Among the many important issues that the Minnesota Legislature will consider this year, at least one is expected to generate significant passions both in support and in opposition. That proposal, known as the End-of-Life Option Act, addresses a practice referred to as medical aid-in-dying or, for some, assisted suicide. It is a proposal that merits scrutiny and robust deliberation. A pre-session hearing on January 25 in the House of Representatives generated heartfelt testimony and significant media coverage. Much of the resulting media coverage, however, inaccurately characterized the MMA’s position on this important topic as “neutral.” This incorrect representation of MMA’s policy would suggest that the MMA – the largest physician advocacy group in Minnesota – is uninterested or only passively engaged in this topic. That is simply not correct. With this Insights issue, we write to clarify the MMA’s position.  

The fact that there are split viewpoints on this issue, including among physicians, is not surprising. Physicians play a privileged role in the lives and deaths of our patients. The MMA acknowledges that well-meaning, ethical individuals hold different and varying opinions. Key principles at stake in this issue – to “do no harm” and to respect patient autonomy and self-determination – are both at the core of medical ethics and professionalism. We appreciate that each physician will need to reach their own conclusion.  

As an advocacy organization, however, the MMA is asked by policymakers for our position on critical health policy issues. Prior to 2016, the MMA relied on policy adopted in 1992 that opposed “physician-assisted suicide” noting that, “the societal risks of involving physicians in medical interventions to cause patients' deaths” were too great. In 2016, a legislative proposal was introduced in Minnesota that would have allowed the practice and, by that time, five other states had enacted laws legalizing it. As a result, the MMA Board of Trustees commissioned a task force to further examine the issue, review the legislative proposal, and gauge the sentiment of Minnesota physicians.  

The task force had participation from a variety of specialties and perspectives. The task force informed their direct deliberations by seeking broad physician input via an in-person policy forum and through a statewide survey (with 700 respondents). The MMA Board of Trustees adopted the task force report and recommendations in May 2017; the policy (240.48) was reaffirmed in 2021. 

The adopted MMA policy deliberately articulates neither support for nor opposition to physician aid-in-dying out of respect for the diversity of viewpoints of Minnesota physicians. The policy, instead, establishes boundaries and safeguards to guide MMA analysis of any physician aid-in-dying proposals. At its core, the MMA policy recognizes the sacred trust inherent in the patient-physician relationship; a relationship that must be protected through all stages of life, including the dying process.  

The policy further notes that the MMA will oppose any aid-in-dying legislation that fails to adequately safeguard the interests of patients and physicians. Such legislative safeguards include but are not limited to the following: 

•   must not compel physicians or patients to participate in aid-in-dying against their will;  
• must require patient self-administration; 
•  must not permit patients lacking decisional capacity to utilize aid-in-dying;  
•  must require mental health referral of patients with a suspected psychological or psychiatric condition; and  
•  must provide sufficient legal protection for physicians who choose to participate.  

The policy further notes that all physicians who provide care to dying patients have a duty to make certain their patients are fully aware of hospice and palliative care services and benefits.  

It is the assessment of the MMA that the current legislative proposal, authored by Rep. Mike Frieberg and Sen. Kelly Morrison, MD, meets the core safeguards defined in MMA policy. Should the legislation advance this year, the MMA will continue to ensure that such safeguards remain in place.  

On behalf of the MMA, we appreciate the opportunity to provide you with clear and accurate information about the MMA’s position on this important proposal.  

Laurel Ries, MD 

MMA President 

Kimberly Tjaden, MD, MPH 

Board Chair