“People have a right both to receive and to refuse health care. Significant improvements have been made in our ability to manage pain, known as palliative care, which makes physician-assisted suicide unnecessary,” John Hoffman writes. (iStock/The Minnesota Star Tribune)

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Legislative proposals to legalize physician-assisted suicide in Minnesota have been introduced in Minnesota every year since 2015. The bill contents change regularly as the authors try to stay ahead of the numerous legal, medical and ethical objections that are raised ("Whose decision at death's door," Nov. 12). Many of the changes just create new concerns. In whatever form, such legislation is dangerous and would likely have serious consequences for vulnerable populations — particularly those with disabilities.

People have a right both to receive and to refuse health care. Significant improvements have been made in our ability to manage pain, known as palliative care, which makes physician-assisted suicide unnecessary. In Oregon, where assisted suicide is legal, people choose assisted suicide primarily because they do not want to be dependent upon or a burden to others as they near the end of life. But what assisted suicide thereby teaches is a type of ableism, meaning that the lives of those who are dependent upon others for care lack quality and are not worthy to continue.

The haunting echoes of Hadamar, a chilling chapter in history, reverberate through time as a stark reminder of the perils in allowing societal judgments about what constitutes quality of life to dictate who lives and who dies. As we grapple with the complexities of the assisted suicide movement and the increasing influence of health maintenance organizations (HMOs), which make such judgments in their coverage decisions, we must ensure that the most vulnerable members of our society — those with disabilities — are not forsaken in the name of misguided ethics or economic considerations.

During the darkest days of the German eugenics regime in World War II, the Hadamar Euthanasia Center became synonymous with the systematic extermination of those deemed unfit, a gruesome precursor to the atrocities of the Holocaust. Among the victims were individuals with disabilities, perceived as burdensome to society. The horrors of Hadamar underscore the dangers of devaluing certain lives based on social prejudices and the profound consequences when vulnerable populations are left unprotected.

Although the autonomy of individuals facing terminal illnesses is a crucial consideration, and proponents of assisted suicide argue that the legislation only extends to those with terminal diagnoses, the slippery slope emerges when the criteria for assisted suicide broadens to include those with disabilities, those with dementia, those with mental illness and others.

The risk lies not in undervaluing personal autonomy for the few who currently want assisted suicide, but in normalizing attitudes that prioritize convenience over compassion. We are already seeing this dynamic at work in Canada, where the list of eligible persons continues to expand and where veterans with disabilities are offered assisted suicide drugs instead of coverage for things such as wheelchair lifts.

In Minnesota, HMOs' health care decisionmaking introduces another layer of complexity. When profit-driven entities are entrusted with determining the allocation of resources and medical care, the risk of neglecting the needs of individuals with disabilities becomes pronounced. Ethical guidelines and oversight mechanisms must be in place to ensure that financial considerations do not override the commitment to the well-being of all individuals, regardless of ability.

At the end of the day, when care is expensive and killing is cheap, which do we think will prevail? Do we really believe that economics will play no part in shaping assisted suicide laws? Despite assisted suicide being sold as protecting choice and autonomy, it will likely end up limiting the health care options of vulnerable populations and perhaps the rest of us as well.

As we navigate the ethical landscape of the assisted suicide movement and grapple with the influence of HMOs in health care decisions, the shadows of Hadamar serve as an ominous warning. We must approach these issues with compassion, recognizing the inherent value of every life, including the lives of individuals with disabilities. The legacy of Hadamar beckons us to tread carefully, ensuring that our commitment to human dignity remains steadfast.

John Hoffman, DFL-Champlin, is a member of the Minnesota Senate.