March 17, 2019

New Assisted Suicide Bill Introduced

HF 2152, an assisted-suicide bill was introduced in Minnesota on Thursday, March 8th.   After a brief analysis, the Minnesota Catholic Conference presents the following review:

  1. There is new language in the definitions section and in a new subdivision (line 3.20) that spells out in more detail what prescribing health care providers must provide regarding alternatives to assisted suicide.
  2. There is a new section that lays out the appropriate “standard of care,” which requires that health care providers unwilling to prescribe the death drugs still “obtain informed consent” and transfer the patient to another provider.  “Informed decision” is defined in the statute and not “informed consent,” so it is unclear if the appropriate standard of care is for the provider, even if unwilling to prescribe, to still facilitate the “informed decision.” My reading is, “yes.”  The appropriate standard of care requires that all providers inform patients about PAS, whether they will prescribe or not.  Lines 3.20-3.29. Absolutely terrible.
  3. Palliative care is no longer specifically defined.
  4. It is no longer the case that assisted suicide is forbidden based merely on the patient having a “specific illness.”  These sorts of omissions that cut directly from prior versions are a red flag and should be given more attention.
  5. There is an ominous provision that alternative means of taking the request are now permissible including “lip reading.”  See line 4.26  “For terminally ill adults who may have difficulty with oral communication, note 
    taking, written materials, technology-assisted communication, or, if viable, lip reading and 
    communication through persons familiar with the terminally ill adult’s manner of 
    communicating are acceptable.”
  6. Only one oral request and one written request is required.  No longer is a written request required to trigger the process.  It can be obtained at any time in the process.  There is only a recommended form for consent, which does not even require witnesses.  It looks like an attending physician could prescribe these pills based solely on lip reading or the advice of a “person familiar with the person’s manner of communication.”  The attending provider has to offer the opportunity to rescind before prescription, but that could function as the oral request, theoretically.  So, a doctor could (must) recommend as an option assisted suicide, and as long as he obtained the written form (which requires no witnesses or notary!) and got a lip read from the patient, it would comply with the statute.
  7.  Though it appears that doctors must still prescribe — as pharmacists and nurses are not generally in charge of a patient’s care, diagnosis, and prognosis — the use of the word “physician” has been dropped in favor “health care provider,” which is also defined to include pharmacists and RNs.  Providers who can prescribe is limited to the “Attending health care provider.”
  8. The requirements for a mental health evaluation are essentially the same.  It is required only if the attending provider believes the patient may not be competent.  It is not a requirement before prescription.
  9. There is more detail regarding safe disposal of drugs that are not used, including requirements that those in control return them to law enforcement or another appropriate entity.
  10. There is a data collection requirement, less well defined than the previous one, that requires the commissioner of health to collect data related to these prescriptions and make a report available to the public.  What is required to be in the report is not spelled out, though the commissioner must make rules regarding data collection and review a sample of the files to ensure compliance.  The information collected is NOT public data, so we have to rely on the commissioner.  Further, there are no prescribed forms that providers must complete, nor any requirement (yet) that they or the facility report any information to any particular party.  The previous bill actually spelled out record-keeping and reporting requirements.  So, any data collected will likely have little value.
  11. There is a new provision forbidding insurers from coercing patients into receiving PAS (line 10.6):  c) It is unlawful for an insurer to deny or alter health care benefits otherwise available 
    to a terminally ill adult based on the availability of medical aid-in-dying medication or 
    otherwise attempt to coerce a terminally ill adult to make a request for medical aid-in-dying 
  12. There are stronger protections and immunities for those who participate in the assisted suicide process.
  13. The old “subd. 14” (from last session) laying out conscientious protections for providers (individual and institution) is gone.  A health care provider (which could include a pharmacist under this language) has no duty to prescribe or dispense.  But there are no protections for not doing so, either from the facility, or the state.  Only for those “brave” providers who kill.  And the provider must still facilitate referral.  Given how few providers are willing to participate in some places, it is unclear how “reasonable” the referral efforts must be.  Must a referring provider find another doctor who he/she knows will participate?
  14. Ominously, health care facilities may not interfere with an employed provider’s decision to prescribe assisted suicide drugs, unless the patient wants to self-administer on campus.  Further, a doctor in a faith-based setting may not be prohibited from advising about the option.  In other words, faith-based hospitals and other facilities must facilitate assisted suicide.  This is absolutely terrible and should be deeply alarming to faith-based providers.
  15. Again, there are no requirements for what happens between the drug being dispensed and death.
  16. There is stronger language about coercion or forgery and it being punishable as a felony, but there are no prescribed penalties.  Perhaps judges and county attorneys will continue to go light on these “mercy” killers.
  17. There is a new statutory “construction” provision that states the following:  “(a) Nothing in this section authorizes a health care provider or any other person to end an individual’s life by lethal injection, mercy killing, or euthanasia.  (b) Actions taken under this section do not, for any purpose, constitute suicide, assisted suicide, euthanasia, mercy killing, homicide, or elder abuse under the law.”