We are all dying. Every day we are alive moves us closer in line to that day of transition from this life to eternity. There is no need to hurry death.

Yet, 10 states (California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont and Washington) and the District of Columbia where assisted suicide is legal are hurrying the most vulnerable patients to their deaths—and more states are pushing for the same. As of March 2023, Arizona, Connecticut, Florida, Indiana, Iowa, Maryland, Minnesota, Nevada, New York, Pennsylvania, Rhode Island and Virginia have introduced bills again in attempts to legalize assisted suicide (Massachusetts is likely do so soon). So far, Virginia SB 930 was defeated on January 26 by a vote of 9 to 5 to suspend the bill indefinitely.

Plus, Hawaii, New Jersey, Oregon, Vermont and Washington have introduced bills to expand their laws (as of this writing, Hawaii and Washington’s expansion bills have passed, unfortunately). Expansion would allow nurse practitioners and physician assistants, in addition to physicians, to prescribe lethal drugs; allow psychiatrists, psychologists and social workers to serve as assessors of capacity to make medical decisions; reduce waiting period between patient request and prescription; and repeal residency requirements by allowing non-residents to obtain lethal prescriptions (in Oregon, Vermont and Washington). Whether or not you reside in the state of Washington, I invite you to read this excellent March 24, 2023 op-ed published with The Spokesman-Review “Overall Patient Safety More Than Cosmetic Need” written by Washington CMDA member and retired pediatric anesthesiologist/critical care physician Sharon Quick, MD, MA. Dr. Quick is quite an expert on the issue and has heavily advocated against such bills in Washington and other states where this awful legislation is seeking to be legalized or expanded. Dr. Quick is also president of Physicians for Compassionate Care Education Foundation.

The public and legislators are being sold a lie. Using camouflaged language such as “compassionate care,” “death with dignity,” “medical aid in dying” or better yet—“a Christian option to stop end-of-life suffering”—it is still assisted suicide. It is rarely pain or suffering that is the real driving issue, but rather a loss of control. The Oregon Death with Dignity Act Reports show the five most common “end-of-life concerns” among patients deal with not pain but with “existential distress” over the disabling aspects of serious illness, from depending on others for care to grief over lost abilities, loss of social status (“dignity”), incontinence and feeling like a burden. When people are permitted to die by assisted suicide for these reasons, it reinforces the message that disabled people who live with these conditions are incapable of living full, satisfying lives.

If you are interested in knowing what this could mean in your state, here are some of the trends we are seeing in the ever-increasing push for assisted suicide:

• Terminal illness is no longer the sole criteria for assisted suicide. For some time, a six-month prognosis was the permanent criteria for a person to be considered for assisted suicide. However, we are increasingly seeing latitude given for non-terminal patients (ex: anorexia nervosa, arthritis, mental health issues) being able to request lethal prescriptions for assisted suicide—and sometimes without a mental health evaluation.
• Reduced waiting periods. We are seeing a significant reduction in waiting periods between patient request and prescription, decreasing from 15 days to seven days in Washington or from 15 days to 48 hours in Oregon. This is problematic in mitigating abuse or coercion by a family member, and it harms a patient who is experiencing emotional, mental or physical distress and thereby diminished competent, decision-making ability.
• Catering to the white and well-off will automatically write off the disabled, the black and brown and low-income. Patients seeking assisted suicide are predominately white and well-off. With a healthcare and insurance industry more enticed to protect profits over people, such demand for a lethal prescription instead of ongoing end-of-life care presents even fewer options for those who are low-income who desire to live and want healthcare. The disabled want to live. The low-income want to live. Black and brown folks, who have fought injustices at almost every turn, want to live and are primarily not those who seek assisted suicide. No one needs more ways to get dead. We are all appointed a day and time.
• Lack of mental health evaluation or counseling requirements. We are seeing more bills (such as those in Maryland and Washington) without an affirmative requirement that any patient requesting assisted suicide undergo a mental health evaluation or be screened for treatable conditions like depression. Imagine if a patient’s mental health concerns are properly diagnosed and treated, then they may change their minds about suicide because the mental distress has been addressed.
• Mail delivery of lethal prescriptions. There is a move toward sending lethal prescriptions by personal delivery, messenger or parcel service or U.S. mail and potentially signed for by someone else who is not the qualified recipient. Here we have a gaping hole for abuse or coercion—or the lethal prescriptions being intercepted by someone else for other nefarious means. We simply have no way of knowing.
• Bait and switch. Sadly, even if assisted suicide laws are passed with multiple safeguards to prevent abuse, assisted suicide proponents will then push for those safeguards to be removed once the law is enacted. This “Bait and Switch” infographic prepared by Patients Rights Action Fund depicts 10 ways in which safeguards are removed once assisted suicide laws are passed.

All of this is unsatisfactory and unacceptable, because assisted suicide is not a medically acceptable standard of care and is poor public policy. Loosening requirements and removing safeguards does not communicate compassion; rather, it displays a blatant disregard and value for human life. Better ethical alternatives such as palliative care and hospice care are available for managing end-of-life needs and concerns. 

Assisted suicide is a direct attack on the Hippocratic Oath to “do no harm.” It is contrary to the healthcare professional’s role as healer and undermines the physician-patient relationship. Legislators are also patients and should highly value the healthcare professional’s calling to help patients value their lives at all stages—not to hasten their death.