Assisted Suicide for people with eating disorders.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On July 30, 2026 we published an article about the Colorado 2025 assisted suicide data. There were three key take-aways from the Colorado data.

1. Colorado does not know how many people died by assisted suicide. 
2. Colorado has missing data concerning how many lethal poison prescriptions were filled.
3. 
   The number of people who were approved for assisted suicide for eating disorders in Colorado has grown substantially. In 2024, 19 people with eating disorders were approved for assisted suicide and in 2025, 17 people with eating disorders were approved for assisted suicide.

During the assisted suicide bill debate in the UK, Eat, Breathe, Thrive, an organization that specializes in the treatment of eating disorders produced a video about the threat of legalizing assisted suicide for people with eating disorders. 

The video features Ailidh, who lives with an eating disorder and says:

I'm worried. My concerns lie with people like myself who are still in the throws of anorexia right now and what the assisted dying bill could mean for them and the families.

The film shows an anthropologist speaking to the UK assisted dying bill committee claiming that only one or two people have died by assisted suicide for eating disorders in America.

Considering the fact that Colorado alone approved 19 people in 2024 and 17 people in 2025 for assisted suicide based on an eating disorder, clearly the comments to the committee were wrong.

Chelsea Roff

Chelsea Roff, the founder of Eat, Breathe, Thrive, explains the study that they did on assisted death for eating disorders and found that at least 60 people died by an assisted death based on having an eating disorder.

People with eating disorders are living with a serious but treatable condition. 

They are not terminally ill.

What Does ‘Suicide’ Have to do with the Oregon assisted suicide Model?

By Meghan Schrader

Meghan is a disability activists and a member of the EPC-USA board.

Meghan Schrader

One time when I was testifying at an Oregon model assisted suicide hearing I decided to describe one of my episodes of psychotic depression in detail, to try to get legislators to observe parallels between what I was describing and the experiences of terminal illness that the proponents were describing. It struck me as a way to illustrate the overlap between the Oregon Model proponents’ logic that assisted suicide is a valid response to end of life suffering, and expansionists’ logic that “psychiatric assisted suicide” is a valid solution for extreme mental suffering.

Also, the Oregon assisted suicide model proponents describe disturbing physical symptoms at hearings all the time. So it should be ok for me to describe my past severe psychiatric symptoms, right?

The legislators looked at me kind of like I was high and then made comments along the lines that what I had described had nothing to do with the proposed law, but they appreciated my bravery in sharing my story.

I feel kind of silly about that testimony now. After all, I was describing severe mental illness, not a terminal illness like cancer. Also, maybe providing all those details came across as trauma dumping and attention-seeking. Perhaps it would have sufficed to say, “Having experienced mental illness in the past and observed expansionists efforts to legalize psychiatric euthanasia, I think society should not take another step towards that world by legalizing the Oregon model.”

But I still think that talking about severe mental illness and suicidal ideation during discussions about the Oregon model is less ridiculous than those legislators seemed to think. As disability rights opponents of assisted suicide have pointed out, the distinction between “terminally ill” and “disabled” can be blurrier than the Oregon model proponents would like it to be. There are some people who can live for years with their disabilities with the proper support, yet would die quickly if that support were withdrawn. And some of those people experience suicidal ideation. Moreover, there have been instances of people with mental illnesses like anorexia nervosa dying by assisted suicide. This abuse thins the distinction between “suicide” and assisted suicide” that the Oregon model proponents perceive.

Furthermore, some proponents have openly admitted that they want to medicalize disabled people’s suicides; famous euthanasia activist, Thaddeus Mason Pope told me so.

Nevertheless, I’ll entertain the position that there may often be meaningful distinctions between the “Oregon assisted suicide model” and “regular” suicide, with respect to the reasoning behind the decision, the possibility of graphic violence, the typical impact on family members, the length of time that the person had left to live, etc. So, I can understand why there are a lot of people who think that equating the Oregon assisted suicide model and suicide is “silly.”

I’ll again use my former pastor as an example. This pastor was a wonderful person and a dedicated faith leader. She did a lot of great work with marginalized people. She was also very anti-suicide. One time when I was sobbing in front of her about how much pain I was in during a bad bout of depression, she asked, “I don’t want to scare you, but as your pastor I need to know: are you having any thoughts about hurting yourself? Is there anything that we need to do to keep you safe?”

I wasn’t planning to harm myself, but I appreciated the compassion behind the pastor’s question.

This pastor also did a lot of terrific work with terminally ill people, and she disagreed with me about the Oregon assisted suicide model. When we had a friendly debate about the issue, she said, “Having been with people who have experienced a horrible death from Glioblastoma, I strongly reiterate my comments. And I hope that I would have the grace to make a similar choice.”

Obviously I disagree with the pastor, but I feel able to respect her motivations and logic. After all, she had had years of working with terminally ill people and I hadn’t. And she had worked with a lot of people experiencing suicidal ideation. So although assisted suicide and “regular” suicide both involve dying by one’s own hand (and hence meet the technical definition of suicide) I can “get where she was coming from.”

Unfortunately, not all assisted suicide proponents think like my former pastor. Some of them would like to expand assisted suicide to disabled people who aren’t dying. And that’s a situation where I think proponents’ distinction between assisted suicide and suicide is indisputably linked to ableism.

Disabled people are already systemically excluded from suicide prevention. Peer-reviewed research shows that there is a high suicide rate among people with disabilities and that people are more likely to think suicide is acceptable if the victim is disabled. There is also a lack of suicide prevention resources designed for people with disabilities. In that context, suicide prevention organizations equivocating on whether disabled people’s assisted suicide deaths are suicides falls into a longstanding pattern of abandonment.

The Oregon assisted suicide model proponents’ argument that assisted suicide is never suicide would be on much firmer ground if the Oregon model had never been used to kill people with anorexia, and if it were the only assisted suicide model that existed anywhere in the world. But it isn’t. Moreover, the Oregon model movement leaders routinely do things that normalize discussions about expanding assisted suicide such as by rubbing elbows with assisted suicide expansionists who have said that medicalizing the suicides of disabled people is ok. Compassion and Choices leaders cannot possibly have missed People Magazine and the New York Times’ enthusiastic platforming of people with chronic mental illnesses who would like to die by assisted suicide. Compassion and Choices leaders have published statements declining to take a position on whether Canada’s euthanasia (MAiD) program is ok, even though the United Nations Special Rapporteur on the Rights of People With Disabilities says that it’s not.

In short, although the Oregon model is ostensibly limited to terminally ill persons, it is helping to normalize the expansive proponents’ position that disabled people’s suicides are therapeutic.

Author Note: For a nuanced discussion of why what the Oregon Model proponents call "MAiD" is best described as “Assisted Suicide,” and why such “MAiD” is most accurately understood as a variation of suicide, read Harold Braswell’s article, “In Defense of "Physician-Assisted Suicide": Toward (and Back to) a Transparent, Destigmatizing Debate.”

Canada and Euthanasia for Eating Disorders.

Alex Schadenberg

Alex Schadenberg
Executive Director,
Euthanasia Prevention Coalition

I have been busy with speaking engagements, so I didn't report on all of the important issues. While going through my emails I found an article by Frank Bergman that was published by Slaynews on April 15, 2026. 

Bergman's article concerns a psychiatrist who presented to the Special Joint Parliamentary MAiD Committee that is examining the issue of euthanasia for mental illness alone. Euthanasia for the sole criteria of mental illness is currently scheduled to begin in Canada on March 17, 2027.

Dr Mona Gupta and MP Andrew Lawton

Psychiatrist Mona Gupta stated during the committee hearing that euthanasia would be permitted for people with eating disorders. Bergman reports:

The disturbing exchange took place during a Special Joint Parliamentary Committee hearing on Medical Assistance in Dying (MAiD).

During the hearing, a psychiatrist suggested that even non-terminal mental health conditions could qualify someone for taxpayer-funded, state-assisted death.

During questioning, Conservative MP Andrew Lawton pressed Dr. Mona Gupta on whether individuals with depression or eating disorders should be eligible for euthanasia.

“It depends on the circumstances of the person,” said Gupta, a psychiatrist and professor at the University of Montreal.

Lawton followed up directly: “So it could?”

“Potentially,” Gupta admitted.

So let's be clear. People living with eating disorders are experiencing difficult conditions, but these are treatable conditions.

On August 1, 2024, Eat, Breathe, Thrive published a Joint Statement Against Assisted Suicide for Eating Disorders that was signed by the Euthanasia Prevention Coalition.

In June 2024 the Anorexia Nervosa and Associated Disorders (ANAD) approved a statement clarifying that Anorexia Nervosa is not a terminal condition.

In October 2023, a group of psychiatrists published a research article explaining why Anorexia does not justify Aid in Dying.

Euthanasia provides death and eliminates hope. People need hope to recover. Euthanasia is abandonment not compassion.

A psychiatrist told parliament committee that depression qualifies for MAiD

This article was published by Kelsi Sheren on her substack on April 27, 2026.

April, in front of Canada’s Special Joint Parliamentary Committee on MAiD, a psychiatrist said the quiet part out loud.

Dr. Mona Gupta former chair of the federal Expert Panel on MAiD and Mental Illness testified before the committee between March 25 and April 2026. When Conservative MP Andrew Lawton asked directly whether depression or eating disorders could qualify someone for assisted death, she replied: “It depends on the circumstances of the person.” That’s it, that’s the answer.

Dr Mona Gupta

Not a no, not a “those conditions fall outside the eligibility framework.” Just it depends. Let me tell you what that answer means in practice, i means the most common mental health diagnoses in this country the ones your kids have, your coworkers have, the ones millions of Canadians are managing right now are being actively contemplated as qualifying conditions for state-assisted death and the federal government’s own hand-picked expert couldn’t rule it out.

This wasn’t a fringe voice. This was the person Ottawa chose to lead the expert panel reviewing whether Canada is ready to expand MAiD to mental illness and her testimony was effectively yes, maybe.

The law currently excludes MAiD where mental illness is the sole underlying condition. But only until March 17, 2027. That date has already been pushed back twice…... Not because the government changed its mind but because it needed more time to get ready.

A committee of 10 MPs and five Senators is currently studying the question. The expansion has been delayed twice in the last three years..they’re not studying whether to do it, they’re studying how.

Here’s what the psychiatric community has actually said the people who treat these patients, not the people who administer death. The Canadian Psychiatric Association, the Canadian Mental Health Association, and the Society of Canadian Psychiatry have all said irremediability cannot be reliably predicted in psychiatric conditions. Eating disorders show long-term remission rates of 50 to 70 percent with appropriate care. Fifty to seventy percent with care.

We’re not offering that care. Wait times for psychiatric services in this country are unconscionable. Beds don’t exist. Therapists are inaccessible. The system is broken and underfunded and everyone knows it, but we’re preparing to offer assisted death to the people falling through its cracks.

Official 2024 figures show 16,499 MAiD provisions across Canada 5.1 percent of all deaths. Track 2 cases for people whose natural death is not reasonably foreseeable numbered 732, a 17 percent increase from the previous year. 17 percent increase, in one year, for people who weren’t dying and now the next frontier is people who are depressed, and let’s be very uncomfortably honest here. Have you seen the state of Canada?! Of course young people are depressed!

I’ve said this before and I’ll keep saying it, this isn’t about autonomy. Autonomy requires real options. You can’t call it a free choice when someone is suffering, broke, on a waiting list, and the system hands them a pamphlet for death. That’s not autonomy. That’s a system that decided their life wasn’t worth the cost of fixing.

The parliamentary committee has been asked to complete additional review steps before the 2027 expansion proceeds, reflecting concern about safeguards and implementation readiness.

“Implementation readiness.” That’s the language. Not “is this the right thing to do.” Just are we ready to do it.

They’re not asking the right question and nobody in that committee room is being asked to answer for the people who will die because of their non-answer.

I’m asking. Because someone has to and there is a reason why people like me are not asked to testify on this committee and it’s because myself and others have healed from the same issues their trying to kill you for.

The Myth of a Safe Assisted Suicide Regime.

Alexander Raikin

Alexander Raikin was published by the Wall Street Journal on December 23, 2025 in response to a December 17 letter by Corinne Carey celebrating New York Governor Hochul's decision to sign the New York assisted suicide bill into law. 

Raikin is a visiting fellow in Bioethics at the Ethics and Public Policy Center, who has been published by multiple journals and news agencies. Raikin writes.

How humane is assisted suicide? Corinne Carey, from the advocacy group Compassion & Choices, suggests the answer is very (Letters, Dec. 17). New York’s bill places the decision only with a mentally competent patient, and “safeguards are in place to ensure that those who don’t qualify—say, those with eating disorders or psychiatric conditions—couldn’t receive it.”

No need to fear? Not quite.

That’s the same promise Compassion & Choices made in other states before legalization. Three years ago, the organization’s then chief legal advocacy officer—recently promoted to CEO—promised that Colorado’s legislation “does not and was never intended to apply to a person whose only diagnosis is anorexia nervosa.”

But physicians have simply stopped following the law. In at least Oregon, California and Colorado, patients with eating disorders have already qualified and died through assisted suicide. Despite the claim that this is illegal, in Colorado—the sole state to report “malnutrition” as a qualifying illness for assisted suicide—at least 30 MAID deaths between 2017 to 2024 were due to “severe protein calorie malnutrition.” The main lobby group for assisted suicide claims it is illegal to prescribe the “treatment” for eating disorders, and in response, the number of assisted suicides for eating disorders has increased nationwide.

Unfortunately, this follows a larger trend. A Washington state health department report in 2022 found that a third of all relevant physicians in the state failed to submit legally mandated compliance forms for assisted suicide. The result: The state looked hard at the practice, at the assisted-suicide physicians blatantly failing to follow the most minimal of safeguards, and then decided this year to discontinue “suspend” its monitoring program for the procedure.

Previous articles by Alexander Raikin. (Articles Link).

Game of Thrones actress opposes assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Sophia Turner

People Magazine, which has continuously promoted the legalization of euthanasia and assisted suicide, offered neutrality in the resent article by Vanessa Etienne that was published on November 27.

Etienne reported that Sophie Turner, the 29-year-old Game of Thrones alum signed an open letter to the U.K. House of Lords opposing the Terminally Ill Adults (End of Life) Bill, which would allow adults in the U.K. to be killed by their doctor upon request.

The Open Letter which was published on November 18 by the Eat Breathe Thrive Foundation an organization that changes the lives of people who struggle with eating disorders.

The Open Letter that was signed by Sophie Turner and many more states:

November 18, 2025

Dear Members of the House of Lords,

We are writing to express deep concern about the Terminally Ill Adults (End of Life) Bill and the serious risk it poses to people with eating disorders.

If passed, this bill could make individuals with eating disorders eligible for assisted death at times when they are unable to access or accept treatment. Many young people who could recover with effective care might instead receive lethal medication during a period of despair.

In jurisdictions where assisted death is legal, women with eating disorders have already died under laws intended only for those who are terminally ill. One such woman was Jessica, a thirty-six-year-old from Colorado who lived with anorexia and depression. When she was unable to increase her nutritional intake, her doctor concluded that her illness was irreversible and incurable, and prescribed medication to end her life. Jessica died after taking the drugs. According to her family, she repeatedly said she did not want to die but could not continue living as she was.

These were not individuals who were inevitably dying, but individuals whose illnesses had become life-threatening in the absence of effective treatment. The bill’s definition of “terminally ill,” like that used in Colorado, could be interpreted to include people with eating disorders who develop severe physical complications from starvation, purging, or restricting insulin. In a health system already stretched beyond capacity, someone who is severely ill and ambivalent about treatment could be assessed as eligible for assisted death.

Some have argued that people with eating disorders would not be eligible because they lack capacity. This reflects a misunderstanding of capacity and the nature of these illnesses. People with eating disorders are often coherent and capable of making decisions unrelated to nutrition, even when seriously ill. Evidence from other countries shows that in sixty documented cases where people with eating disorders died by assisted death, doctors found they had capacity to make that decision.

Amendments may lessen the risk for people with eating disorders but cannot remove it entirely. The deeper problem lies within the healthcare system itself. Decades of underinvestment, limited research, and poor coordination have left services overstretched and fragmented. Families are waiting months, sometimes years, for treatment while the illness progresses to more severe, complex, and life-threatening stages.

The Eating Disorders APPG’s most recent report has called for a confidential inquiry into eating disorder deaths to identify and address failings that contribute to preventable deaths. That recommendation remains unfulfilled.

No eating disorder expert was invited to give evidence to the Select Committee, despite repeated warnings from charities, campaigners, families, and the Royal College of Psychiatrists that the bill, as drafted, places this group at risk.

We urge you to pause and ensure that legislation intended to bring compassion to those facing terminal illness does not end the lives of those who could still recover.

Previous articles on Eating Disorders:

• As an Anorexic I would have longed for an assisted death (Link).
• Landmark study: Assisted death for eating disorders (Link).
• At least 60 people with eating disorders euthanized or assisted in suicide since 2012 (Link).
• ANAD clarifies that Anorexia Nervosa is not a terminal condition (Link)
• When I was Anorexic I would have chosen assisted suicide (Link).
• Psychiatrist: Anorexia does not justify Aid in Dying (Link).
• Anorexia is not a terminal condition (Link).

Assisted suicide was offered to Jane Allen. She had an eating disorder.

This guest commentary was published by The Denver Post on October 2, 2025.

By Matt Vallière

The big selling point of assisted suicide laws is that they are supposedly compassionate and a progressive step toward enlightened autonomy. But assisted suicide is anything but compassionate for vulnerable people, like the tragic story of my friend with anorexia, Jane Allen, which shows how assisted suicide laws threaten the lives of the young and curable.

There is a controversial diagnosis circulating called “terminal anorexia,” which is an arrow to the heart of young people with eating disorders who are already experiencing distorted ideas of their worthiness to live. Now, where assisted suicide is legal, they have the state and part of the medical profession telling them they were better off dead.

After struggling with anorexia for most of her life, in 2018, Jane was living in Colorado Springs and getting help for her mental health disabilities, including her eating disorder. She ended up in the care of an exclusive boutique eating disorder practice. She was in and out of hospitals and residential treatment. Jane’s condition resisted treatment, and she ended up receiving a “terminal anorexia” diagnosis.

Jane wrote that her eating disorder doctor, “would ‘make an exception’ for me and ‘allow’ me to die, if that was my choice. It didn’t feel like my choice – I felt coerced and spent an incredibly agonizing months in an assisted living facility.” Jane did not get the lethal prescription directly from her eating disorder doctor; instead, she was referred to another doctor who promptly checked the boxes required under Colorado’s “safeguards,” and saw to it that Jane got the lethal drugs.

Jane’s life was saved at the last minute when her father received a guardianship order from a Colorado judge and was able to have the lethal drugs destroyed. After that, Jane said, 

“I ate just enough to not die right away. And then I ate more. I weaned off the morphine and all the other hospice drugs that kept me in such a fog. I was getting better, and then I was told that I was too much of a liability and dropped from the [boutique] clinic.”

“I moved from Colorado to Oregon. I have a job that I love, a new puppy, and a great group of friends. I’m able to fuel my body to hike and do the things I love. I’m repairing my relationship with my family, and I have a great therapist who is helping me process all of this. Things obviously aren’t perfect, and I still have hard days. But I also have balance, and flexibility, and a life that is so much more than I was told would ever be possible for me.”

A week before she planned to go public with her story, however, she died suddenly of complications to her health caused by over two decades of starving herself. To this day, I wonder whether the months of treatment lost during Jane’s detour into “terminal anorexia” care worsened her condition, whether she could still be with us today, doing all the good. We’ll never know…

What we do know is that these laws are not so rosy as the propaganda would have you believe. They are as messy as life itself and there has been and will be more collateral damage in people like Jane or Coloradan, Mary Gossman, who was told by a nationally renowned Denver eating disorder treatment facility, “there’s nothing we can do for you,” which qualified her for lethal drugs under the law. She’s in a better place now and has joined as a plaintiff in a lawsuit to overturn the law. So, I ask: how many collateral deaths are acceptable to you? For whatever purported good they do, these laws just aren’t safe.

Matt Vallière is the executive director of the Patient Rights Action Fund and the Institute for Patient Rights both of which advocate against physician assisted suicide policies.

Previous articles on this topic:

• Netherlands woman dies by euthanasia based on anorexia (Link).
• Landmark study: Assisted death for eating disorders (Link).
• At least 60 people with eating disorders euthanized or assisted in suicide since 2012 (Link).
• ANAD clarifies that Anorexia Nervosa is not a terminal condition (Link)
• When I was Anorexic I would have chosen assisted suicide (Link).
• Psychiatrist: Anorexia does not justify Aid in Dying (Link).
• Anorexia is not a terminal condition (Link).

How America abandoned its assisted suicide "safeguards"

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alexander Raikin

Alexander Raikin wrote an excellent article: How America abandoned its suicide safeguards which explains how the US states that have legalized assisted suicide abandoned the "safeguards" in their assisted suicide laws. I have written several articles on this topic especially since nearly every assisted suicide law in America, once passed, was later expanded. Raikin explains:

In 2020, Jane, a 29-year-old Colorado woman with eating disorders, was “provided with lethal drugs … in the midst of a mental-health crisis”, according to a lawsuit filed this year by the Institute for Patients’ Rights, an advocacy group seeking to overturn Colorado’s assisted-suicide program. Jane qualified for assisted suicide, the lawsuit contends, yet she was discharged from a hospice because she no longer qualified for hospice care, and her hospice considered her no longer competent to consent to medical treatments. So how could she have consented to suicide-by-doctor?

Jane was fortunate: her parents successfully sued for guardianship, and a court ordered the medication to be destroyed. Jane “went on to recover from all of it, including her anorexia”, according to Matt Vallière, the executive director of the Institute for Patients’ Rights. Jane found work as an occupational therapist, went on vacation, and even purchased a home. Although she ultimately died two years later of complications from her history of eating disorders, she’d had an opportunity to “live her best life”, Vallière says. That any medical professional decided that Jane qualified for assisted suicide, he claims, was “absurd”.

Raikin states that Jane’s case isn’t unusual and violations of assisted-suicide laws are rampant with no known suspensions or revocations of clinician licenses, even when patients were endangered. Raikin explains how these laws are being violated:

Much of the issue is oversight. In each of the 11 states that have implemented suicide-by-doctor, regulations require clinicians to submit compliance forms, typically within days of a patient’s death. These forms document that the patient expressly consented to die through assisted suicide, and that the clinicians followed all necessary legal safeguards and eligibility criteria, including affirming that the patient is terminally ill and of sound mind.

Failure to submit this documentation isn’t just a statutory offense. Medical providers and pharmacists who fail to “make a good-faith effort to file required documentation in a complete and timely manner”, as Washington state law instructs, risk losing“immunity protection” for the criminal act of assisting someone’s suicide. Yet a Department of Health report found that physicians improperly reported compliance for a third of all assisted suicide deaths in the Evergreen State. Indeed, Washington is missing 515 compliance forms entirely for the period between 2009 to 2023, according to my calculations based on annual reports, and is also short of 293 “written request” documents that patients are required to sign attesting that they wish to die by suicide. In Colorado, my calculations find that almost 1,800 compliance forms have remained missing since 2017.

The actual number of assisted suicide deaths is unknown. Raikin writes:

States can’t answer the most basic question: how many physician-assisted suicides have been facilitated by clinicians in America? Across Colorado and California, state authorities have no record of the type of “aid-in-dying drugs” that were prescribed to more than 1,000 patients, according to my analysis of state reports, including the California End of Life Option Act 2024 Data Report. In Oregon, the health authority has records on 376 assisted suicides completed in 2024, but for another 178 cases in which medications were prescribed, authorities don’t know if the patient died by ingesting the drugs, or even died at all.

Washington State has decided to stop publishing the assisted suicide data.

In 2022, Washington state announced that its Department of Health is diverting “all available funding” for its assisted-suicide compliance-review program to “data entry of submitted forms”, due to lack of funding from the state. Data entry is commendable. But by law, the state is also required to “review” reporting compliance and issue an annual report. Instead, this summer, a pop-up appeared on the department’s website: “Important Note: Due to funding cuts, the Death with Dignity Program at the Department of Health is suspended. … A 2024 annual statistical report will not be released.”

Washington state’s decision surprised even assisted-suicide clinicians. Jessica Kaan, the medical director for End of Life Washington, an institution which facilitates assisted suicides in the state, warned on a forum for providers that “no one will even be monitoring or responding to emails or phone calls that come into the DOH [Department of Health] about the DWD [Dying With Dignity] program”. Kaan called it “a grim situation”. After this push back, the state announced that it will release the 2024 report after all — but it will be the last one ever to be released.

Raikin then explains that New Mexico does not publish an annual report, even though the assisted suicide law requires an annual report. States are also removing the "safeguards" in the law. Raikin explains:

This systematic disregard of safeguards is happening as the process is being fast-tracked: states are removing requirements that applicants reside in state; allowing less-credentialed providers, such as social workers, nurses, and physician associates,to perform assessments instead of psychiatrists and psychologists; and reducing minimum waiting periods. In Oregon, which waived waiting periods in 2020,clinicians have reported in Oregon’s annual Death with Dignity Act report that assisted suicides routinely occur on the same or next day the patient makes there quest. Since in some cases it takes up to five days for a patient to die from ingesting the death cocktail, it is possible that it will take a patient longer to die than to receive lethal prescriptions.

The proportion of vulnerable persons dying by assisted suicide has also increased. Raikin writes:

The proportion of deaths of vulnerable patients has also increased by magnitudes. In the first year of Washington state’s program, 16% of patients mentioned “the physical or emotional burden on family, friends, or caregivers” as a reason for their decision to die, and 2% were concerned about “the financial cost of treating or prolonging the patient’s terminal condition”. By 2023, according to the state’s reporting, the number concerned with “feeling like a burden” jumped to half of all assisted-suicide deaths, and a 10th were concerned about “financial implications of treatment”.

A similar trend is unfolding in Oregon. In 2009, the first year that the program was available, no patients told their assisted-suicide clinician that they were choosing to die because of financial concerns, and only 12% felt like a burden. By 2024, the state’s reporting revealed that it was 9% and 42% of all assisted suicide deaths, respectively. No other states even report this data. The “attending physician follow-up form” in California, which records patient concerns that contribute to the choice of “aid-in-dying”, doesn’t have “financial concerns” or “feeling like a burden” on its otherwise identical menu of options.

Compliance with the law from physicians and the government is lacking. Raikin interviewed Craig New who overseas the assisted suicide program in Oregon. Raikin reports:

Craig New, who told me on the telephone that he’s the sole employee of the Oregon Health Authority responsible for monitoring compliance reporting, says that “ultimately the things usually get resolved because we bug them until they finally send in the paperwork”,but even so, his office has reported around a dozen physicians to the Oregon Medical Board for violations of compliance reporting. Thanks to privacy laws regarding medical licensing, it is impossible to know whether the reported physicians faced repercussions, but my review of the Oregon Medical Board’s investigations reveals that few offenses are prosecuted.

Raikin reports that Dr Rose Jeanine Kenny, in Oregon, was reprimanded by the Oregon Medical Board for contravening the assisted suicide law:

One example is Rose Jeannine Kenny, a family doctor, who in 2016 was sentenced to five years probation by the Oregon Medical Board for dozens of alleged prescription violations. Later the board received “credible information” that Kenny may have again violated the same provisions she was previously reprimanded for, and may possibly have committed “violations of the Oregon Death with Dignity Act”, such as failure to ensure consent, follow the rules of written and oral assisted suicide requests, abide by the minimum waiting period, and file compliance records. Kenny once again kept her license, this time by agreeing to “participate in all physician steps” for 10 more assisted suicides, supervised by a mentoring physician from Compassion & Choices — the largest lobbying group for assisted suicide in the United States. (UnHerd was unable to reach Dr. Kenny at any of the medical practices with which she is associated online.)

Raikin states that no researchers or law enforcement are allowed to systematically review the assisted suicide records. He then tells the story of a person in Maryland with a eating distorder:

Recent court proceedings in Maryland eerily echo the lawsuit regarding Jane. Angela Guarda, the director of the Eating Disorders Program at Johns Hopkins Hospital, testified that she was contacted by an ex-patient of Jennifer Gaudiani, the physician who coined the term “terminal anorexia”, and who has prescribed assisted-suicide medication to at least one patient. The concept of terminal anorexia was meant to apply only to patients over age 30; for younger patients, Gaudiani stressed in a paper for the Journal of Eating Disorders that “every effort should be made to promote full recovery and continuation of life”.

The ex-patient reported that her assisted-suicide assessor told her “she would ‘make an exception’ for me and ‘allow’ me to die”. The patient reported feeling coerced. She eventually weaned herself off morphine and hospice drugs and, 18 months later, reports that she’s doing well, with a job, a group of friends and a new puppy.

Raikin ends the article by stating:

Patients like these, who need hope the most, are facing much more than their illnesses. They also confront an assisted-suicide regime that blatantly and routinely violates the legal safeguards that were meant to ensure their protection from a death they might not want.

Further articles on this topic:

• Assisted suicide lobby launches court case to force Colorado to permit suicide tourism (Link). 
• The push to legalize and extend assisted suicide in America (Link).
• Oregon 2024 assisted suicide report (Link). 
• Death by assisted suicide is not what you think it is (Link).  
• Assisted suicide laws, once passed will inevitably expand (Link). 
• New York assisted suicide bill is a "bait and switch" (Link). 
• Oregon bill would expand assisted suicide again (Link).
  

As an Anorexic, I'd have longed for assisted dying.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Britain is debating an assisted suicide bill sponsored by Kim Leadbeater (MP).

The Committee that is examining the assisted suicide bill is stacked with pro-assisted suicide members. The committee has debated multiple proposed amendments to the legislation and yet all of the amendments that would tighten the bill have been rejected.

An article by Hadley Freeman that was published in The Times on March 2, 2025 looks at the issue of assisted suicide for people with Anorexia. According to Freeman, Leadbeater rejected the proposal in this manner.

One suggested amendment that would have protected anorexics was that a person can’t qualify for assisted death because they have stopped eating and drinking; Leadbeater rejected that, referring to a woman with mouth cancer who had her tongue removed and starved to death. “We have to be careful not to dismiss those cases because they are real stories of real human beings,” she said.

In response Freeman tells her story and the story of a friend who struggled with anorexia.

Here’s another real story of a real human being. When I was 15, I made a new friend. Her name was Nikki Hughes and she was a talented artist, kind and funny. She was also anorexic, and we met because we were admitted to an eating disorders ward on the same day, and that, she said, bonded us for life. I don’t know what doctors made of Nikki, but I do know what they made of me, 15 and on my fifth hospital admission for anorexia. One told my mother to prepare for the very real chance that I would die. That sounded — to my nutrients-starved, illness-addled brain — great, because it confirmed I was good at anorexia.

Nikki was different. She talked about the art she would make when she recovered and would tell me off when she caught me hiding food. Two years later, when I was recovering and back at school, I opened the newspaper and there was a photo of Nikki: she had died. The hospital she was in at the time was told it could not “override her wishes” to starve herself to death and it would be assault if it tried to save her life with a feeding tube.

Freeman continues by explaining anorexia:

Anorexia is complicated: it’s a mental illness that leads to physical complications, which exacerbate the mental ones, and so on. Even more complicated, the more ill a person becomes, the more they resist treatment (eating, in other words) and the more they want to die. Offering an anorexic assisted death is like offering her liposuction: her desire for it is a symptom of her illness.

Right-to-die campaigners love to talk about autonomy, but such terms are meaningless when it comes to women whose minds are crazed by starvation. (Danny) Kruger pointed out last week that increasing numbers of anorexics are being classified as “terminal” in the NHS and given “palliative care”, which the Royal College of Psychiatrists has described as “troubling”.

Freeman further explains her concerns:

As Nikki and I learnt, it is impossible, even for doctors, to predict outcomes. The patient most determined to starve herself into the ether can recover. As my psychiatrist 30 years ago told me, there’s always hope.

Freeman explains that the assisted suicide bill excludes assisted suicide for people with mental illness but anorexia also leads to physical conditions. She writes:

Some believe that the bill excludes those with mental illness. In fact, it excludes those who are terminally ill “only” because of mental illness — anorexia can lead to physical problems, and these can qualify a person for assisted death. Others say only a tiny number of anorexia patients could qualify. But what number is acceptable? Anorexics are already gaining access to assisted death in Colorado, California and Oregon. One consultant said she could foresee a time when “20 to 30 patients with anorexia access assisted dying in this country every year, because of the contagion effect”.

Freeman states that amending the assisted suicide bill was necessary but there was a "religious fervour" in the committee room among "right-to-die" campaigners to push the bill through.

Freeman concludes her article by stating:

It is impossible for most people to comprehend the mind of an anorexic, which hisses that death is preferable to eating. Which is why it is unforgivable that MPs decided not to get hung up on those who do.

More articles on this topic:

• Proposed assisted dying bill fails public safety test (Link).
• Netherlands woman dies by euthanasia based on anorexia (Link).
• Landmark study: Assisted death for eating disorders (Link).
• At least 60 people with eating disorders euthanized or assisted in suicide since 2012 (Link).
• ANAD clarifies that Anorexia Nervosa is not a terminal condition (Link)
• When I was Anorexic I would have chosen assisted suicide (Link).
• Psychiatrist: Anorexia does not justify Aid in Dying (Link).
• Anorexia is not a terminal condition (Link).

 

Proposed UK Assisted Dying Bill Fails Public Safety Test

This letter was published in the British Medical Journal.

Dear Editor,

As the UK Parliament prepares to debate assisted dying, its impact on those with mental health conditions, particularly eating disorders, must be urgently considered. If legalised, the proposed bill may enable patients with treatable eating disorders who have life-threatening malnutrition and/or feel suicidal to qualify for assisted death. Looi (1) highlights global expansion in assisted dying laws, yet gaps in safeguarding vulnerable groups remain.

Research suggests assisted dying laws have already led to preventable deaths of young people with eating disorders in multiple countries (2). At least 60 individuals with eating disorders have died through physician-assisted death, including in jurisdictions limiting the practice to terminal conditions. Of these, one-third involved women under 30. These deaths raise profound ethical concerns, as many patients were severely depressed or suicidal when deemed eligible.

These patients did not have concurrent terminal illnesses. Rather, clinicians asserted their eating disorders were “untreatable,” offering limited substantiating evidence. Some practitioners suggested patients had “terminal anorexia,” a term not recognised by any medical authority (3). Downs et al. (4) described it as a “nosological free-for-all,” highlighting the danger of inventing new illness classifications to justify ending vulnerable lives under the guise of medical treatment. Empirical efforts to validate terminal anorexia have raised significant questions about its validity (5). Anorexia nervosa is not a terminal condition; almost all the medical complications of eating disorders are reversible with nutrition and weight restoration (6).

The proposed bill aims to restrict eligibility to terminal illness — in practice, this safeguard is porous. In Oregon US, officials interpret “terminal illness” as any condition expected to cause death within six months if untreated (7). Patients with non-terminal conditions can become terminal by choosing to forego life-extending treatments, such as dialysis. This has led to deaths in patients with non-terminal conditions; including anorexia, arthritis, and hernias (8). The wording of the proposed U.K. bill similarly allows for this broad interpretation, offering minimal protection to vulnerable patients (9).

Assessing capacity to make a life-ending decision is particularly fraught in patients with malnutrition or mental distress (10, 11) who may appear lucid and articulate, yet struggle to process information fully. Evidence suggests that clinicians’ judgments of capacity in these patients are often inconsistent (11). In Oregon, only three individuals who received lethal prescriptions (1%) were referred for psychiatric evaluation in 2023, down from 33% in previous years (12), raising concerns that evaluators have become less cautious about capacity and psychiatric comorbidities.

Moreover, evidence from jurisdictions where assisted dying is legal reveals weak oversight and opaque reporting mechanisms (13). For example, U.S. oversight agencies confirmed anorexia nervosa has been documented as a terminal illness in cases of assisted death; however, these cases are hidden in public reports under the broad category “Other Illnesses” (2). Officials declined to disclose the exact number of cases, and agencies have limited authority to investigate potential misapplications of the law.

In the UK, the Court of Protection has already allowed treatment withdrawal and palliative care for eating disorders deemed ‘untreatable’ (14). However, researchers have raised concerns that many patients are labeled 'untreatable' without having received adequate treatment (4). If the proposed bill passes, “palliative care for eating disorders” may expand to assisted dying, undermining protections for those with complex, often stigmatised mental health conditions.

Evidence from other jurisdictions should serve as a stark warning to UK policymakers. The question before Parliament is not only whether individuals have the right to die, but whether assisted dying can be safely implemented within the NHS. Evidence from other countries shows that safeguards intended to protect vulnerable patients from medically-assisted suicide have failed. We urge MPs to weigh these findings carefully and vote against the bill—it fails the public safety test.

Chelsea Roff
Executive Director, Eat Breathe Thrive

James Downs
Peer Researcher and Expert by Experience

Agnes Ayton
Consultant Psychiatrist in Eating Disorders
Oxford Health NHS Foundation Trust

Ashish Kumar
Chair, Faculty of Eating Disorders, RCPsych
Clinical Director at Mersey Care Foundation Trust

Angela Guarda
Professor of Psychiatry and Behavioral Sciences Director
Eating Disorders Program Johns Hopkins School of Medicine

Patricia Westmoreland
Medical Director, ACUTE Center for Eating Disorders & Severe Malnutrition Department of Psychiatry, University of Colorado

Philip Mehler
Founder, ACUTE Center for Eating Disorders & Severe Malnutrition
Professor of Medicine, University of Colorado

Mark S. Komrad
Faculty of Psychiatry
Johns Hopkins School of Medicine, Tulane, and University of Maryland

Paul Appelbaum
Dollard Professor of Psychiatry, Medicine & Law
Columbia University

Ronald W. Pies
Professor Emeritus of Psychiatry
SUNY Upstate Medical University

Annette Hanson
Assistant Professor
University of Maryland

Catherine Cook-Cotton
Licensed Psychologist, Professor and Researcher
University at Buffalo (SUNY)

Anita Federici
Clinical Psychologist
Center for Psychology and Emotion Regulation

Hope Virgo
Founder of #DumptheScales, Author,
Mental Health Campaigner

Ali Ibrahim
Consultant Psychiatrist, Eating Disorders

Suzanne Baker
Family & Carer Representative, FEAST UK

Marissa Adams
Peer Research & Expert by Experience

References
1. Looi, M. K. (2024). Assisted dying laws around the world. bmj, 387.
2. Roff, C., & Cook-Cottone, C. (2024). Assisted death in eating disorders: a systematic review of cases and clinical rationales. Frontiers in Psychiatry, 15, 1431771.
3. Gaudiani, J. L., Bogetz, A., & Yager, J. (2022). Terminal anorexia nervosa: three cases and proposed clinical characteristics. Journal of eating disorders, 10(1), 23.
4. Downs, J., Ayton, A., Collins, L., Baker, S., Missen, H., & Ibrahim, A. (2023). Untreatable or unable to treat? Creating more effective and accessible treatment for long-standing and severe eating disorders. The Lancet Psychiatry, 10(2), 146-154.
5. Robison M, Udupa NS, Abber SR, Duffy A, Riddle M, Manwaring J, Rienecke RD, Westmoreland P, Blalock DV, Le Grange D, Mehler PS, Joiner TE. "Terminal anorexia nervosa" may not be terminal: An empirical evaluation. J Psychopathol Clin Sci. 2024 Apr;133(3):285-296. doi: 10.1037/abn0000912. PMID: 38619462; PMCID: PMC11062513.
6. Westmoreland P, Krantz MJ, Mehler PS. Medical Complications of Anorexia Nervosa and Bulimia. Am J Med. 2016 Jan;129(1):30-7. doi: 10.1016/j.amjmed.2015.06.031. Epub 2015 Jul 10. PMID: 26169883.
7. Stahle F. Notarized Questions to Oregon Health Authority. January 2018. Available online: https://drive.google.com/file/d/1XopTDjBA2SAVBGBxpDazNN899eTHixSe/view
8. Oregon Health Authority. Oregon Death with Dignity Act: 2021 Data Summary (2022). Available online at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARC...
9. Leadbeater K. Terminally Ill Adults (End of Life) Bill. Nov 11, 2024. https://bills.parliament.uk/bills/3774 [Accessed 14th November 2024].
10. Van Elburg, A., Danner, U. N., Sternheim, L. C., Lammers, M., & Elzakkers, I. (2021). Mental capacity, decision-making and emotion dysregulation in severe enduring anorexia nervosa. Frontiers in Psychiatry, 12, 545317.
11. Elzakkers, I. F. F. M., Danner, U. N., Grisso, T., Hoek, H. W., & van Elburg, A. A. (2018). Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice. International journal of law and psychiatry, 58, 27–35. https://doi.org/10.1016/j.ijlp.2018.02.001
12. Oregon Health Authority. Oregon Death with Dignity Act: 2023 Data Summary (2024). Available online at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARC...
13. Raikin, A. (2024). A pattern of non-compliance. The New Atlantis. 11 November 2024.
14. Cave, E., & Tan, J. (2017). Severe and enduring anorexia nervosa in the England and Wales Court of Protection. International Journal of Mental Health and Capacity Law, 23(17).

Netherlands woman (33) dies by euthanasia based on anorexia

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Esther Beukema with her mother.

Poppy Bilberbeck wrote an article that was published by Unilad.com on November 4 about the Netherlands euthanasia death of Esther Beukema (33) who died on December 10, 2021. Beukema was approved for euthanasia based on mental illness. Her condition was anorexia.

Bilberbeck's article describes Beukema's euthanasia death for anorexia in a positive manner. The article interviews the family and suggests that they were supportive of Esther's death and happy that she didn't die alone.

The article states that there was no other choice, when euthanasia is done for mental illness, and in this case for anorexia. Bilberbeck writes:

The Dutch Termination of Life on Request and Assisted Suicide (Review Procedures) Act of 2002 states someone can be permitted euthanasia for psychiatric as well as physical illnesses if there is 'no reasonable alternative' and the patient's suffering is 'unbearable with no prospect of improvement'.

For people with anorexia there is always a reasonable alternative.

A landmark study by Chelsea Roff and Catherine Cook-Cottone titled: Assisted death in eating disorders: a systematic review of cases and clinical rationales, was published by Frontiers in Psychiatry on July 30, 2024.

The authors of the study responded by promoting a Joint Statement Against Assisted Suicide for Eating Disorders. The Joint Statement says:

Eating disorders are treatable conditions that require timely and comprehensive treatment. Yet many cannot access care due to cost, inadequate insurance coverage, extensive wait times, and a shortage of specialist services. The notion that they are incurable or terminal is scientifically unsupported and dangerously misleading. The term “terminal anorexia” is not recognized by any formal medical body, has been widely rejected by researchers and clinicians, and represents a profound misunderstanding of these conditions.

People with eating disorders need access to evidence-based and inclusive treatment, not lethal medications. Poor outcomes, including deaths, are nearly always preventable.We categorically reject the argument that assisted suicide is a form of compassionate care for individuals with eating disorders. Compassionate care involves consistent, effective treatment — not facilitating suicide. Together, we call on governments to act to ensure that every individual with an eating disorder receives the care, compassion, and treatment they need to recover.

The statement by the National Association of Anorexia Nervosa & Associated Disorders (ANAD) in June 2024 concerning euthanasia and anorexia stated:

We must not confuse ‘chronic’ with ‘terminal.’ Being labeled with a terminal illness has the potential to become a self-fulfilling prophecy.

I reject the concept that eating disorders are a terminal condition.

I am convinced that Esther Beukema was abandoned by the medical system. Her family would have wanted her to be happy, but in fact Esther was abandoned to death.