Switzerland was the first country to allow some form of assisted suicide as far back as 1941. Photo by doble-d

After years of relatively obscure and futile legislative wrangling, the question of physician-assisted death suddenly seems very salient in New York, as the Medical Aid in Dying Act picks up significant steam.

Death is, in essentially all its forms, a thorny issue socially and politically. Most often, we have debates about how to prevent it — how to reduce traffic fatalities or retrain police officers to use lethal force as a last resort, how to structure our public and individual health delivery systems to prevent the spread of infectious disease and manage chronic conditions, and how to reduce the kind of poverty that increases  mortality.

In some instances, we talk about if and how to cause death — whether to go to war, inflict the death penalty and, in this particular case, when to allow someone to seek death on their own, and how to facilitate it. Physician-assisted suicide or medical aid in dying (each side has its own preferred terminology, with the pro side preferring the latter and the anti side the former) is really the only context in which we talk about death policy where death is neither a punishment, consequence, or externality, but the desired outcome for the person facing death. That can make it both extra uncomfortable to discuss and complicated to legislate around.

Rather than a binary of physician-assisted death or not, I think it’s more useful to consider this as a spectrum, where on one side we have total prohibition, assisted medical death totally off the table, and on the other you have basically death on demand, where pretty much anyone can petition to be prescribed death-causing medications. Aside from some hardcore libertarian types, there’s not really anyone calling for medical death as a service that anyone can access, so the debate is really between whether to remain at the former end — none available — or land somewhere in the middle.

There’s also the less-discussed question of what “assistance” even means. To orient a patient around where to procure life-ending drugs is technically assistance. So is providing the drugs, and so is administering them, but those are undeniably different levels of involvement, and existing physician-assisted death schemes have different ways of handling those gradations. Switzerland — which famously became the first country in the world to allow some form of assisted suicide as far back as 1941 — is the only jurisdiction that permits non-doctors to assist with suicide, but also does not actually permit anyone but the receiver to directly administer the life-ending procedure, a practice commonly known as euthanasia.

Perhaps the most well-known U.S. proponent of this practice was Michigan-based Dr. Jack Kevorkian, sometimes known as “Dr. Death.” He was tried multiple times in the 1990s for his participation in patient deaths, but only convicted in 1999 after he personally administered potassium chloride to a man whose advanced ALS did not allow him to administer the drugs himself, as prior Kevorkian patients had.

Dr. Jack Kevorkian

Speaking of Kevorkian, among his opponents were the standard anti-physician-assisted death groups, who for reasons of medical ethics, religious belief, or general policy preference oppose any effort to allow the practice. But there was also well-documented pattern, as exposed by the Detroit Free Press, of the doctor rushing through the process, including at least one instance in which he assisted with a death one hour after the patient signed a formal request. He was also shown to have assisted patients who were not near death or even in significant pain, including some with histories of depression.

Which raises the other big question, about the state that a person has to be in — both mental and physical — for physician-assisted death to be potentially reasonable. Canada, which has allowed the practice it terms medical assistance in dying (MAID) since 2016, recently ignited a nationwide controversy by moving to allow people suffering from mental illness to access physician-assisted death. The backlash pushed the government to delay this eligibility until at least March 2027, a decision welcomed by several patient and medical groups but unsurprisingly decried by some patients who wanted to end their lives.

The Canadian government had previously expanded its program in 2021, allowing people not at imminent risk of death from disease but suffering from chronic illnesses like Parkinson’s to access MAID, which prompted some critical coverage around people who were making the decision mainly out of the desire to not be a burden, financial or otherwise, on the their families or the health system. Essentially, there is the fear that an expansive enough system is eugenics by another name — effectively strong-arming people with serious but treatable mental and physical conditions into accepting death in lieu of complex or expensive treatment.

Photo by lenets_Mikolay. The measure recently received support from influential professional and civil rights groups.

It is with these serious pitfalls in mind that most states have moved to allow it in statutorily limited circumstances. As of now, ten states — Oregon  (the first to do so in 1994), Maine, Colorado, Washington, California, Hawaii, Vermont, New Mexico, Montana, and New Jersey — allow some form of physician-assisted death, and several others are considering it. Sometimes, it’s been enacted by legislation, sometimes by ballot measure, but they generally require that prospective patients be terminally ill, mentally capable, and with six months or less to live. That’s the case for New York’s bill, which would require the assent of two doctors.

Though the measure has been percolating in New York for about a decade, it seems like the closest it’s ever been to passing, with a highly-organized lobbying and advocacy effort by pressure groups like Compassion & Choices and the recent nod from influential professional and civil rights groups like the New York State Bar Association and the New York Civil Liberties Union. Medical groups in general remain more split, though the Medical Society of the State of New York has dropped its opposition to the bill. Despite all that activity, it’s not a sure shot; Senate Majority Leader Andrew Stewart-Cousins’ assertion that there’s not enough time left in the session probably means it’s doomed.

Yet it even if it doesn’t make it across the finish line this time around, it seems clear that it will keep inching closer, which means New Yorkers should be thinking about how we feel about this, which in turn I think means listening more to the people at issue: patients, families, and doctors, and come up with our own definitions of what it means to exercise compassion. No one wants to end up in situations where physician-assisted death is on the table, but none of us can claim to be immune, either.

Felipe De La Hoz is an immigration-focused journalist who has written investigative and analytic articles, explainers, essays, and columns for the New Republic, The Washington Post, New York Mag, Slate,...

Leave a comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.