11 steps toward empowering Minnesotans at life's end

Part of Minnesota's law against "assisting suicide" has been found unconstitutional by the Minnesota Supreme Court ("Nurse wins appeal over suicides," March 20). Freedom of speech covers discussing methods of dying.

Exploring end-of-life options is now permitted. But it is still against Minnesota law to assist someone in killing himself or herself.

Minnesota already has revised its law against assisting suicide so that doctors can help their patients die in reasonable ways such as ending medical treatment and disconnecting life-support machines. But laypersons are not empowered to help anyone make end-of-life choices.

Advances in medical technology now mean that most of us will be exercising some choices at the end of our lives. If no one says "enough," we might be in danger of being "treated to death." Maximum medical efforts will continue to be applied to our bodies until we die despite everything medical science and technology can offer.

However, medical practice now does allow reasonable choices to be made so that we are not required to die while still connected to life-support tubes and machines.

Minnesota laws regarding end-of-life care should be revised again so that helping someone to make wise end-of-life medical choices does not result in a trial for committing the crime of assisting suicide.

Perhaps the existing law should be replaced by a more detailed law against "causing premature death." Our goal should be avoid both dying too soon and dying too late.

Any new law governing end-of-life choices must include safeguards to distinguish premature death from timely death:

1 Minnesota's new right-to-die law should require the primary-care physician to issue a written statement describing the condition and prognosis of the patient.

2 An independent physician should also examine the patient and medical records, in order to create a second written opinion about the medical problems and prospects.

3 If the patient had the foresight to create an advance medical directive, how does that apply to the present end-of-life situation?

4 If the patient is still able to make medical choices, he or she should add an explicit request for death, explaining in his or her own words exactly why death at this time seems better than death at some later time.

6 In some cases, it would be wise to require trying palliative care. Would better symptom control make life more bearable?

7 Do the patient's close relatives also agree that death is the best available option under the circumstances? If the patient has selected proxies to make medical decisions, do they also agree that all of the medical facts and options suggest a shorter pathway toward death rather than keeping the patient alive as long as possible?

8 If the patient is being cared for in some medical facility that has an ethics committee, does this group of doctors, nurses, ethicists and lawyers also agree with the plan?

9 If the patient has a meaningful connection with any organized religion, perhaps the opinion of a minister, priest or rabbi could be requested.

10 If there is any doubt about the legality of the life-ending decisions, all of the fulfilled safeguards could be presented to the county attorney to see if any criminal charges might result.

These 11 safeguards could be elaborated as needed for difficult cases. But the new law against causing premature death would name specific safeguards that could be presented as proof that this life-ending decision was reached only after the most careful examination of all the relevant facts and professional opinions. Clarifying our end-of-life options would allow all Minnesotans — both doctors and patients — to know just what decisions we can make as we choose the best pathways toward death.