The fate of even serious discussion about a right-to-die law in Minnesota currently lies in the hands of what may seem like an unlikely character: California Gov. Jerry Brown.

True, a bill was presented to a Senate committee last spring by a handful of DFL senators. But the bill — the Minnesota Compassionate Care Act — was presented in an informational hearing only, meaning there was no vote by the committee. The idea of presenting the bill, according to Sen. Chris Eaton, DFL-Brooklyn Center, was “to get the conversation started.”

Yet the conversation supporting what is often referred to as assisted suicide often seems as if it’s being conducted in whispers. The loudest, most organized activity isn’t among supporters of the right-to-die bill, in fact. It’s by Minnesota Citizens Concerned for Life (MCCL), which opposes the legislation. At this point, it is highly unlikely that the Compassionate Care Act will be a topic of discussion in Minnesota’s 2016 legislative session.

That’s where California’s Brown figures in the picture. In mid-September, the California legislature passed a right-to-die bill, which has been lying on Brown’s desk ever since. He has three choices: sign it, veto it, leave it unsigned. If he leaves it unsigned, it would become law in mid-October, meaning California would become the sixth state where physicians are allowed to hasten the death of some terminally ill patients.

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More important, legalization in California would create a new round of national media attention on this issue, which would create momentum in other states toward passing assisted dying laws.

Is ‘right-to-die’ the new ‘freedom-to-marry’?

Start with this: The phrase “assisted suicide” is considered misleading — and politically loaded — among proponents of “end of life” choices.

“Suicide is a terribly tragic event,” said Rebecca Thoman, who for years was a volunteer with the Minnesota Chapter of Compassion & Choices. She helped organize Compassion & Care chapters in across both Iowa and Minnesota. “A suicide represents somebody not receiving the mental health treatment they needed. … Aid in dying represents an end-of-life choice by an individual.”

By any name, where does the issue stand in Minnesota?

Sen. John Marty, DFL-Roseville, was among the handful of DFLers who took leadership in presenting Minnesota’s right-to-die bill in May. He compares the issue to same-sex marriage.

“Over time you will see an attitudinal change,” Marty said. “When you look back just 10 years, you see how much attitudes changed on same-sex marriage. The more people think about this, the more they’ll see it as an issue of personal choice.”

What’s different about this issue and same-sex marriage is that for years, the American public has supported right-to-die legislation at much higher levels. A Gallup Poll in May showed 68 percent support the idea. The issue has support, according to the poll, across all age and political spectrums. Indeed, public support for physician-assisted dying dates back nearly two decades.

Well-organized opposition

As shown repeatedly, politicians don’t necessarily respond to public opinion (hello, Sunday liquor sales). Instead, special-interest groups — especially well-organized ones — have big voices in public policy.

In this case, that’s the MCCL, which has fought the legalization of abortion dating back to 1968. Now it’s stepping front and center in opposing end-of-life legislation; when Sen. Eaton asked for a statewide conversation on the issue, the MCCL was more than happy to oblige.

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MCCL Executive Director Scott Fischbach says that the organization has held 50 meetings across the state over the summer and that there has been as much passionate opposition to aid in dying as there’s been around opposition to abortion.

MCCL Executive Director Scott Fischbach

Fischbach says that the Compassionate Care Act, which is based on Oregon’s landmark right-to-die law, is loaded with dangers, ranging from financial pressures on the poor to end their lives prematurely, to a lack of safeguards, to psychological burdens on physicians. The discussion should not be about assisted suicide, Fischbach said, but about more resources for hospice care and mental health treatment.

Those associated with Compassion & Choices don’t disagree with Fischbach that more should be invested in palliative and hospice care. But they also say that the Minnesota bill is, in fact, filled with myriad safeguards.

Under the proposed law, a person wishing to hasten his or her own death would need to meet the following criteria: The attending physician would have to determine that the person has less than six months to live; the person would have to be assessed as competent (no signs of depression, mental illness or dementia); the person would have to make two written requests to a physician for prescription of lethal drugs within 15 days; and the person would have to be able to administer the lethal dosage by him or herself.

The notion that low-income people would feel more pressure than those of higher income is not borne out by statistics in Oregon, where assisted dying has been legal since 1997. Statistics there show that most who request assisted dying measures are white, well educated and from middle- to upper-middle-class backgrounds. (The number of requests in Oregon is minuscule. Last year, for example, about 33,000 people died in Oregon. Of that number, about 100 people died as a result of physician assisted aid.)

Physicians, too, would have choice in this matter. Under the proposed Minnesota law, physicians would not be required to prescribe life-ending drugs, but would be obliged to refer their patients to physicians who would write the needed prescription.

How the notion of a ‘natural death’ has changed

So, given these safeguards, why have the American Medical Association and statewide medical organizations traditionally opposed life-ending drugs?

“I think that aiding dying makes us face our limitations,” said David Plimpton, a retired Minnesota physician who is on the board of directors of the Minnesota Chapter of Compassion & Choices. “As physicians, we’re afraid of death. Death is failure. We’re warriors against death. Death is evil. Life is good.”

But, Plimpton says, the whole notion of “natural death” has been stood on its ear by modern medical practices, which have extended life, though not necessarily quality of life. He argues, in a quiet voice, that dying aids would make medical practices “patient-centered” in a way that currently does not exist.

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Plimpton also points out that attitudes among physicians are changing. For example, after years of opposing aid in dying, the California Medical Association took a “neutral” position on the subject prior to the recent legislative action in California. He also notes that the American Medical Student Association has come out in favor of patient choice in this matter.

Laws lag changing attitudes

But if attitudes are changing, the process likely is going to be slow, for aid in dying represents political risk. When an organization such as the MCCL stands in opposition, there are a significant number of politicians, especially within the Republican Party, who will listen closely. The organization may not be huge — it claims 70,000 members in Minnesota — but its members show up at such events as party caucuses, meaning conservative pols must listen or lose endorsement.

But Fischbach says that “the political opposition will be bipartisan.” He says that national polling doesn’t show support for physician assisted suicide so much as it reflects a national desire “for more caring” for those in pain and nearing the end of life.

The Minnesota Chapter of Compassion & Choices has been around since 2000 quietly urging support for aid in dying. Janet Conn, president of the organization, believes momentum is increasing not only in Minnesota but across the nation.

State Sen. Chris Eaton

“We’re doing more speaking than we’ve ever done and we’re passing out more literature,” Conn said. “There’s a lot more conversation about end-of-life issues than we’ve seen before. There are more articles, more books. People are seeking a peaceful end to the dying process.”

But Conn also admits that opponents are more visible. “People who oppose anything often are real vocal and really organized,” Conn said. “Part of our job is to show legislators that we’re here and we represent a large majority. … You wouldn’t think it would fall along party lines. Everybody dies.”

Wherever this is going in Minnesota, it’s likely going slowly. Again, look to the California process. In 1992, Californians, via the petition process, had a chance to vote on the issue and overwhelmingly rejected “Californians Against Human Suffering.” In ensuing years, physician assisted suicide was frequently introduced in the state legislature and always defeated.

But the political tone changed dramatically in California in 2014 when Brittany Maynard, a young California woman with terminal brain cancer, moved to Oregon so she could have “the right to die on my own terms.” Her highly public decisions were especially powerful in California where the law that would allow physicians to assist in the suicide of some people sits on the governor’s desk.

By contrast, the discussion is in the early stages in Minnesota. Eaton says she believes her bill was the first ever introduced in the state Legislature.