‘Coercion and Despair’: Lawmakers Grapple With Ethics of State-Sanctioned Suicide as Advocates Push for Broader Availability

France’s parliament on Tuesday passed a bill to legalize medical aid in dying. Delaware’s Democratic governor, Matt Meyer, signed one last week legalizing physician-assisted suicide for terminally ill patients, making his state the 11th in the country to allow the practice. Several European countries and Canada have already legalized it. Is physician-assisted dying destined to become a standard of care in the West?At least 15 states have recently or are currently debating bills to legalize medical aid in dying, often called MAID for short. New York’s assembly passed a bill last month that would permit terminally ill patients with six months or less to live to request a cocktail of drugs to end their lives.Proponents of physician-assisted suicide say it’s about relieving suffering for patients and their families, and giving people the freedom to choose how and when they die. Opponents cite religious objections, the doctors’ oath to do no harm, and concerns that legalizing MAID will lead to a “slippery slope” expansion of eligibility criteria and hurt the most vulnerable.‘Coercion and Despair’The New York bill passed along partisan lines, with no Republicans and a handful of Black Democrats — worried that poor and minority patients would be disproportionately steered to assisted suicide for cost savings or health inequity reasons — opposing the legislation. The bill is now headed to the state senate. Governor Hochul is conspicuously silent on the issue so far.“Governor Hochul will review the legislation if it passes both houses of the Legislature,” a representative for the governor told The New York Sun by email, declining to take a stance.A congresswoman and potential GOP challenger to Ms. Hochul in the governor’s race next year, Elise Stefanik, isn’t mincing words about her opposition to assisted suicide and the New York bill. “The New York State Assembly’s decision to pass this disgusting assisted suicide bill is a shameful attack on the sanctity of life and a betrayal of our most vulnerable citizens,” Ms. Stefanik said in a statement, adding that the legislation “normalizes the termination of human life under the guise of ‘compassion,’ putting the elderly, disabled, and terminally ill at risk of coercion and despair.”A ‘Civil Rights Issue’The rash of MAID legislation in America mirrors what’s happening across the West. Canada, Switzerland, Belgium, the Netherlands, Spain, and Australia have all legalized physician-assisted suicide. The United Kingdom is debating legislation for terminally ill patients in England and Wales. The French assisted suicide bill is now headed for the upper house, yet that it passed the lower chamber reflects a sea change on the issue in this historically Catholic country. President Macron has previously expressed support for the bill.“Legalizing MAID is about legalizing choice,” the head of the Division of Palliative Care at the University of Ottawa, James Downer, who says he’s helped dozens of patients in Canada end their lives, tells the Sun.“It really boils down to people wanting and ultimately receiving the right to decide when their quality of life, their suffering is intolerable to them,” Dr. Downer says. “It is a civil rights issue.”The American public largely supports MAID, with 71 percent saying doctors should be allowed “to end a patient’s life by painless means” and 66 percent saying doctors should be “allowed to assist a patient to commit suicide,” according to Gallup. Yet despite support for making assisted suicide legal, Americans are split on the morality of the practice, with a slim majority — 53 percent — saying physician assisted suicide is “morally acceptable.”MAID laws vary by state — and widely by country — but the New York legislation’s restriction to terminally ill patients is in line with other states that have legalized MAID. This is not the case, though, in Canada, where a patient seeking MAID does not need to be terminally ill but must prove he has an illness or disability that is causing irreversible decline and “physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable.” This means a person with a physical disability that is not terminal may qualify to end his life.Expanding the CriteriaIn 2027, Canada is expanding MAID eligibility criteria further to include those with mental illness. This means that a person suffering from depression could qualify for physician-assisted suicide — an anathema to American medical standards of care. A leading advocacy organization for physician-assisted suicide, Dying With Dignity Canada, is also working to expand MAID eligibility to “mature minors” — in other words, teenagers. “MAID for mature minors would be limited to those with a grievous and irremediable medical condition, not those with a mental illness or whose deaths were not reasonably foreseeable,” the group’s website says. “Dying With Dignity Canada believes mature minors should be allowed the right to choose MAID.”Images from a pamphlet seeming to support MAID for teenagers and children in Canada went viral on X this month, sparking outrage. The pamphlet said MAID for minors would not require parental consent. The Canadian Press reports that the pamphlet was created by the Evangelical Fellowship of Canada, a group opposed to MAID. That so many believed Canada had approved MAID for minors speaks to the perception that Canada’s assisted suicide laws have become too liberal.One in 20 deaths in Canada in 2023 was from MAID. In the Netherlands, where MAID is available for those suffering from mental illness, the number of physician-assisted suicides increased by 10 percent last year. Critics of legalizing physician-assisted suicide say one ought to look at these countries as a warning.“I think we have seen in Canada that people are being referred to assisted suicide instead of support services for people with disabilities,” a disability rights advocate and director for the New York Association on Independent Living, Alex Thompson, tells the Sun. “Medical doctors don’t perceive people with disabilities as having a very high quality of life.”Eroded SafeguardsMr. Thompson’s organization opposes New York’s assisted suicide bill. “Experience in other states demonstrates that so-called ‘safeguards’ are quickly eroded, leading to expansions of eligibility and a growing normalization of suicide for people who could otherwise live meaningful lives with appropriate supports,” the group said in a statement.A report in the Associated Press last fall found a “significant number” of people who were euthanized in Ontario were from the poorest areas, and it detailed cases of patients requesting assisted suicide for lack of housing or support services. Dr. Downer and Canadian officials, though, dispute this.“Canada’s federal reports suggest that fewer than 2 percent of MAiD recipients lack access to needed disability supports in the opinion of the MAiD provider,” a report co-authored by Dr. Downer in the Canadian Medical Association Journal states.“Nobody is eligible for assisted dying on the basis of housing, on the basis of poverty, or on the basis of an inability to access services,” Dr. Downer says. “There have been, I would say, tremendous amounts of disinformation being spread around what’s happening in Canada.”A ‘Slippery Slope’This notion of a “slippery slope” — that legalizing physician-assisted suicide for the terminally ill will eventually lead to an expansion of criteria legislatively, through court challenges or a breaking of the rules — is common among opponents. MAID is a controversial subject and opinions in America do fall roughly along partisan lines, though not exclusively.“It’s very concerning,” Mr. Thompson says about the increasing number of states debating legalizing MAID. He says it’s “a gross oversimplification” that opponents of MAID are all rightwing Christians. “I encourage people who are on the political left to maybe give this a little more thought,” he says.A Black Democratic assemblywoman in New York, Rodneyse Bichotte Hermelyn, expressed her worries about the state’s legislation during debate on the floor. “While I do support the freedom to choose and freedom to decide in the pursuit of happiness, my concern and opposition of this bill comes from the great risk of targeting vulnerable communities of color, given the historical health disparities that they continue to face,” she said.For those facing their own mortality, though, the issue is personal. “What I’m really concerned about personally is something that would be painful, lingering, devastating to my family, devastating to my wife, waste our resources, I’m miserable, I have no control,” a retired market scientist, Dennis Pratt, who was part of a bipartisan coalition supporting an assisted suicide bill in New Hampshire earlier this year, tells the Sun.Mr. Pratt battled colon cancer the last few years and had a stroke earlier this year. He says he was disappointed that his state’s legislature tabled the MAID bill.“If you believe in a God that tells you don’t do this, well, don’t do it,” Mr. Pratt says. “My philosophy is I own my own body.”

‘Coercion and Despair’: Lawmakers Grapple With Ethics of State-Sanctioned Suicide as Advocates Push for Broader Availability

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