Where -- and WHY -- 'medical aid in dying' has become a leading cause of death

Thus when New York's Legislature recently passed a bill authorizing physicians to help patients end their lives, state Senator Brad Hoylman-Sigal, the measure's chief sponsor, praised its "state‑of‑the‑art safeguards" and pledged that it would lead to no "unintended consequences." Similarly, sponsors of legislation to legalize assisted suicide in Massachusetts insist that what they propose would be "the strongest, by far, hands down, bill in the nation."

But two just-published investigations blow apart the soothing "safeguards" refrain.

Writing in UnHerd last week, Alexander Raikin of the Ethics and Public Policy Center documented how the safeguards in assisted-suicide statutes are "blatantly and routinely" ignored. And in a lengthy article in the September issue of The Atlantic, staff writer Elaina Plott Calabro describes how Canada's medical assistance in dying (MAID) regime, enacted with supposedly firm limits less than a decade ago, has metastasized into something approaching a national ideology.

Raikin's exposé, "How America Abandoned Its Suicide Safeguards," shows that in the 11 states where assisted suicide is permitted, oversight is threadbare. He begins with Jane, a 29-year-old Colorado woman in a mental health crisis so severe that she was deemed incompetent to consent to treatment. Nevertheless, according to documents filed in federal court, she was approved for assisted suicide and given a prescription for lethal drugs.

Far from anomalous, Raikin writes, Jane's case is "a symptom of unprecedented behind-the-scenes chaos." In multiple states, rules meant to ensure compliance are ignored with impunity. Washington has suspended its publication of oversight records. New Mexico has never issued the annual report required by law. Oregon erases key information after just a year, making long-term scrutiny impossible. Violations of assisted-suicide laws are "rampant" in the states with the largest and oldest programs, Raikin warns, yet no medical licenses have been suspended or revoked.

Meanwhile, legislatures keep loosening rules. Washington recently halved its waiting period, approved sending lethal drugs by mail, and extended prescribing authority to nurse practitioners and physician assistants. Oregon and Vermont scrapped their residency requirements, turning themselves into the nation's first "suicide tourism" destinations. Step by step, the guardrails that were touted to win public approval are crumbling.

But that's nothing compared with what has happened in Canada.

When Parliament legalized MAID in 2016, it stressed that death by euthanasia would be strictly limited to mentally competent adults with a terminal illness. Today MAID accounts for 1 in 20 Canadian deaths. In 2023, there were 15,343 "medically assisted" deaths in Canada. "In Quebec," Plott Calabro notes in The Atlantic, "more than 7 percent of all deaths are by euthanasia — the highest rate of any jurisdiction in the world." Cumulatively, more than 60,000 Canadians have been euthanized since the law took effect.

Plott Calabro's article, "Canada Is Killing Itself," recounts stories of patients who turned to MAID not because their illnesses were untreatable but because they lacked social or psychological support. There was the quadriplegic man who chose euthanasia because he developed a painful bedsore and didn't "want to be a burden." A Winnipeg woman with ALS opted for MAID because she couldn't obtain more than 55 hours of government-funded home care. In one notorious case, a government caseworker turned down a disabled veteran's request for a wheelchair lift to be installed in her home — but offered euthanasia instead.

The lesson could not be plainer. When physician-assisted suicide or euthanasia are legalized, guardrails soon collapse. Legislators may promise "state-of-the-art safeguards," but those promises are illusory. Oversight fails. Death is approved even for individuals whose condition is not terminal. Eligibility standards stretch until they vanish. And society grows inured to the idea that medical providers should help people die.

The overwhelming majority of American states have rightly refused to cross this line. Experience shows that once doctors are authorized to facilitate suicide, the practice cannot be contained. Yet a decent society does not enlist physicians to end lives; it strives to relieve suffering while upholding life's inestimable worth.

As another "aid in dying" bill is being pushed on Beacon Hill, Massachusetts lawmakers tempted to follow Oregon or Canada should be under no illusions: The safeguards they're counting on will not hold. By far the wiser course is to uphold life, protect the vulnerable, and insist that doctors remain healers, not executioners.

Jeff Jacoby is a columnist for The Boston Globe, from which this is reprinted with permission.

(COMMENT, BELOW)