NSS Weekly: The Debate to Legalize Medical Aid in Dying

Transcript

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INTRO: You are listening to North Star Stories: Voices from Where We Live, a newscast about what it means to live in Minnesota, produced by AMPERS, with support from the McKnight Foundation and the State of Minnesota.

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HOST: This is North Star Stories: Voices from Where We Live. I'm Britt Aamodt.

This week, we reflect on Mental Health Awareness Month. Then, we examine the debate to legalize Medical Aid in Dying, also known as death with dignity or suicide. And after 50 years, lawmakers look to recognize the impact one immigrant community has had on our state. But first, a look at some of the state's headlines from the past week.

Childcare providers and Minnesota's economic development leaders say the state's childcare industry is in financial trouble and it's holding back families, employers, and local economies. The Minneapolis Federal Reserve Bank says 86-percent of childcare owners and managers say the state's industry is in crisis. On the Iron Range, a task force says more than two thousand children on the Mesabi and Cuyuna ranges, and the North Shore, don't have care. Keeping an estimated 800 people out of the workforce. Shawntel Gruba owns Iron Range Tykes in Mountain Iron. She told AMPERS member station KAXE that parents already pay high tuition but that doesn't mean childcare workers can earn a living.

SHAWNTEL GRUBA: Because there are so many unsubsidized state mandates that I still pay myself and my providers poverty wages.

HOST: The task force wants employers, local governments, and donors to help fund more childcare slots and better wages.

May is Mental Health Awareness month, and findings from a new national study and a new Minnesota student survey point to one key factor in youth mental health. A sense of belonging. The Trevor Project, the world's largest suicide prevention and crisis intervention organization for LGBTQIA2S+ young people under 25, surveyed more than 16,000 youth and found 36 percent seriously considered suicide last year. One in ten attempted it. Among those teens surveyed, 59 percent reported being bullied in the past year, 48 percent said they were bullied in person, and 36 percent said they were bullied online. The study found that youth who experienced bullying had more than three times the rate of suicide attempts compared with those who were not bullied. The Trevor Project also found that LGBTQIA2S+ youth in very accepting communities attempted suicide at about one-third the rate of those in unaccepting communities. State education officials say that sense of belonging is paying off with students feeling safer, less anxious, and more engaged. If you or someone you know needs help, call or text 9-8-8.

In related news, a mother's push to make Minnesota bridges safer is now state law. Governor Tim Walz signed Kayla's Hope Act into law. The act requires state agencies to identify bridges and other public structures with a history of suicides or attempts, then develop criteria for when suicide-reduction measures should be added to bridge construction projects. The law is named for Kayla Gaebel, a 29-year-old mother of two who died by suicide at Minneapolis's Washington Avenue Bridge in 2023. Kayla's mother, MJ Blair, says constructing physical obstacles can give people in crisis more time to live.

MJ BLAIR: Her death was so preventable. You know, had those barriers been put up a year ago, two years ago.

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HOST: Efforts to pass legislation legalizing medical aid in dying, also known as assisted suicide, have been introduced nearly every year for more than a decade at the State Capitol. But despite those efforts, the proposals have not become law. Reporter Jules Yaeger spoke with legislators and advocates about why the issue remains so contentious.

[NANCY UDEN: "I'm not afraid of death, but I am afraid of how I will die. I promised my family that I would fight this ugly disease until there's no hope left, and my death is inevitable. So if there are no more treatment options, then I deserve more death options."]

JULES YAEGER: That's Nancy Uden, a resident of Corcoran, just west of the Twin Cities, speaking in support of a bill at the Minnesota Legislature in 2024. She was diagnosed with aggressive, terminal brain cancer two years earlier. The bill she's advocating for would legalize Medical Aid in Dying, commonly known as physician-assisted suicide. Ten states have laws allowing it, but it has never been legal in Minnesota. Since testifying, Uden has died without the option to end her life before her illness, did. The End of Life Option Act would change that. Under the proposed law, Minnesotans who are terminally ill would be able to request assisted suicide if they have less than six months to live. Advocates for the bill say it would allow terminal patients to die on their own terms, with dignity and autonomy, and that it would reduce the suffering that can accompany illnesses like cancer and ALS. State Representative Mike Freiberg, who serves part of the Twin Cities western suburbs, is the chief author of the bill.

REP MIKE FREIBERG: After having met with people who've gone through this, they want to be able to end their lives on their own terms, surrounded by family. If I were ever in a situation like this, personally, I would want to have this option.

JULES YAEGER: Terminally ill Minnesotans would only be able to receive Medical Aid in Dying if they meet certain requirements. Eligible patients would have to be over the age of 18, mentally capable of making their own healthcare decisions and able to self-administer the lethal medication. Kathy Ware has been working as a registered nurse in Dakota County for almost 30 years. She's an opponent of Medical Aid in Dying.

KATHY WARE: As a registered nurse and a medical professional, I just don't believe that the medical community doctors and nurses should be engaged in ending people's lives prematurely.

JULES YAEGER: Opinion in the medical community is mixed. In a 2020 poll of doctors nationwide, 55% said that Medical Aid in Dying should be on offer for terminally ill patients. The Minnesota bill leaves the question of participation up to individual doctors.

REP MIKE FREIBERG: The bill does not require any physician to participate. So if they are opposed to it, they don't have to. I do think it's telling that groups like the Minnesota Medical Association, they had been opposed to it previously, but they changed the organization's positions to one of neutrality, just because so many doctors felt like this was the right thing to do.

JULES YAEGER: Alongside her work as a nurse, Kathy Ware cares for her 31-year-old son, Kylen, who has profound physical and mental disabilities due to a genetic condition. She feels that offering assisted suicide to terminal patients is an insult to people with disabilities and their caretakers.

KATHY WARE: It bothers me a lot, this loss of dignity thing. You hear lawmakers say it, and doctors and nurses say death with dignity. What you're saying is you want to die before you become like my son. What's undignified? Needing a diaper change, needing the saliva wiped from your mouth? That's not undignified, and providing those cares is demonstrating empathy and love.

JULES YAEGER: The bill came close to becoming law during the 2023-2024 session of the legislature. It passed several committees in the House, but was stopped in the Senate, in large part by DFL Senator John Hoffman. He wrote an editorial in the Star Tribune urging fellow lawmakers to tread carefully around assisted suicide. He echoed Ware's concerns for the disabled, saying, "What assisted suicide 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." Representative Freiberg says the bill will not have an adverse effect on the disabled.

REP MIKE FREIBERG: There has been no documented instance of anybody being coerced into using Medical Aid in Dying, disabled or otherwise.

JULES YAEGER: The bill does not allow patients to receive medical aid in dying based on disability status alone. Even so, opponents like Kathy Ware would prefer lawmakers focus not on legalizing assisted suicide, but on other improvements to end of life and chronic illness care in Minnesota. She says her experience with the State Health System, both as a medical professional and a caretaker, has allowed her to see the system's deficits.

KATHY WARE: People in palliative care or hospice care are not given access to our most successful opioids or narcotics or medications. There is a catastrophic staffing crisis. If we had total pain management, total symptom control, to the extent of the medical community's available resources, total support effort in staffing, your loved one doesn't have to feel like a burden to you, and you can just be mom, wife, sister, brother. If we could present those options equally, I don't think that we would have nearly the number of people requesting this or wanting this.

JULES YAEGER: Freiburg says that Minnesota can and Minnesota should do both: provide its citizens with adequate and affordable care and legalize Medical Aid in Dying. But the future of the bill in the Minnesota Legislature is uncertain. Lawmakers have pursued the legalization of Medical Aid in Dying in Minnesota for more than a decade. Its support breaks down largely on partisan lines, and though the current bill has over 30 DFL co-sponsors, it's unlikely to pass until the DFL controls the legislature by a larger margin. It's too late this session for the bill to get a hearing to have a shot at becoming law. It will have to be reintroduced next year. For North Star Stories, I'm Jules Yaeger.

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HOST: Discussions about end-of-life planning are often avoided or pushed aside. But delaying those conversations can make the unexpected loss of a loved one even more difficult for families to navigate. To learn more about how to plan and prepare for these moments, we are joined now by Jennifer Bueno, an attorney at law with Southern Minnesota Regional Legal Services, or SMRLS. They provide free legal services to low-income people in critical civil matters, including help with health care directives and powers of attorney. Jennifer works in the elder law unit. Thanks for joining us, Jennifer.

JENNIFER BUENO: Hi, thanks for having me.

HOST: So from your experience, what is the best way to begin a conversation about end of life planning?

JENNIFER BUENO: Whether it be for yourself or you're thinking about approaching a loved one about it, I encourage everyone not to think of it only as end of life planning. It's also long-term care planning, and you want to frame it as a way of "Let's create a plan that will protect me." It protects yourself, but it also protects the people you love and gives guidance to the people you love, who naturally will want to help you in some of these situations. You're creating a plan today to protect your tomorrow.

HOST: So what are some of the most important estate planning tools people should know about, and when should someone start thinking about putting those plans in place?

JENNIFER BUENO: One, a power of attorney, and two, a healthcare directive. Both of these documents are free, or nearly free to complete, and both have forms and templates that are readily available to the public. And as far as when should someone start, we always say, start now, regardless of your age, regardless of your wealth, especially these two documents. These are two documents that can be applicable at any point in your life, not necessarily right, at your time of death or just before that time of death. A power of attorney, that's a written legal document where you would give another person legal authority to handle your financial matters and your legal matters, and that person you appoint that's your choice. It can be a loved one, it can be a friend, but we emphasize that this absolutely needs to be a person that you trust, without a doubt. Looking at the health care directive very quickly, by comparison, that is considered, in a way, kind of like a medical power of attorney. That first one is financial stuff and legal stuff. This one is medical issues. It tells your caregivers and doctors what to do if you become unable to make decisions for yourself regarding your health care.

HOST: That's a lot to think about. When is it important to work with an attorney versus doing it yourself?

JENNIFER BUENO: I would say that if your situation is very straightforward and you really just want to name one trusted person as your agent, you have no major disputes in your family, things like that, then you might be in the realm where DIY it's okay to do that. Same with if you're comfortable using free guided tools like, for example, LawHelpMN.org. That's an excellent tool. Same with if you don't need help finding a notary or meeting some of the signing requirements for these documents. When you're in the realm of wanting to work with an attorney, I would say that is when your family situation is complicated. You have a blended family. You know, you have disputes in your family. You have, you know, step children, etc. If you're receiving medical assistance too or another government benefit, you might want to contact an attorney to see how one might affect the other. You want to make sure that in your planning you're not accidentally negatively impacting another aspect of your life and vice versa.

HOST: If people wanted to get a hold of you or SMRLS, how would they go about doing that?

JENNIFER BUENO: So you can give us a call at 1-877-696-6529. And again, that's free legal help for Minnesotans who are income-qualifying or who are 60 years and older. Well, thank you so much for your time, Jennifer, thank you.

JENNIFER BUENO: Thanks. Thanks for having me.

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HOST: After the break, efforts in the legislature to recognize the impact Minnesota's Hmong community has had on our state. This is North Star Stories: Voices from Where We Live, produced by AMPERS with support from the McKnight Foundation and the State of Minnesota. We'll be right back.

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HOST: You are listening to North Star Stories, I'm Britt Aamodt.

In other news from across the state, statewide hunger is reaching record levels. Minnesotans made some nine million visits to food shelves last year, while Northland Hunger Relief groups say more than one in five children in the region face food insecurity. But, on the North Shore, the Grand Portage Band of Lake Superior Chippewa is growing its own way towards food sovereignty by breeding bison. In just three years, they've grown the herd to 34 bison, with seven new calves this spring, and distributed more than 2,600 pounds of meat from four bison. In an interview with AMPERS member station WTIP, Herd Manager and Tribal Planner Jared Swader says the goal is to expand.

JARED SWADER: I'm hoping to get closer to about five to seven harvests per year, because I think that'll really impact. It'll make a larger impact on our community.

HOST: Swader says they'll keep the herd between 35 and 50 animals and bison will be a regular source of food for the community.

The Department of Public Safety, or DPS, fired the head of its Missing and Murdered Indigenous Relatives, or MMIR, Office, Guadalupe Lopez, after less than a year on the job, and just one day after National MMIR Day. Lopez was the third permanent director since the office opened in 2021, and the first to be clearly reported as fired. When Lopez was hired, DPS described her as a nationally respected advocate with more than 25 years of work on domestic violence, sexual assault, trafficking, and MMIR issues. Senator Mary Kunesh helped create the office. She says the moment should bring the focus back to the families and communities it was built to serve.

SEN MARY KUNESH: And I am 100% dedicated to ensuring its ability to continue the work and to find a way to evolve in a way that truly supports our Native communities.

HOST: The office works with families, law enforcement and tribal governments on cases involving missing and murdered indigenous people. DPS has not given a reason for why it fired Lopez.

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HOST: This spring, Minnesota legislators introduced a bill to officially recognize Hmong Cultural Heritage Week in the state. During committee hearings, families and community members shared personal testimony, describing the need to recognize the Hmong community's contributions to Minnesota as a way to help future generations preserve cultural traditions. Reporter Jamad Jama has the story.

SEN SUSAN PHA: The Hmong people, as you know, are unique people, because they do not have a country of their own. They do not have a national government or a formal system to preserve their language, their culture or their history.

JAMAD JAMA: At the Capitol this spring, Minnesota lawmakers heard testimony on a bill that would create and formally recognize Hmong Cultural Heritage Week throughout the state. Senator Susan Pha brought forth the proposal, saying it's not just about an official week on the calendar.

SEN SUSAN PHA: Without intentional preservation and observance, cultures can disappear, not by vanishing all at once, but slowly over time.

JAMAD JAMA: Hmong Cultural Heritage Week is meant to acknowledge and preserve that history, and would build on earlier recognition, including the governor's declaration of Hmong Heritage Month in 2025.

SEN SUSAN PHA: We chose May 14 as the beginning and May 23 as the ending of that week, because May 14 was the day where mass amounts of Hmong people escaped out of the country they'd known. May 23 was the day that President Gerald Ford signed into law the bill that would open up the doors and welcome these refugees.

JAMAD JAMA: Senator Pha says the proposed bill will reflect that history, especially in a state where one of the largest Hmong populations in the country, where they've built both businesses and community.

SEN SUSAN PHA: Today, in Minnesota, it is thriving. The Hmong people are thriving here, and it's only because Minnesota embraces diversity of all cultures, embraces people from all corners of the world, and this bill ensures that a people like the Hmong, without a country, are not without value, and that their history has a place.

JAMAD JAMA: At the Hmong Museum, located in St Paul, staff say that history is something they must work to preserve every day.

MAI HUIZEL: My name is Mai Huizel. I am the Executive Director of Hmong Museum. What Hmong Museum does is we document, record Hmong-American experiences, as well as share those experiences and stories out into the public.

JAMAD JAMA: For Huizel, recording those stories is one aspect of the work. Making sure they're recognized and understood by future generations is another step.

MAI HUIZEL: A lot of our history and knowledge is passed on through oral culture, and so it's passed on from one generation to the next. So a lot of these experiences, a lot of Hmong history and knowledge, is not written anywhere for us. It's important to document these stories in a library or archive so that we can have some evidence of our history to share for future generations.

JAMAD JAMA: But preserving a community's history and formally acknowledging it are not always the same thing, and that's where the idea to create a Hmong Cultural Heritage Week comes in.

MAI HUIZEL: I think it's really important, and it's a way for us to just remember one little piece of history. It would give people validation in recognizing the contributions of the Hmong people to the community. It's a great way for the community to kind of rally around that remembrance and that sharing of those experiences.

JAMAD JAMA: For some Minnesota families, that work to preserve Hmong culture and knowledge feels deeply personal.

DR KHA YOUNG: My name is Dr Kha Young. I am a Hmong Minnesotan, a scholar of Hmong language loss and an author of Hmong children's books. My research shows that this loss is accelerating. What typically takes three generations is happening in less than one in many Hmong families.

JAMAD JAMA: The impact of that cultural loss is something she's seen up close within her own family, and she spoke about that experience during the bill's initial hearing.

DR KHA YOUNG: While I held on to my language, many others did not. My own brother lost his Hmong language completely. Today, he can only communicate with our mother through a translator. This is more than language loss. It is severed relationship.

JAMAD JAMA: For Kha, stories like this are part of what makes official and recognized cultural preservation so important. So other Hmong families don't go through that kind of loss.

DR KHA YOUNG: This legislation benefits all Minnesotans by fostering understanding, unity and respect across cultures.

PANG YANG: Chair and members of the committee, my name is Pang Yang, executive director of MN Zej Zog, whose mission is to empower the Hmong community.

PANG YANG: As a graduate of St Paul Public Schools, I never saw Hmong history taught in the classroom.

JAMAD JAMA: Yang later returned to these schools as a teacher, hoping to bring these histories into the classroom with her.

PANG YANG: When I was finally able to share my family's story of the Secret War, a student walked out, refused to listen. That moment had stayed with me, because absence sends them a message. It tells students their stories don't matter. For Hmong students, this is about belonging, knowing that Minnesota is home, not just to where we live, but in what we learn. Hmong American Heritage Week can fill that gap.

JAMAD JAMA: For North Star Stories, I'm Jamad Jama.

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HOST: The Hmong community has called Minnesota home for half a century, and today the population numbers more than 100,000 people, especially in the Twin Cities. They represent an important part of the state's cultural diversity and also a strong economic force. We're joined now by Toua Xiong, the founder of St. Paul's HmongTown Marketplace, which includes a food court, hundreds of vendor stalls and an outdoor market. HmongTown Marketplace opened in 2004. Thank you so much, Toua, for joining us.

TOUA XIONG: Thank you for giving me the opportunity.

HOST: So the Hmong community is one of the largest immigrant groups in Minnesota. How would you describe its economic influence?

TOUA XIONG: In terms of economic, we are contributing to the state of Minnesota as a whole. For example, the article from Dr. Bruce Corrie in 2023 says, the year 2000 the income growth for the Hmong community is $311 million. For the year 2021 that $311 million grew to $2.3 billion. The home equity growth in the year 2000, it was $281 million but in the year 2021 is was$4.1 billion. So these are just some of the economic impacts of the Hmong community's growth here in the state of Minnesota.

HOST: What do you think is behind that growth?

TOUA XIONG: Being more familiar in the system, being more professional, being more proficient, being more experienced and being more understanding of the overall infrastructure. Those are the main reasons contributing to this growth. For example, the parents that brought us in the mid 80s, there were the people that mainly served the US CIA in Laos. And those mostly are not educated. And then, having become this age, in this group of our population, we are very proficient. We are starting to be proficient, and then to be professional, to understand, to have some money to invest. So those are the things.

HOST: So I'm going to ask about some recent history here. We had Operation Metro surge earlier this year. Did that have an impact on Hmong businesses?

TOUA XIONG: I can't really say, and I don't want to say on behalf of others, but I am saying on behalf of myself. The HmongTown Marketplace and Pan Asia Center, which is the former Macy's and former Sears of Maplewood Mall. I own both properties. During that ICE surge here in Minnesota, we as owners are even though we are legally, we're US citizens, we are still panicking that we might be detained out in the parking lot. Now, talking about our vendors, even though we are most of us are US citizens, many of our vendors do not speak English. So if they come and they look at the social media, for example, the Hmong person that got dragged out of his house with no clothing out of the middle of the winter. Many of our vendors are afraid that they may drag them like that, and they may be out there and they may get detained. For example, we have over 200 small booth here at the HmongTown during those month and a half. It is less than half of those vendors are opening on a daily manner. It is that dramatic. It is that that that much of a negative impact, to be honest with you.

HOST: Thank you for sharing that. What do you think the general public should understand about Hmong owned businesses?

TOUA XIONG: In the past, until today, are still owning small mom and pop shops, but now that enough experiences have been gathered, moving into the future, we are going to be launching ourselves, increasing ourselves, lifting ourselves from a mama papa shop into more economic driven projects. So we are that. We are got to be a social contributor, political contributing community, or economic contributing community, here in the City of St Paul, in the Twin Cities, on the state of Minnesota as a whole. We are not going to go away. We are going to be thriving. We will continue to thrive and will continue to grow in the years to come.

HOST: Well, thank you so much for sharing your insights and your stories today, Toua.

TOUA XIONG: Thank you so much.

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HOST: The state is calling on you to help our local businesses. The Minnesota Department of Employment and Economic Development, or DEED, is launching a new statewide campaign called Choose Minnesota to encourage support for local businesses. The agency says the initiative will promote shopping, dining and spending locally to help strengthen communities and boost Minnesota's economy. DEED will also host a series of round table discussions with business owners across the state this summer.

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HOST: This is it for today's program. If you missed any part of today's newscast, you can find this and past episodes at AMPERS.org or listen to the podcast wherever you get your podcasts. You can also get North Star Stories daily on our website or check your favorite station's schedule. Thanks for listening, and we'll be back next week with more stories and voices from the North Star State.

OUTRO: North Star Stories is produced by AMPERS, diverse radio for Minnesota's communities, with support from the McKnight Foundation and the State of Minnesota. Online at AMPERS.org.