MINNESOTA LAW PERMITS

SOME FORMS OF

PHYSICIAN AID-IN-DYING


    The following law was copied from the Minnesota Statutes on February 24, 2008.
Nothing in the text of the law has been changed.
Only line-divisions have been added to aid reading on computer screens.

    More comments and suggestions follow the text of the law.
Other jurisdictions could make similar changes.

    In March 2014, the Minnesota Supreme Court struck down "advises" and "encourages",
removing them from the first line of this law.
Freedom of speech covers all discussion of methods of dying.
Thus, the only prohibition that remains in this law is ASSISTING a suicide.



2007 Minnesota Statutes

609.215 SUICIDE.

    Subdivision 1. Aiding suicide.

Whoever intentionally advises, encourages, or assists
another in taking the other's own life
may be sentenced to imprisonment for not more than 15 years
or to payment of a fine of not more than $30,000, or both.

    Subd. 2. Aiding attempted suicide.

Whoever intentionally advises, encourages, or assists
another who attempts but fails to take the other's own life
may be sentenced to imprisonment for not more than seven years
or to payment of a fine of not more than $14,000, or both.

    Subd. 3. Acts or omissions not considered aiding suicide or aiding attempted suicide.

(a) A health care provider, as defined in section 145B.02, subdivision 6,
who administers, prescribes, or dispenses medications or procedures
to relieve another person's pain or discomfort,
even if the medication or procedure may hasten or increase the risk of death,
does not violate this section unless the medications or procedures
are knowingly administered, prescribed, or dispensed to cause death.

(b) A health care provider, as defined in section 145B.02, subdivision 6,
who withholds or withdraws a life-sustaining procedure
in compliance with chapter 145B or 145C
or in accordance with reasonable medical practice
does not violate this section.

    Subd. 4. Injunctive relief.

A cause of action for injunctive relief may be maintained against any person
who is reasonably believed to be about to violate
or who is in the course of violating this section
by any person who is:
(1) the spouse, parent, child, or sibling of the person who would commit suicide;
(2) an heir or a beneficiary under a life insurance policy of the person who would commit suicide;
(3) a health care provider of the person who would commit suicide;
(4) a person authorized to prosecute or enforce the laws of this state; or
(5) a legally appointed guardian or conservator of the person who would have committed suicide.

    Subd. 5. Civil damages.

A person given standing by subdivision 4, clause (1), (2), or (5),
or the person who would have committed suicide, in the case of an attempt,
may maintain a cause of action against any person who violates or who attempts to violate subdivision 1 or 2 for
compensatory damages and punitive damages as provided in section 549.20.
A person described in subdivision 4, clause (4),
may maintain a cause of action against a person who violates
or attempts to violate subdivision 1 or 2
for a civil penalty of up to $50,000 on behalf of the state.
An action under this subdivision may be brought
whether or not the plaintiff had prior knowledge of the violation or attempt.

    Subd. 6. Attorney fees.

Reasonable attorney fees shall be awarded to the prevailing plaintiff
in a civil action brought under subdivision 4 or 5.

History: 1963 c 753 art 1 s 609.215; 1984 c 628 art 3 s 11; 1986 c 444; 1992 c 577 s
6-9; 1998 c 399 s 37



CRITIQUE OF THE PRESENT LAW AGAINST 'ASSISTING SUICIDE'
AND SOME SUGGESTED MINOR REVISIONS

   
Suicide itself was long ago removed from the law of Minnesota and most other states.
All that remains from ancient times is the crime of 'assisting a suicide'.
And now even this crime has been clarified
so that it does not include the standards practices of terminal medical care.
Normal medical care and the withdrawal of care
do not fall under laws prohibiting assisting a suicide.
The most useful and interesting new provisions of this law are Subdivision 3 (a) and (b).

    (a) permits health care providers to give medications to their patient
for the relief of pain and discomfort,
even with the knowledge that such medications might shorten the process of dying
as long as the intention of the health care provider is not to cause death.

    This has been a long-established practice in medicine,
but only recently has it been explicitly recognized in law.
Other states are encouraged to follow the example of Minnesota.

    The use of medication for controlling pain and discomfort
could be divided into two categories as used in the medical profession:
(1) increasing pain-medication & (2) terminal sedation.

1. Increasing pain-medication.

Whatever medications are normally used for a specific medical problem
can be increased within reasonable limits
as long as the decision to increase medication
is not an explicit decision to bring death to the patient.
The knowledge that the increased medication
will probably shorten the process of dying (in a dying patient)
is not the same as assisting an irrational suicide,
which this law defines as advising, encouraging, or assisting
another person in "taking the other's own life".

2. Terminal sedation.

Altho this law does not explicitly describe terminal sedation,
this common medical practice would fall under this permission to use medications.
Terminal sedation is the practice of giving a dying patient
enough medication to keep him or her continuously unconscious
until death take place from natural causes.
Under this practice, the medication is not intended directly to cause the patient's death.
Such a purpose is prohibited by this law against assisting in an irrational suicide.
But the practice of terminal sedation acknowledges that death is the very likely outcome
of the medical decision to keep the patient continuously unconscious by medical means.
Coupled with terminal sedation,
the patient will almost always be removed from all forms of life-support,
including food and water provided by any means, including tubes.
Termination of life-supports is discussed in the next section of this law (b).

    Because increasing pain-medication and terminal sedation
have now become so common in modern medical practice,
this section of any law against assisting an irrational suicide
or causing a premature death might be given a better formulation:

    Here is the current formulation in Minnesota law:

(a) A health care provider, as defined in section 145B.02, subdivision 6,
who administers, prescribes, or dispenses medications or procedures
to relieve another person's pain or discomfort,
even if the medication or procedure may hasten or increase the risk of death,
does not violate this section unless the medications or procedures
are knowingly administered, prescribed, or dispensed to cause death.

    Because it is so difficult to prove the complete intent or purpose of the health-care provider,
this reference might better be dropped from any new laws following this pattern:

A health care provider (as defined by another section of the law)
does not violate this section
if drugs are prescribed, dispensed, or administered
or if medical procedures are ordered
for the purpose of relieving the patient's pain, distress, of discomfort
as long as such medical care is in accordance with reasonable medical practice.
Such medical care may be lawfully provided
even if the drugs or procedures are likely to shorten the patient's process of dying.




    (b) permits health-care providers to withhold or discontinue any form of life-support.

    This is also a long-established part of medical care.
When there is no reasonable hope of recovery,
the patient, the family, & the doctors agree to withhold or withdraw
any and all forms of life-sustaining procedures and technology.
Everyone knows that death will inevitably follow.
But the death is recorded as having been caused by the underlying disease or condition
and not by the fact that life-support measures were terminated.

    This section of a law against assisting an irrational suicide
explicitly states that health-care providers who 'pull the plug'
on any means of sustaining life
are not guilty of assisting an irrational suicide.

    This revised law does not mention another common medical practice,
namely giving up all food and water at the end of life.
But especially when food and water
are being provided to the patient by means of tubes,
such means of sustaining life would be considered part of the life-supports,
which can now be withdrawn
without danger of a charge of assisting an irrational suicide.

    Voluntary death by dehydration is not mentioned in this law,
but it could be argued that this freedom to decline food and water
is completely compatible with everything in this law.
When the life-support provided by a feeding-tube is removed,
then the immediate cause of death might be medical dehydration.
But the official cause of death should be recorded
as the underlying medical condition
that led to this decision to discontinue life-supports,
including food and water provided by any means.

    Perhaps other states or countries will include such provisions
when they revise their laws against assisting irrational suicide.

    Here is this very brief mention in current Minnesota law:

(b) A health care provider, as defined in section 145B.02, subdivision 6,
who withholds or withdraws a life-sustaining procedure
in compliance with chapter 145B or 145C
or in accordance with reasonable medical practice
does not violate this section.

    And such a provision might be expanded to be even more explicit:

A health care provider (as defined in another part of the law)
does not violate this section
if any or all forms of medical treatment or life-support systems
are withdrawn or withheld from the patient.
Such changes in medical care may be lawfully decided
even if the changes will likely result in the death of the patient
as long as such changes are in accordance with reasonable medical practice.




    These four legal ways to choose to die are discussed more completely here:
"Four Legal Methods of Choosing Death":
http://www.tc.umn.edu/~parkx032/CY-L-END.html

    Any combination of the legal options for bringing life to a close
might be applied in a right-to-die hospice:
http://www.tc.umn.edu/~parkx032/METHODS.html

    Perhaps about half of all deaths taking place in the state of Minnesota
already use one of these available methods for making life-ending decisions:
http://www.tc.umn.edu/~parkx032/CY-1MILL.html

    The difficulties of applying old-fashioned laws
against encouraging or assisting self-killing
are explore completely in the following on-line essay:
"Interpreting Laws Against 'Assisting Suicide' ":
http://www.tc.umn.edu/~parkx032/CY-ASLAW.html

    And forward-looking prosecutors who must apply out-dated laws about 'assisting suicide'
can apply prosecutorial discretion in deciding exactly when to bring charges:
"Prosecutors Can Announce their Guidelines":
http://www.tc.umn.edu/~parkx032/SG-A-PROS.html




REVISING OR REPLACING LAWS AGAINST 'ASSISTING SUICIDE'

    The exceptions added to Minnesota law for health care providers
was accomplished without any public debate or fanfare.
These new sections were probably added by a doctor who is also a legislator.
And the argument was that terminal care practices noted
are already well established in the normal practice of medicine.
And since 'assisted suicide' laws were never intended
to control the behavior of doctors caring for patients who are dying
there was no oppostion to including these additions to the law about 'assisting suicide'.

    Other states and countries that prohibit helping anyone to commit suicide
could also add these medical exceptions to their laws,
probably without meaningful opposition.
Doctors should be permitted to increase pain-medication,
to order terminal sedation, and to discontinue curative treatments and life-supports
all without any fear of being charged with 'assisting a suicide'.

    When such a change of law is introduced by a medical doctor,
who can answer any questions from other legislators about medical practice,
the changes should be simple to add to the section
of any set of laws that outlaws 'assisting or encouraging suicide'.

    An even more comprehensive reform of any set of laws
would completely replace the law against 'assisting suicide'
with a new law against causing premature death.
Such a law would specifically address bedside terminal-care decisions,
allowing all reasonable medical care without any threat of criminal prosecution.
But it would continue to prohibit assisting people foolishly to commit irrational suicide.
Here is a draft of such suggested legislation:
Causing Premature Death:
http://www.tc.umn.edu/~parkx032/PREM-DTH.html

    And here is a brief explanation of how such laws might work:
"A New Way to Secure the Right-to-Die: Laws Against Causing Premature Death"
http://www.tc.umn.edu/~parkx032/CY-RTD-N.html

    A more extensive set of essays explains 12 advantages
of replacing laws against 'assisting suicide'
with new laws against causing premature death:
"Advantages of the Premature-Death Approach to the Right-to-Die"
http://www.tc.umn.edu/~parkx032/PD-ADV.html

    Any such changes in end-of-life law should include careful safeguards
to prevent mistakes, abuses, and distortions of the right-to-die.
Here is an on-line book that supports such changes of law:
How to Die: Safeguards for Life-Ending Decisions:
http://www.tc.umn.edu/~parkx032/HTD.html.
And PART ONE discusses 14 worries, problems, abuses, & mistakes
that might arise under any law that allows chosen death:
http://www.tc.umn.edu/~parkx032/SG-ABUSE.html.



created 2-24-2008; revised 2-28-2008; 4-7-2012; 4-11-2012; 4-25-2012; 4-4-2013; 3-21-2014;


Links to revised laws in other states and countries
which have overturned or modified laws against 'assisting a suicide'.
{Please send information about such changes to the webmaster:
James Park, e-mail: PARKx032@TC.UMN.EDU }

New South Wales in Australia
has issued a similar document explaining what doctors can do at the end of life:
End-of-Life Care and Decision-Making---Guidelines:
http://www.health.nsw.gov.au/policies/gl/2005/GL2005_057.html




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The contents of this page have not been reviewed or approved by the University of Minnesota.