The United States’ northern neighbor is on pace to having the world’s most liberal assisted suicide policies. Are Canada’s policies trickling down to the U.S.?

It might appear so, given that border state Vermont not only allows its citizens to choose to die, but is also allowing people who live elsewhere to seek access to assisted death in Vermont, a practice that one Catholic publication recently dubbed “death tourism.”

It’s important, then, for people concerned about assisted suicide to keep an eye on what’s happening in Canada, where policies on medically assisted death have expanded dramatically since it became legal in June 2016.

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For a while, it was expected that Canada would open the doors last month to medically assisted death for people with mental illness as the sole qualifying condition, but recently, the country delayed that to March 2024. Marie-Claude Landry, the head of the United Nations Human Rights Commission, raised alarm bells about the country’s policies, insisting that the practice “cannot be a default for Canada’s failure to fulfill its human rights obligations.”

Assisted suicide in the U.S. hasn’t been a dominant issue of late. New York Times columnist Ross Douthat has speculated that robust conservatism acts as a bulwark against the practice becoming more widespread in the U.S.

Euthanasia isn’t legal anywhere in the U.S. Generally, the difference between assisted suicide and voluntary euthanasia comes down to who administers the lethal drugs, per The Guardian. In assisted suicide, a patient has to be able to consume the drugs themselves while in euthanasia, the doctor administers the drugs.

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Where assisted dying is legal in U.S.

In the U.S., no states permit people with mental illnesses to choose assisted suicide, as is proposed in Canada.

California, Colorado, District of Columbia, Hawaii, Maine, Montana, New Jersey, New Mexico, Vermont, Oregon and Washington are the places in the U.S. that currently have physician-assisted suicide policies. There are some differences among the laws, but there’s one consistency — the laws state that an individual needs to have a terminal illness and a prognosis of six months or less to live to be prescribed the medications to die.

In states where assisted suicide is legal, physicians typically lead patients through the process, but in some states, there have been challenges to that. Montana lawmakers, for example, recently considered legislation that would have exposed physicians to charges of homicide when helping a patient die; a patient’s consent would not have been enough to protect them from liability. The bill failed on its third reading.

Washington is looking at ESSB 5179, which is a bill that would allow a “qualified medical professional” who isn’t necessarily a physician to be more involved in the process of patients accessing assisted suicide. The bill slashes the waiting period to a week and permits the lethal drugs to be delivered to patients.

Nevada has SB 239 before the Senate, which would introduce parameters for assisted suicide in the state. Dr. Kirk Brolander of Reno gave testimony regarding what he sees as a flaw in the bill — relying on doctors to offer accurate prognoses. He said, “A misdiagnosis coupled with poor prognostication results in a patient getting a lethal prescription when they could have years of good quality life left to live.”

Other states that have considered or are considering medically assisted dying bills this year include: Arizona, Connecticut, Florida, Indiana, Iowa, Massachusetts, Minnesota, Nevada, New York, Pennsylvania, Rhode Island and Virginia. Hawaii, Oregon and Vermont have considered or are considering amendments this year.

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Disability rights and assisted dying

Some believe that disability rights are threatened by medically assisted death. Canada’s recent parliamentary report said that 43% of the 10,064 individuals who accessed medically assisted death in 2021 were people who accessed disability services.

Peter Wolfgang, executive director of the Family Institute of Connecticut, doesn’t often find himself working shoulder to shoulder with progressives. As a social conservative, he said that their causes rarely align, but the issue of physician-assisted suicide has brought him unexpected allies — progressive disability advocates.

Wolfgang said some disability rights advocates “are the ones who understand that the right to die could become a duty to die for them” because of financial pressures. These pressures have already been seen in Canada — The Associated Press obtained a recording of a hospital director of ethics telling Roger Foley, an Ontario patient with a degenerative brain disorder, how much money it would cost for him to remain in medical care and asking him if he had interest in assisted suicide.

Physician-assisted death activists have had better luck in blue states than in red, although in December, the highest court in Massachusetts ruled that the commonwealth’s constitution does not permit medical aid in dying. Afterwards, in March 2023, S.1331 was introduced in the state, which if passed would grant terminally ill patients the ability to request assisted death.

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Public support in the U.S.

Lois Anderson, director of Oregon Right to Life, said that her organization and other right-to-life groups in the U.S. spend a significant amount of time opposing assisted suicide laws.

While Americans are evenly divided on abortion, they generally support assisted suicide and euthanasia. Wolfgang said the framing of these polls does impact the results, as does confusion about what various terms mean. He believes sanitization of the language around assisted suicide leads to wrongly inflated levels of support.

When Gallup asked, “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it,” 72% of U.S. adults support it.

But that number drops to 65% when the question changes to “When a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patient requests it?”

Data from Pew Research show people unaffiliated with religion are the demographic most likely to support assisted suicide legislation at 66%. Black Protestants, white evangelical Protestants and Hispanic Catholics are the most likely religious groups to oppose assisted suicide. In general, 53% of white people support assisted suicide while 65% of Black people oppose it as well as 65% of Hispanic people.

Analyzing data from different polls showed people who are white, wealthier and more educated are more likely to support assisted suicide. There’s preliminary evidence this same demographic is the demographic most likely to access assisted suicide. Looking at Oregon specifically, the Disabilities Rights Education & Defense Fund said, “... reported assisted suicide deaths in Oregon have largely occurred to white educated individuals who are not poor.”

While that may be true, the people who are most likely to be negatively impacted by assisted suicide are poor people in marginalized communities, according to the Disability Rights Education & Defense Fund, which says “large numbers of people, particularly among those less privileged in society, would be at significant risk of harm.”

In sum, this organization argues that assisted suicide availability can easily be abused, prognoses aren’t always accurate and there is inadequate oversight. Additionally, the practice disincentivizes health care systems to improve care.

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What’s next for in the U.S.

As it stands, no state in the U.S. allows assisted suicide without a terminal illness diagnosis, but it could happen if the country follows the path of countries like Belgium.

Overseas, assisted suicide has expanded beyond the terminally ill. Belgian law requires patients have an incurable illness and the country is considering expanding to dementia. Laws in the Netherlands require “unbearable suffering,” but not necessarily terminal diagnoses. Switzerland’s laws require that the person assisting the patient in dying not be assisting them due to selfish motivations and also, patients who are otherwise healthy have to prove unbearable suffering — a terminal diagnosis isn’t required.

Canada, however, might be the most frightful example. The government, which approved assisted suicide for someone who listed only hearing loss on his application, is considering how to expand assisted suicide to people with mental illnesses and are strategizing how they will allow “mature minors” to access it.

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While that’s unlikely to happen in the U.S. anytime soon, residency requirements in the states that already have assisted suicide legalized may be the next frontier for activists. Oregon is the only state where non-residents can legally obtain assisted suicide, but Vermont is heading down that path. According to The Associated Press, 75-year-old Connecticut resident (and lifelong assisted suicide activist) Lynda Bluestein reached a settlement earlier this month that allows her to become the first nonresident to access assisted suicide in Vermont.

Since there is no federal right to assisted suicide, it’s likely that activists will use residency requirements to expand access.

In Oregon, Anderson said she already sees activists advocating for more expansive laws — the natural progression once assisted suicide is an option for some. “... Once you accept that killing someone is a solution to a medical problem, you can’t make an argument that it should only be limited to certain people at certain times,” she said.