This essay is presented in two different formats:
first using the line-divisions preferred by the author
and then as it would appear in a newspaper.
The text is the same both formats.

Should Minnesota clarify end-of-life choices?

By JAMES LEONARD PARK

    Part of Minnesota's brief law against 'assisting suicide'
has now been found unconstitutional. 
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 to kill himself or herself.
  
    Minnesota has already revised its law against 'assisting suicide'
so that doctors can help their patients to die in reasonable ways
such as ending all medical treatment and disconnecting life-support machines.
But laypersons are not explicitly empowered to help anyone to die.

    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 at the end of life
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 yet again
so that making wise end-of-life medical choices
does not put anyone on trial for committing the crime of 'assisting suicide.'

    Perhaps the existing law against 'assisting suicide' should be replaced
by a more detailed law against 'causing premature death.'

_____________________________________________

 We want to avoid both
dying too soon and dying too late.

_____________________________________________

    Such a new law would permit Minnesotans
to make wise end-of-life medical decisions
as long as such choices did not result in dying too soon.
We want to avoid both dying too soon and dying too late.
Taking everything into account,
we should be permitted to choose the best time to die.

    Any new law governing end-of-life choices
will embody meaningful safeguards
to separate premature death from timely death.

    Here are 11 safeguards to include in Minnesota's new right-to-die law:

    (1) The primary-care physician should issue a written statement
describing the condition and prognosis of the patient.

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

    (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 also 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.

    (5) If there is any doubt about the patient's capacity
to make life-and-death decisions,
let a psychological professional such as a psychiatrist or psychologist
interview the patient to assess the patient's mental abilities
and reasons for choosing death.

    (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? 
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 towards 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 end-of-life plan?

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

    (10) If there is any doubt about the legality of the
life-ending decisions, all of the fulfilled safeguards
could be reviewed by county attorney to
see if any criminal charges might result from
making the proposed end-of-life choices.

    (11) Whatever safeguards are specified in the new right-to-die law for Minnesota,
meaningful waiting periods for reflection should be included.
Have all end-of-life options been explored deeply enough?

     These eleven 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 are permitted
as we choose the best pathways towards death.

James Leonard Park
is the founder of Right-to-Die Minnesota
and author of How to Die:
Safeguards for Life-Ending Decisions.
same essay with the length of line used on the StarTribune op-ed page:

Should Minnesota clarify
end-of-life choices?

By JAMES LEONARD PARK

    Part of Minnesota's brief law against 'assisting
suicide' has now been found unconstitutional. 
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 to kill himself or herself. 
    Minnesota has already revised its law against
'assisting suicide' so that doctors can help
their patients to die in reasonable ways such
as ending all medical treatment and disconnecting
life-support machines. But laypersons are not
explicitly empowered to help anyone to die.
    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 every-
thing medical science and technology can offer.
    However, medical practice now does allow
reasonable choices to be made at the end of life
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 yet again so that making
wise end-of-life medical choices does not put
anyone on trial for committing the crime of
'assisting suicide.'
    Perhaps the existing law against 'assisting
suicide' should be replaced by a more detailed
law against 'causing premature death.'

We want to avoid both
dying too soon and
dying too late.

    Such a new law would permit Minnesotans
to make wise end-of-life medical decisions as
long as such choices did not result in dying
too soon. We want to avoid both
dying too soon and dying too late. Taking
everything into account, we should be
permitted to choose the best time to die.
    Any new law governing end-of-life choices
will embody meaningful safeguards to separate
premature death from timely death.
    Here are 11 safeguards to include in Minnesota's
new right-to-die law:
    (1) The primary-care physician should issue
a written statement describing the condition
and prognosis of the patient.
    (2) An independent physician should also examine
the patient and the medical records in order to
create a second written opinion about the medical
problems and prospects of this patient.
    (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 also 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.
    (5) If there is any doubt about the patient's capacity
to make life-and-death decisions, let a psychological
professional such as a psychiatrist or psychologist
interview the patient to assess the patient's mental
abilities and reasons for choosing death.
    (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?  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 towards
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 end-of-life plan?
    (9) If the patient has a meaningful connection with
any organized religion, perhaps the opinion of
a minister, priest, rabbi, or other religious leader 
could be requested.
    (10) If there is any doubt about the legality of the
life-ending decisions, all of the fulfilled safeguards
could be reviewed by county attorney to
see if any criminal charges might result from
making the proposed end-of-life choices.
    (11) Whatever safeguards are specified in the new
right-to-die law for Minnesota, meaningful waiting
periods for reflection should be included. Have
all end-of-life options been explored deeply
enough?
     These eleven 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 are permitted
as we choose the best pathways towards death.

 James Leonard Park
is the founder of Right-to-Die Minnesota
and author of How to Die:
Safeguards for Life-Ending Decisions.

Created June 10, 2012; Revised 6-12-2012; 6-20-2012; 6-28-2012; 7-26-2012;
3-31-2013; 4-3-2013; 4-4-2013; 4-24-2015; 4-25-2015; 5-15-2015; 3-30-2018;

  James Park is an independent thinker
with deep interest in medical ethics,
especially the many issues surrounding the end of life.  
Medical Ethics and Death are two of the ten sections of his website:
James Leonard Park—Free Library

    Right-to-Die Minnesota can be found on Facebook:
http://www.facebook.com/pages/Right-To-Die-Minnesota/165503450171710
And here is the Internet location for Right-to-Die Minnesota:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/RTD-MN.html

    James Park's most relevant book is available free of charge on the Internet:
How to Die: Safeguards for Life-Ending Decisions:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/HTD.html

    And here is a draft of a possible new law called
Causing Premature Death:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/PREM-DTH.html

    A Free Book on Facebook keeps up-to-date on right-to-die issues:
Choosing Death Wisely: Notes from the Edge of the Right-to-Die:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CDW.html


    Here are a few related chapters and on-line essays:

Advance Directives for Medical Care:
24 Important Questions to Answer

Losing the Marks of Personhood:
Discussing Degrees of Mental Decline

Fifteen Safeguards for Life-Ending Decisions

Will this Death be an "Irrational Suicide" or a "Voluntary Death"?

Will this Death be a "Mercy-Killing" or a "Merciful Death"?

Four Legal Methods of Choosing Death

Methods of Choosing Death in a Right-to-Die Hospice

Pulling the Plug:
A Paradigm for Life-Ending Decisions

Increasing Pain-Medication:
Palliative Care as a Method of Dying

Terminal Sedation:
Dying in Your Sleep—Guaranteed

VDD:
Why Giving Up Water is Better than other Means of Voluntary Death

Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice

Depressed?
Don't Kill Yourself!
   
    Further Reading:

Best Books on Voluntary Death


Best Books on Preparing for Death


Books on Terminal Care


Books on Helping Patients to Die


Medical Methods of Managing Dying


Best Books on the Right-to-Die

Books Opposing the Right-to-Die



If you have appreciated this op-ed piece,
here are three more concerning the right-to-die:

Right-to-Die Hospice

Do We Need a New Method of Dying?

Replacing Laws against 'Assisting Suicide'


Go to the Right-to-Die Portal.

Return to the DEATH page.

Go to the Medical Ethics index page.

Go to other on-line essays by James Park,
organized into 10 subject-areas.

Go to the beginning of this website
James Leonard Park—Free Library