What does it mean to die well, with dignity? The question is at the heart of the contentious debate over whether legalizing physician-assisted death for terminally ill patients is an act of compassion, upholding an individual’s dignity, or a troubling step toward devaluing human life.
The debate has recently returned to the spotlight in New York, where the state Assembly passed a bill in April that would allow terminally ill patients with a prognosis of six months or less to live to request life-ending medication.
It also came up in May, when “Dilbert” cartoonist Scott Adams revealed that he only has a few months to live and indicated that he might take advantage of California’s End of Life Option Act.
New York’s proposal requires confirmation from two doctors, who must verify the diagnosis and ensure the patient is mentally sound. The measure passed narrowly — 81 to 67 — after more than four hours of debate. Its fate now rests with the state Senate, where it needs 32 votes to pass and currently has 26 co-sponsors.
Currently, 12 jurisdictions — including Oregon, Colorado and the District of Columbia — permit what’s commonly known as “medical assistance in dying” (MAiD) or “assisted suicide.” On May 20, Delaware became the latest state to legalize medical assistance in dying, and at least 19 other states are considering similar laws.
Canada, Switzerland, Belgium and the Netherlands have adopted MAiD laws, some extending eligibility to people without terminal illnesses. The United Kingdom is also reviewing a similar bill, with a vote expected later in June.
“Passing this bill is about love, compassion, and reducing needless suffering. No one should have to endure agony when there is a better, humane choice available. This is not a political issue — it’s a human issue, and we owe it to New Yorkers to pass the Medical Aid in Dying Act,” said the bill’s sponsor, Assemblymember Amy Paulin, D-Westchester, in a press release. Supporters argue that allowing patients to choose death in the face of unbearable suffering respects their dignity and autonomy.
For those speaking out against the bill, legalizing physician-assisted suicide devalues life and puts vulnerable populations at risk, including people with disabilities, poor people and people with mental illness. Dr. Lydia Dugdale, a physician and ethicist at Columbia University, wrote in a recent New York Times op-ed that the debate isn’t about dying well.
“It is about relieving society — government, medical systems, even families — of the responsibility to care for those who need the most help: the mentally ill, the poor, the physically disabled,” she wrote.
Opponents worry about a “slippery slope,” arguing that vague eligibility requirements could lead to the kind of expansion seen in Canada, where assisted suicide has become available to people suffering not only from terminal illness, but also from conditions like loneliness, eating disorders and mental illness. “I cannot get through a day ... It’s physical torture,” said a Canadian woman with a series of nonterminal diagnoses, whose journey seeking, and receiving, MAiD is the focus of a recent New York Times story.
“Once we go down this road, there is no going back,” said Ed Mechmann, the director of public policy at the Archdiocese of New York, speaking at a recent event in New York hosted by Communion and Liberation, a Catholic lay movement, along with other opponents of physician-assisted suicide. “It will change the nature of health care, of living and dying forever,” Mechmann said.
What is medical assistance in dying?
The terms “physician-assisted death” or “assisted suicide” typically refer to a medical practice in which a terminally ill person is provided a lethal dose of medication they can take to end their life. The term “medical assistance in dying” is commonly used in U.S. and Canada policy discussions and often refers to both assisted suicide and euthanasia.
Euthanasia, by contrast, involves a medical professional administering a life-ending medication, typically by injection, at the patient’s request. Euthanasia is not legal in the states that have legalized MAiD, whereas countries like Canada and the Netherlands allow both.
Although the proponents of MAiD often frame assisted suicide as a matter of personal autonomy, those who oppose it believe that in reality, it would accomplish the opposite and endanger vulnerable patients who struggle to access care and support. “As a practicing physician, I will tell you this does not become a matter of choice for most people,” said Dugdale, author of the 2020 book “The Lost Art of Dying,” speaking at the New York event. “The concern is that once you have a choice legalized for the privileged few, it will then threaten life for many others who find it difficult to maintain life for a variety of reasons.”
Weak safeguards of the laws and ambiguous definitions would likely contribute to eventually including a wide range of chronic conditions, including diabetes, heart disease, cancer and even mental health disorders like anorexia, Mechmann noted. In such cases, choosing death may not reflect true autonomy but rather systemic neglect, he said.
In Colorado, for instance, patients with anorexia have already qualified for assisted death on the grounds that the condition can be fatal if untreated. In 2024, Quebec, a province in Canada, established the right for a person with a serious and incurable illness to choose a medically assisted death in advance. Also in Canada, patients with a mental illness as an underlying medical condition will be eligible for MAiD in 2027.
But even with long-term patients, it can be difficult to determine whether a desire to die stems from informed decision-making or untreated depression, Dugdale said. “The people who tend to seek to end their lives through lethal prescription, who want assisted suicide, are at high risk for depression demographically,” Dugdale said. Among those groups are older adults with advanced cancer, especially white men.
Depression is often overlooked or misdiagnosed, despite being treatable. In Oregon, where MAiD has been legal the longest, less than 1% of patients requesting lethal prescriptions are referred for psychological evaluation. “This is a major oversight that fails to protect depressed people from making flawed decisions,” Dugdale wrote in her op-ed.
Opponents also challenge the popular narrative of MAiD as a carefully considered choice made by an informed patient with a long-trusted physician. “Very few patients have a doctor they call their own anymore, or a doctor who knows them,” said Dr. Eve Slater, a physician and Columbia University professor at an online event hosted by Plough, a Christian magazine, on June 2. Slater, who previously served as assistant secretary for Health and Human Services, said that for many today, especially in New York, care is fragmented, which makes it more challenging to make intimate and ethically sound decisions. She added that legalizing physician-assisted death could further erode the foundational trust between doctor and patient.
Physicians also often misjudge how long terminally ill patients will live, according to Slater. “I’ve been thankfully proved wrong on many occasions,” Slater said. “ I think there is a fallacy in the premise that you qualify if you have less than six months to live, because any doctor who declares that is assuming a crystal ball that they don’t have.”
In reality, legalizing assisted death risks creating a new social norm — one that pressures vulnerable individuals, especially those who are alone, seriously ill or unsupported, into feeling like death is their best or only option.
‘Dying is not a problem to be solved’
In 2019, Kate Connolly, a communications professional in New York City, received a call that her mother had been rushed to the hospital with a brain aneurysm, she recalled while speaking alongside Dugdale and Mechmann. For the next four and a half years, her mother remained confined to her bed and wheelchair, on a feeding tube, unable to do much without assistance.
Yet, even in a severely disabled state, her mother’s presence was cherished by her family before she died, Connolly said. “Her family’s role, which was also a great sacrifice, was to be steward, not dictators, but respectful stewards of a precious gift,” Connolly said.
Around the same time, Connolly learned her unborn son had developed a cystic hygroma — a condition often considered incompatible with life.
Both with her mother and her son, Connolly described pressure from medical professionals to end their life prematurely — through abortion or withdrawal of care, which were presented as practical and compassionate choices. She chose to continue her pregnancy, giving birth to a son and holding him after he died.
Although hastening death may sometimes seem like a more compassionate and pragmatic decision, this mindset fosters a view of suffering lives as disposable, Connolly said. “The truth is, from what I’ve seen, dying is not a problem to be solved,” she said. “It is an experience to be lived and even embraced. It is a sacred time, truly set apart from any experience.”
End-of-life decisions must involve thoughtful, peaceful conversations between patients, families and doctors, Connolly noted. “What is the right course of action? What is reasonable or what is needlessly extending pain and suffering?” she said. “You cannot ask these questions thoughtfully or with any real meaning when you’re being pushed to just do the expedient thing and end the life in front of you.”
A question of control
According to studies from Canada, the top reasons that patients say they seek a lethal prescription are more social rather than physical. In Canada, the 2022 annual report revealed that the most commonly cited reasons for requesting MAiD were loss of ability to engage in meaningful activities (86%) and loss of ability to perform daily activities (81%). While supporters of MAiD often argue that alleviating pain is one of the main reasons for hastening the death of a patient, about 59% are concerned about “controlling pain.”
According to Oregon data, nearly 30% of MAiD-seeking patients cite current and future concerns about pain. “So it’s much more an issue of control,” Dugdale said, adding that the U.S. has robust pain control. “Dying in pain is not an issue. It should not be an issue.” Instead, loss of independence and fear of being a burden often are.
These fears should be met with care, not a prescription, Mechmann said. “It’s incumbent on us to make sure people don’t feel (like a burden).”
A culture of death?
With her medical trainees, Dugdale observed a shift in attitudes toward physician-assisted dying. In recent conversations, she said, some trainees wondered, “Why don’t we just do away with our societal aversion to suicide altogether?” and embrace the view that if individuals wish to end their lives, they should be free to do so without interference. Once, she was asked whether assisted suicide can be a solution to the problem of loneliness.
With this mindset, end-of-life decisions would be made through a utilitarian and individualistic lens. Many physicians are uneasy about appearing “paternalist,” Dugdale said. “And so to mitigate that, we defer everything to the patient,” she said.
The core ethical principles of beneficence (doing good) and non-maleficence (avoiding harm) have, in practice, been overshadowed by an almost singular focus on autonomy, Dugdale said. For doctors, she continued, MAiD can offer a controlled intervention in the often unpredictable process of dying, providing a sense of agency amid uncertainty.
“There’s already a growing pressure to sacrifice one’s life for the so-called ‘greater good’ and to rid the world of expensive, hopeless cases,” she said. Normalizing the idea of choosing death, especially in a society already grappling with high health care costs and an aging population, may cause younger health care professionals to view seriously ill, expensive patients as burdens.
A study from Oxford University points to a correlation between legalized assisted suicide and euthanasia and increased rates of more common forms of suicide in both the U.S. and Europe. “Once it becomes widely acceptable that I can end my life on my own terms, that feeds a culture of death,” Dugdale said.
In Canada, euthanasia is now the fifth most common cause of death.
“At some point, the vast majority of people in the state of New York are gonna be laying in a hospital bed. And when the doctor shows up, what are we gonna think? Is this my ally or is this my enemy?” Mechmann said.
So what, then, is the way forward?
Investing in meaningful relationships and community and maintaining deep personal connections through family, faith communities, clubs or friendships is a bulwark against loneliness and despair, experts agreed. It’s human connection — not lethal prescriptions — that is the real antidote to suffering, participants in the event said.
“Suffering is inevitable,” Mechmann said. But the assisted suicide is a “bad answer” to the problem of suffering. “It’s love, it’s community, it’s not despairing. It’s being willing to embrace some of the suffering and to live with it and to walk with it.”
Editor’s note: This story deals with the practice of assisted suicide. If you or someone you know is struggling with thoughts of self-harm, the 988 Suicide and Crisis Line is always available. You can text or call 988 any time or chat at 988lifeline.org. In Utah, you can also reach out to SafeUT, 833-372-3388, or download the SafeUT app.