with a serious illness had a 90 percent chance of living for decades with recommended treatment.  The woman, however, refused the treatment. “That was a very challenging situation,” he said.  “You have to ask yourself, ‘Why doesn’t that patient want to take a relatively non-toxic treatment and live for another seven decades?'”   Blanke ended up prescribing the deadly overdose for the woman anyway.[11]

Should health care providers be able to prescribe assisted suicide for patients who could live for many years?

Government bureaucrats and profit-driven health insurance programs could cut costs by denying payment for treatment that patients need and want, while approving payment for less costly assisted suicide deaths.

The bill requires that the health care provider discuss “feasible alternatives” with the patient before prescribing drugs to cause death.[12]

However, informing someone of all options does not mean the patient will have the ability or financial resources to access those options.  It only means the person must be told about them.

If prescribed suicide becomes just another treatment option (and a cheap one at that), the standard of care and provision of health care changes.  There will be less focus on extending life and eliminating pain, and more focus on the efficient and inexpensive “treatment option” of death.

Patients may find that their insurance provider will not cover the treatment they needed and wanted but, instead, will pay for prescribed suicide as has happened in states where prescribed suicide is legal.

There is documented information about terminally ill patients in Oregon and California who were denied coverage for treatment by insurance providers and, instead, were told that assisted suicide would be covered.[13]

Referring to payment for assisted suicide, the Oregon Department of Human Services explains, “Individual insurers determine whether the procedure is covered under their policies, just as they do any other medical procedure.”[14]

If the Minnesota bill is approved, will insurance programs do the right thing – or the cheap thing? 

Minnesota could become an assisted-suicide destination. 

Nothing in the bill requires that a patient be a resident of Minnesota to be eligible for assisted suicide under the “End-of-Life Options Act.”

………………

[1]   Minn. Stat. § 609.215.

[2]   H.F. 2152, Subdivision 2 (f). Definition of “Health care provider.”

[3]   H.F. 2152, Subdivision 6, “Request process.”

[4]   H.F. 2152, Subdivision 2, (d).  Definition of “Consulting health care provider.”

[5]   H.F. 2152, Subdivision 9, “Attending health care provider responsibilities,” (12) (i).

[6]   H.F. 2152, Subdivision 9, “Attending health care provider responsibilities,” (12) (ii).

[7]   H.F. 2152, Subdivision 2 (o). Definition of “Terminal illness.”

[8]   H.F. 2152, Subdivision 2 (m). Definition of “Qualified individual.”

[9]   Oregon Death With Dignity Act, 2018 Data Summary, February 2019, p. 11 and p. 13, fn. 3..  Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf.    (Last accessed, March 14, 2019.)

[10]   Lynne Terry, “Oregon’s Death with Dignity: Barriers remain 20 years later,” Oregon Live: The Oregonian, October 27, 2017.  

[11]  Tara Bannow, “Rural Oregonians Still Face Death with Dignity Barriers,” Bend Bulletin, August 14, 2017.

[12]   H.F. 2152, Subdivision 2, Definition of “Informed decision,” (g) (2) and Subdivision 9, “Attending health care provider responsibilities, (3) (v).

[13]  See, for example:  Bradford Richardson, “Assisted-suicide law prompts insurance company to deny coverage to terminally ill California woman,” Washington Times, October 20, 2016.  Available at: http://www.washingtontimes.com/news/2016/oct/20/assisted-suicide-law-prompts-insurance-company-den. (Last accessed March 14, 2019.)
Also see: Susan Donaldson James, “Death Drugs Cause Uproar in Oregon,” ABC News, August 6, 2008.  Available at:  http://abcnews.go.com/Health/story?id=5517492&page=1. (Last accessed March 14, 2019.)

[14]  Oregon Dept. of Human Services, “FAQs about the Death with Dignity Act.”  Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf. (Last accessed March 14, 2019.)

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