Physician-assisted dying
Should physician-assisted dying be legal? Viewpoints from multiple sides.
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What’s happening
Last month, lawmakers in the UK advanced a proposed bill that would legalize a form of physician-assisted dying (PAD) in England and Wales. The legislation, called the Terminally Ill Adults (End of Life) Bill, still needs to advance through additional parliamentary scrutiny before becoming law.
What the law would allow: The UK bill would make it legal for terminally ill adults to end their lives with the help of a physician in specific circumstances. Guardrails would require the patient to:
Have the mental ability to make an informed, independent decision and be making it without any coercion
Have a remaining life expectancy of 6 months or less
Make two separate signed and witnessed statements confirming their decision
Receive eligibility approval from two separate physicians, spaced at least 7 days apart
Receive approval from a High Court judge
Wait at least 14 days after the High Court ruling to ensure adequate reflection time
A doctor would prepare the lethal substance but the patient would be required to administer it themselves.
Broader legality: PAD is legal to varying degrees in approximately 12 countries, including 6 European countries, New Zealand, most of Australia, Canada, Ecuador, Colombia, and parts of the US.
Each of the 6 European countries – the Netherlands, Belgium, Switzerland, Luxembourg, Austria, and Spain – do not limit PAD access to terminally ill patients. Law variations between the countries include whether a patient is required to administer the lethal substance themselves or if a physician may do so, an act known as voluntary euthanasia.
In the US, 10 states plus Washington DC have legalized PAD in some form, with the patient required to administer the dose in all cases. Oregon, in 1997, was the first to install legal guardrails allowing terminally ill patients to end their lives.
Terminology debate: The broader PAD umbrella includes both patient-administered doses and voluntary euthanasia. There is significant debate over the proper terminology to describe assisted dying. Many opponents of PAD prefer the term “physician-assisted suicide (PAS)” based on their argument it more accurately describes the act without softening language. Supporters tend to use terms like “medical aid in dying (MAID)” or “medically assisted dying.”
For the purposes of this edition, we use the term PAD because it is concise and closer to terminology adopted by some organizations with neutral stances on the issue.
Debate over PAD is complex and emotionally-charged. This week we bring you the viewpoints from multiple sides. Let us know what you think.
Notable viewpoints
More opposed to physician-assisted dying (PAD):
Legalizing PAD drives a “slippery slope” of expansion into legalizing other life-ending practices.
Legalizing PAD in specific circumstances would inevitably drive an expanding scope of permitted cases in a “slippery slope” effect. This has been the case in countries such as Belgium, the Netherlands, and Canada that legalized PAD and have expanded the scope of permitted scenarios over time.
Past examples have shown that when a specific line is drawn defining eligibility, individuals falling just outside the line lobby for inclusion, putting pressure on lawmakers and/or caregivers to ultimately broaden eligibility requirements. This effect could ultimately lead to the approval of PAD for anyone that is “suffering.”
Legalizing PAD would put undue pressure on vulnerable groups such as the disabled and elderly.
Legalized assisted dying could put pressure on disabled people or the elderly to end their lives prematurely – either directly from family members concerned about financial burdens or indirectly through the sheer availability of it as an option. In some places like Washington state, where individuals approved for assisted dying can take the lethal substance by themselves at home without a witness, an ill-intentioned caregiver could coerce or even apply lethal medication to the individual.
“This is a very dangerous time for [disabled people]. When the standard of living drops as low as it has for so many people, with costs rising constantly, disabled people are rapidly cast as financial burdens on society and as being of less value than others.” (Merry Cross, disabled person and opponent of legalizing PAD in the UK.)
A 2018 poll commissioned by disability advocacy group Scope found that 64% of disabled respondents were concerned about a potential change to laws in the UK around assisted dying.
Greater emphasis should be placed on palliative care and maximizing living in comfort.
Rather than legalizing assisted dying, better investments should be made in often-underfunded palliative and hospice care, which can improve the well-being of the suffering and remove nearly all pain.
Physicians can incorrectly estimate a patient’s time to live, potentially leading to the assisted deaths of individuals that could continue leading lives with dignity. For example, a 2017 systematic review of 6,000+ patients in the UK that were given 6-12 months to live found that 54% of them outlived doctors’ expectations.
PAD carries ethical burdens and violates the sanctity of life.
Assisted dying changes the fundamental nature of the physician-patient relationship, would cause more harm than good, and is not compatible with the physician’s role as a healer.
Legalized assisted dying runs against the “sanctity of life” and threatens to diminish society’s collective value on preserving it while also violating many religious beliefs.
Medical groups including the American Medical Association (AMA), American College of Physicians (ACP), and World Medical Association (WMA) are opposed to PAD largely on ethical grounds.
More supportive of physician-assisted dying (PAD):
Dying in dignity is a fundamental right that should be accessible to all humans.
For someone who is suffering with no chance of survival, having the option to end their own life enables them to die with dignity rather than in overwhelming pain or loss of function.
Individuals should have the freedom and autonomy to end their life on their terms in circumstances where they have no chance of survival. PAD can also help individuals and their families plan around their death and feel more prepared mentally and emotionally.
“For people to argue against this choice for sick people really seems evil to me…They try to mix it up with suicide and that’s really unfair, because there’s not a single part of me that wants to die. But I am dying.” (Brittany Maynard, a terminally ill patient that decided to legally end her life in Oregon in 2014.)
Access to PAD may provide terminally ill patients with peace of mind from having it as an option, even if they don’t use it, improving their well-being during their final stages of life. For instance, about ⅓ of patients in Oregon approved for PAD do not follow through with it.
Legalized PAD, with adequate safeguards, can help terminally ill patients without putting pressure on them.
In the UK, the current lack of PAD-permissive laws encourages patients to travel to other European countries to legally end their lives, complicating their suffering. For instance, an estimated 571 Britons traveled to Switzerland to end their lives between 1998 and 2023.
Laws in places like the US already allow terminally ill patients to refuse life-saving care, a decision that often hastens death. PAD would similarly help hasten death in potentially less painful ways and should be permitted.
There are already effective protections in place in the UK to prevent abuse or coercion in hospice and end-of-life care. There should be no reason similar safeguards wouldn’t be effective in regulating PAD.
The public generally supports PAD in some form.
A majority of the recently polled public in Great Britain appears to support assisted dying, with a 2024 More in Common poll finding that 65% of Britons support legalizing PAD. A 2024 Gallup poll found that roughly 71% of Americans support doctors being “allowed by law to end the patient’s life by some painless means if the patient and his or her family request it.”
Many people with disabilities support assisted dying legalization. An Opinium poll commissioned by PAD advocacy group Dignity in Dying found that 78% of disabled respondents supported laws that legalize PAD.
Several medical associations support assisted dying including the American Public Health Association (APHA) and the American Medical Women’s Association (AMWA).
Be heard
We want to hear from you! Comment below with your perspective on physician-assisted dying and we may feature it in our socials or future newsletters. Below are topic ideas to consider.
Do you support or oppose legalized physician-assisted dying?
What are some arguments or supporting points you appreciate about a viewpoint you disagree with?
Snippets
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Music on the bottom
Enjoy this soulful track, “Into the Ether,” by Leif Vollebekk. Its lyrics are up for interpretation but suggest an element of coping with life’s frustrations and finding yourself.
Listen on Spotify, Apple Music, or Amazon Music.
Yes, it should be legal. There are some diseases that are so horrendous and cause so much pain that people should be able to make that decision. No one should have to suffer because there’s not a cure.