Assisted suicide was legalized in three US states in 2025. Are you concerned?

Alex Schadenberg

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

In 2025, assisted suicide was legalized in Delaware, Illinois and New York. This means that there are now 13 US states plus Washington DC that permit assisted suicide. The 13 states include California, Illinois and New York, three of the six most populated states in America.

This is tragic and will result in many early deaths and will lead to the further medical abandonment of people in need.

Previous to this year, the last state that legalized assisted suicide was New Mexico in 2021.

Are you concerned? I am concerned.

I watched the recent online US assisted suicide lobby political meeting. During the meeting the assisted suicide lobby outlined that, in 2026, there will be at least 18 states with bills to legalize assisted suicide. 

We are very concerning with some of the listed states which included: Connecticut, Maryland, Massachusetts, Nevada and Virginia. There are other states that the assisted suicide lobby are focusing on that are less likely to legalize assisted suicide in 2026 including (but not limited to) Arizona and Florida.

Our allies have been very successful in the past few years but the issue seems to be changing How are we to respond?

Let's look at the most recent successful campaign. 

The Slovenian people voted on an assisted suicide referendum on Sunday, November 23, 2025 and voted to overturn the assisted suicide bill that was passed in the Slovenian legislature in July 2025. More than 53.5% of the voters rejected the assisted suicide law.

This was a great victory, that was accomplished by a small group of committed citizens who stuck to their talking points. They achieved the victory for people who are sick, people with disabilities and pensioners against all odds, as they were up against the government and a well funded death lobby.

Slovenia is not the United States, but the principles in the successful campaign will transport to North America.

They weren't afraid to call it what it is. They used the term poisoning. Assisted suicide is to provide a lethal concoction to poison a person to death. 

The never used the language of the other side. The other side continuously lied about what the assisted suicide law said or what assisted suicide is. The campaign focused on telling the truth and challenging the lies.

They called assisted suicide, health care reform. Most jurisdictions require health care reform to enable a more equitable provision of care. Assisted suicide poisons a person to death. Dead people don't need health care.

The called assisted suicide pension reform. Slovenia, like most jurisdictions, invest a significant portion of their budget into the pension system. Assisted suicide poisons a person to death. Dead people don't collect pensions.

Proper medical care. The other side focused on suffering. The campaign opposing assisted suicide talked about proper care, and explained that assisted suicide forces people, who cannot attain proper medical care, to be poisoned to death.

The Slovenian campaign was more aggressive than most campaigns, but they won even though they were massively out-spent.

The take-away from the Slovenian referendum is that people innately oppose killing people, but you must be willing to state what assisted suicide is. The Slovenians built their campaign on a few key talking points and stuck to them. Hiding behind nice language or presenting the issue in a way that seems more socially acceptable avoids the reality that assisted suicide is about killing people by poison.

I am not afraid to say that I oppose killing people.

Massachusetts Committee delays vote on assisted suicide bill.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Massachusetts Public Health Committee is delaying their consideration of the state assisted suicide bill by 30 days. Chris Lisinski reported for Yahoo News on June 3, 2025 that:

Legislators last week asked for a 30-day extension on a bill that would authorize physician-assisted suicide (H 2505), according to the House clerk’s office, keeping it idling in the Public Health Committee through a Tuesday event that drew both supporters and opponents of the long-debated policy.

Backers of the proposal, which has stalled out without a House or Senate vote for multiple terms in a row, argued they made “historic progress” last session by winning support from both the Public Health Committee and Health Care Financing Committee.

Lisinski reported that Senator Jo Comerford told an opponent of the bill that:

“This is not an easy conversation to have, yet in this State House, we welcome democratic engagement, we welcome debate, we welcome dissent,” the Northampton Democrat said. “If we weren’t asking important questions about whether or not assisted suicide could be made safe — and I do believe it’s made safe in this bill, I do believe that — we wouldn’t be doing our jobs. This is too important a bill for us not to engage seriously with, so you are welcome here.”

“If there are ways to make this stronger, let’s do it together, friends. We are not railroading this bill through the State House,” she added.

As stated by one of the signs at the Public Health Committee, Assisted Suicide Cannot Be MAiD Safe.

The Euthanasia Prevention Coalition urges our supporters to continue contacting their elected representatives in Massachusetts to oppose the bill. We oppose killing people.

Ronald W. Pies, MD testimony opposing Massachusetts assisted suicide bill.

This testimoney was sent to the Euthanasia Prevention Coalition with permission to publish.

Dr Ronald Pies

Written Testimony of Ronald W. Pies, MD

Massachusetts psychiatric physician and medical ethicist

In opposition to H. 2505/S.1486 MASSACHUSETTS END OF LIFE OPTIONS ACT

Submitted to Massachusetts Joint Committee on Public Health - March 29, 2025

Dear Committee Members:

As a Massachusetts psychiatrist and medical ethicist, I write in firm opposition to H.2505/S.1486 MASSACHUSETTS END OF LIFE OPTIONS ACT—bills that would effectively legalize physician-assisted suicide (PAS) in Massachusetts. 

First, it is important to note the profound ethical problems inherent in the practice of PAS, misleadingly called “aid in dying” in some contexts. (PAS does not “aid” the natural dying process; rather, it terminates dying by terminating the patient, via provision of lethal drugs). The American Medical Association; the American Psychiatric Association; the American College of Physicians; and the National Council on Disability have all rejected physician-assisted suicide. [1] Neither the Massachusetts constitution nor the U.S. Constitution contains a right to assisted suicide; therefore, no individual has the right to authorize another to kill him or her in violation of federal and state criminal laws. (Washington v. Glucksberg, 521 U.S. 702, 735 (1997). Instead, Massachusetts has an unqualified interest in the preservation of human life. Furthermore, in the Massachusetts case of Kligler v. Att’y Gen., 491 Mass. 38, 70 (2022), the court rejected claims that a person has a “right” to assisted suicide. The court found no basis to “conclude that physician-assisted suicide ranks among those fundamental rights protected by the Massachusetts Declaration of Rights.”

Contrary to popular misconceptions, the vast majority of persons requesting PAS are not in the grip of severe, intractable pain and suffering [2]. As data from Oregon have shown, the most common reasons for requesting medical aid in dying were fears regarding loss of autonomy (97.2%), inability to engage in enjoyable activities (88.9%), and loss of dignity (75.0%) [3] These understandable fears are best dealt with via empathic, face-to-face counseling and psychotherapy—not with the ingestion of poison.

Furthermore, a peaceful death is by no means guaranteed using current methods of PAS, as a recent piece by Lo pointed out: 

“Physicians who support PAD need to consider how to address the potential for adverse outcomes, including longer time to death than expected (up to 24 hours or more), awakening from unconsciousness, nausea, vomiting, and gasping.” [4] 

Data collected between 1998 and 2015 showed that the time between ingestion of lethal drugs and death ranged from 1 minute to more than 4 days. During this same period (1998-2015), 27 cases (out of 994) involved difficulty ingesting or regurgitating the drugs, and there were 6 known instances in which patients regained consciousness after ingesting the drugs. However, it is difficult to know the actual rate of drug-induced complications, because in the majority (54%) of cases between 1998 and 2015, no health care professional was present to attend and observe the patient’s death [5].

This last point highlights an additional ethical flaw in so-called “end of life options” bills, including H. 2505/S.1486: they do not require the presence of a physician or other medical personnel at the time the patient ingests the lethal drugs. In addition to denying the patient medical oversight of the suicide, this amounts to abandonment on the part of the physician who authorized the assisted suicide. To compound the ethical lapse, the physician is then permitted to falsify the cause of the patient’s death; i.e., “The attending physician may sign the patient's death certificate which shall list the underlying terminal disease as the cause of death” (lines 195-196 H. 2505/S.1486 ). This is plainly fraudulent, unethical, and inimical to research aimed at tracking the natural course of terminal illnesses.

A major failing of this bill is its ambiguity regarding the concept of “terminal illness.” The bill defines “Terminally ill”, as “having a terminal illness or condition which can reasonably be expected to cause death within 6 months, whether or not treatment is provided.” [italics added]. The phrase “whether or not treatment is provided” is vague and indecipherable. Does this mean that if a patient with, say, type 1 diabetes or anorexia nervosa refuses evidence-based treatment—and thus, is likely to die within 6 months—the patient nevertheless meets the criterion for “terminal illness”? Would a patient with a potentially fatal but treatable infectious disease who refuses treatment be classified as “terminally ill?” Such an interpretation radically distorts the historical meaning of the term “terminally ill.” Moreover, in practice, there are significant limitations in a physician’s ability to predict patient outcomes; this is true even for end-of-life physician specialists. For example, in a study of 364 doctors who provided survival estimates for 468 terminally ill patients, only 20% of predictions were accurate.[6]

Psychiatric and Medico-legal Considerations

As a psychiatrist, I find the bill’s safeguards against missing underlying psychiatric illness—which may compromise informed consent—woefully inadequate. Yes, the bill does mandate (section 8) that:

“…An attending physician shall refer a patient who has requested medical aid in dying medication under this chapter to counseling to determine that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment. The licensed mental health care professional shall review the medical history of the patient relevant to the patient’s current mental health and then shall submit a final written report to the attending physician.”

However, the bill defines licensed mental health professional very broadly, as “…a treatment provider who is a psychiatrist, psychologist, psychiatric social worker or psychiatric nurse and others who by virtue of education, credentials and experience are permitted by law to evaluate and care for the mental health needs of patients.” In what is literally a life-or-death determination, it is far from clear that the average “mental health professional” possesses the requisite skill set to assess mental capacity in the setting of terminal illness—an assessment that would challenge the skills of even a forensic psychiatrist.

Furthermore, there is no requirement in the bill for psychological evaluation at or very near the actual time of lethal drug ingestion, despite the fact that the patient’s mental status and mental capacity may fluctuate from day to day or week to week, in the course of a terminal illness. In addition, it seems that the bill would permit evaluation and “counseling” of the patient without even a face-to-face meeting; i.e., the process could be conducted via “telemedicine”—to my knowledge, a completely untested method of determining mental capacity or providing counseling in the context of a terminal illness.

Finally, there are no well-defined procedures specified in the bill by which any unused lethal drugs would be located and disposed of, in the event the patient elects not to ingest them. The bill merely states, “Any medical aid in dying medication dispensed under this chapter that was not self-administered shall be disposed of by lawful means. The medication dispenser shall be responsible for informing the individual collecting the medication what disposal by lawful means entails.” This says nothing about when the unused medication shall be disposed of—a day after the patient decides not to ingest it? A week? A month? What about the risk that in the interim, a family member—perhaps a young child—will happen upon the lethal medication and ingest it? A recent report in the Journal of Emergency Medical Services reveals that this possibility is not merely theoretical. [7] Do Massachusetts physicians really want to assume medico-legal liability in such a scenario? The bills as written are an invitation to litigation.

Conclusion

End-of-life care deserves far better than effectively handing terminally ill patients a bottle of lethal drugs—a practice that flies in the face of more than two millennia of Hippocratic medical practice. As Dr. John R. Peteet and I have argued, physician-assisted suicide will lead to “distorting the physician’s role; cheapening individual life; and abandoning the most vulnerable people” at their time of most urgent need. Surely as a society we can do better, by providing optimal, accessible psychiatric and palliative care. [8] As physician and medical ethicist Dr. Leon Kass eloquently put it,

“The legalization of physician-assisted suicide [perverts] the medical profession by transforming the healer of human beings into a technical dispenser of death. For over two millennia the medical ethic . . . has held as an inviolable rule, “Doctors must not kill.” The venerable Hippocratic Oath clearly rules out physician-assisted suicide. Without this taboo, medicine ceases to be a trustworthy and ethical profession. . . . We need to care for the dying, not make them dead.” [9]

Respectfully,

Ronald W. Pies, MD ronwpies@gmail.com
Professor Emeritus of Psychiatry
Lecturer on Bioethics & Humanities
SUNY Upstate Medical University;
Clinical Professor Emeritus of Psychiatry
Tufts University School of Medicine

References

1. Snyder Sulmasy L, Mueller PS; Ethics, Professionalism and Human Rights Committee of the American College of Physicians. Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Ann Intern Med. 2017 Oct 17;167(8):576-578. doi: 10.7326/M17-0938. Epub 2017 Sep 19. PMID: 28975242.

2. https://www.hcplive.com/view/twelve-myths-concerning-medical-aid-in-dying-or-physicianassisted-suicide

3. Loggers ET, Starks H, Shannon-Dudley M, Back AL, Appelbaum FR, Stewart FM. Implementing a Death with Dignity program at a comprehensive cancer center. N Engl J Med. 2013;368(15):1417-1424. doi: 10.1056/NEJMsa1213398

4. Lo B. Beyond legalization - dilemmas physicians confront regarding aid in dying. N Engl J Med. 2018;378(22):2060-2062. doi: 10.1056/NEJMp1802218.

5. Oregon Health Authority, Public Health Division, Center for Health Statistics. Oregon Death With Dignity Act: data summary 2016. oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year19.pdf. Published February 10, 2107. Accessed June 6, 2018.

6. Nicholas A. Christakis, Extent and Determinants of Error in Doctors’ Prognoses in Terminally Ill Patients: Prospective Cohort Study, 7233 THE BMJ 469, 469-73 (2000).]

7. Death with Dignity: When the Medical Aid in Dying Cocktail Gets into the Wrong Hands. https://www.jems.com/patient-care/death-with-dignity-when-the-medical-aid-in-dying-cocktail-gets-into-the-wrong-hands

8. https://www.telegram.com/story/opinion/columns/2023/01/29/dr-john-peteet-and-dr-ronald-pies-oppose-physician-assisted-death/69831539007/

9. Kass LR. Dehumanization Triumphant. 1996. See: https://www.psychiatrictimes.com/view/deferring-mastery-death-hippocrates-judge-gorsuch-and-autonomy-fallacy

Assisted suicide lobby launches lawsuit to allow assisted suicide tourism in New Jersey.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The assisted suicide lobby launched a lawsuit on Tuesday, August 29 to force the state of New Jersey to drop its assisted suicide residency requirement. The lawsuit claims that the New Jersey assisted suicide law is unconstitutional because it denies equal treatment.

If the residency requirement in the New Jersey assisted suicide law is withdrawn, the assisted suicide lobby will establish an assisted suicide clinic in New Jersey to assist the suicides of people in the neighboring states that have not legalized assisted suicide.

New Jersey is not far from: New York, Pennsylvania, Massachusetts, Connecticut, Delaware, Maryland and New Hampshire --- states that have not legalized assisted suicide.

The Compassion and Choices media release stated:

Compassion & Choices filed a federal lawsuit Tuesday afternoon on behalf of cancer patients in Delaware and Pennsylvania and two New Jersey doctors asserting the residency mandate in New Jersey’s medical aid-in-dying law violates the U.S. Constitution’s guarantee of equal treatment. The lawsuit asks the U.S. District Court in Camden, New Jersey, to prohibit state officials and the Camden County prosecutor from enforcing this unconstitutional provision of the law. The lawsuit complaint is posted at: bit.ly/NJMedicalAidinDyingLawResidencySuit

...The plaintiffs assert that the law’s residency requirement violates three clauses in the U.S. Constitution, specifically the:

• 1. Privileges and Immunities Clause by limiting the availability of medical aid in dying to residents of New Jersey. 

• 2. Dormant Commerce Clause by restricting interstate commerce, including medical care. 

• 3. Equal Protection Clause by failing to provide residents and nonresidents equal protection under federal law.

On October 2021, the assisted suicide lobby group, Compassion and Choices, and Dr Nicholas Gideonse, an assisted suicide doctor, launched a court case challenging the Oregon assisted suicide residency requirement. Instead of defending the residency requirement, the Oregon Government, on March 29, 2022 agreed to remove the residency requirement.

A February 2023 article by James Reinl for the Daily Mail reported that Dr Nicholas Gideonse has opened the first assisted suicide clinic in Oregon to prescribe lethal assisted suicide drugs for death tourists. At least one person from Texas and an east coast resident has died by assisted suicide in Oregon.

On August 26, 2022, Compassion and Choices launched a lawsuit on behalf of a Connecticut woman and a Vermont doctor challenging Vermont's assisted suicide residency requirement.

Lisa Rathke reported on March 14, 2023 for the Associated Press that Vermont's attorney general's office reached an agreement with the assisted suicide lobby and dropped the Vermont assisted suicide residency requirement.

The assisted suicide lobby failed to legalize assisted suicide in any more states since 2021. By dropping the state assisted suicide residency requirements the assisted suicide lobby is creating suicide tourist states. 

New Jersey neighbors several highly populated states that have not legalized assisted suicide. If New Jersey drops its residency requirement, the assisted suicide lobby will establish an assisted suicide clinic in New Jersey to service the killing across the Northeast United States.

Supreme Judicial Court of Massachusetts decides that there is no right to assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Supreme Judicial Court of Massachusetts decided on December 19 to reject a challenge to the Massachusetts state prohibition of assisted suicide by finding that there is no right to assisted suicide in the Massachusetts Constitution.

EPC-USA is incredibly pleased by this decision. EPC-USA was the only group to submit a friend-of-the-court brief and also provide an oral argument before the Supreme Judicial Court of Massachusetts.

Mark Pratt, in writing for the Associated Press reported Chris Schandevel from ADF who represented the Euthanasia Prevention Coalition as stating:

“Patients should be able to trust their doctors to support and care for them,” said Chris Schandevel, senior counsel for the nonprofit Alliance Defending Freedom, which filed a friend-of-the-court brief in the case on behalf of Euthanasia Prevention Coalition. “Offering terminally ill or disabled patients a ‘quick exit’ through death-inducing drugs destroys that trust.”

The Massachusetts case known as Kligler v Healy concerns Dr Roger Kligler who is living with prostate cancer and seeking death by assisted suicide and Dr Alan Steinbach who is willing to prescribe a lethal drug cocktail for Kligler to die by assisted suicide. Kligler who claimed to be terminally ill when the case began in 2016 is very much alive today.

Kligler and Steinbach argued that doctors cannot be prosecuted for prescribing lethal drug cocktails for assisted suicide to competent terminally ill persons because there was a right to assisted suicide under the Massachusetts state constitution.

The Supreme Judicial Court of Massachusetts decided that:

Although we recognize the paramount importance and profound significance of all end-of-life decisions, after careful consideration, we conclude that the Massachusetts Declaration of Rights does not reach so far as to protect physician-assisted suicide. We conclude as well that the law of manslaughter may prohibit physician-assisted suicide, and does so, without offending constitutional protections.

As to the question of whether assisting a suicide can result in a charge of manslaughter which is described as wanton and reckless behavior. The Supreme Judicial Court of Massachusetts stated that:

As the motion judge concluded, physician-assisted suicide could constitute wanton or reckless conduct. Our case law demonstrates that knowingly providing someone who has expressed an interest in ending his or her life with the means to do so may be considered wanton or reckless behavior. ... That a doctor's intent in providing the lethal medication was to alleviate a patient's suffering is irrelevant, as conduct may be wanton or reckless even where the actor "meant no harm to the victim." ... (motive is irrelevant to crime of manslaughter).

Dr Steinbach argued that prescribing lethal drugs for assisted suicide is not proximate to the death and therefore cannot result in a charge of manslaughter. The Supreme Judicial Court of Massachusetts referred to the February 2019 decision upholding the voluntary manslaughter conviction of Michelle Carter for assisting the suicide of Conrad Roy (18). Carter, who was 17 at the time of the death, pressured Roy to die by suicide by urging him during the act while on her cell phone. She was sentenced to 15 months in prison.

The Supreme Court of Massachusetts settles the argument that assisted suicide is not proximate to the death by stating:

Steinbach argues that, regardless, doctors who provide physician-assisted suicide cannot be the proximate cause of a patient's death because the patient's decision to ingest the medication is a superseding event that extinguishes proximate cause. We do not agree. It is entirely foreseeable that a terminally ill patient who requests medication intended to bring about death may use the medication for such a purpose.

...In sum, under our existing law, doctors who engage in physician-assisted suicide may risk liability for involuntary manslaughter.

The question as to whether the Massachusetts Constitution could be interpreted to include a right to assisted suicide the Supreme Court of Massachusetts stated:

In sum, the history of suicide in general, and physician assisted suicide in particular, provides no support for the conclusion that physician-assisted suicide is an individual right protected by the Massachusetts Declaration of Rights.

Steinbach argued that the right to assisted suicide is a natural outgrowth to the right to refuse medical treatment. The Supreme Court of Massachusetts decided that:

We do not agree, but, rather, recognize an important distinction between the refusal of medical treatment and physician-assisted suicide, which lies in fundamental legal principles of cause and effect; whereas withdrawing or withholding medical care is not the primary cause of a patient's death, physician-assisted suicide is.

The Supreme Court of Massachusetts further analyses the question of the right to refuse treatment and states:

In medical ethics, "the right of competent, informed patients to refuse life-prolonging interventions . . . is firmly established," whereas the right to physician-assisted suicide is a matter of "ethical . . . controversy."

The American Medical Association has opined, for example, that although physicians should "honor patients' informed decisions to refuse life-sustaining treatment," physicianassisted suicide "is fundamentally incompatible with the physician's role as healer."

In their conclusion, the Supreme Judicial Court of Massachusetts states:

In sum, given our long-standing opposition to suicide in all its forms, and the absence of modern precedent supporting an affirmative right to medical intervention that causes death, we cannot conclude that physician-assisted suicide ranks among those fundamental rights protected by the Massachusetts Declaration of Rights. Thus, application of the law of manslaughter to physician-assisted suicide would not impinge on an individual's right to substantive due process.

The Supreme Judicial Court of Massachusetts then states:

Application of the law of manslaughter to physician assisted suicide passes constitutional muster because the law is reasonably related to the State's legitimate interests in preserving life; preventing suicide; protecting the integrity of the medical profession; ensuring that all end-of-life decisions are informed, voluntary, and rational; and "protecting vulnerable people from indifference, prejudice, and psychological and financial pressure to end their lives."

As much as the Supreme Court of Massachusetts reject a right to assisted suicide they do keep the issue open to a legislative change by stating:

These questions are best left to the democratic process, where their resolution can be informed by robust public debate and thoughtful research by experts in the field.

The Euthanasia Prevention Coalition and EPC-USA would like to thank Christopher P. Schandevel from Alliance Defending Freedom (ADF) for representing us before the Supreme Judicial Court of Massachusetts.

EPC-USA not only submitted an excellent friend of the court brief but we were the only group that provided a friend-of-the-court brief that was also asked to provide an oral argument before the Massachusetts Supreme Judicial Court.

Links to more articles on the Massachusetts assisted suicide Kligler court case:

• EPC-USA presented oral argument before the Massachusetts Supreme Judicial Court in the Kligler assisted suicide case (Link).
• If assisted suicide were legal, plaintiff in Massachusetts assisted suicide court case may have died prematurely (Link).
• EPC-USA files brief to Massachusetts Supreme Court in the Kligler assisted suicide case (Link).
• Massachusetts Supreme Court to hear assisted suicide case (Link).
• Assisted suicide lobby to appeal Massachusetts court decision stating that there is no right to assisted suicide (Link).
• Disability leaders praise Massachusetts court decision stating that there is no right to assisted suicide (Link).
• Massachusetts court decision explains why assisted suicide should not be legal (Link).
• Massachusetts court rules that there is no right to assisted suicide (Link).

Boston Globe articles promote the legalization of assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Boston Globe published two articles by Robert Weisman on December 11, 2022 promoting the legalization of assisted suicide in Massachusetts. The articles, which are free advertising for the assisted suicide lobby, are oriented to helping the assisted suicide lobby urge legislators to legalize assisted suicide in the upcoming legislative session. (Article 1) (Article 2).

Based on the tone of the articles, it appears that the Boston Globe plans to strongly support the legalization of assisted suicide in Massachusetts.

The first article begins by quoting Rep James O'Day, a Worcester Democrat and the lead sponsor of the assisted suicide bill, who says that he hopes that the assisted suicide bill can pass in 2022.

The article then quotes Governor Maura Healey who states that she would support the bill under certain conditions.

In the last legislature, the assisted suicide bill passed in the Joint Committee on Public Health but failed to advance in the Joint Committee on Healthcare Financing.

The article does state that opposition to the bill continues. Weisman writes:

House Speaker Ronald Mariano last spring said representatives in his chamber remained “very divided” on the issue. Mariano, through a spokesman, declined a request for an interview for this story. Senate President Karen Spilka similarly declined to discuss the matter. In separate statements, both promised to continue reviewing the bill in conversations with their colleagues in the upcoming session.

But the article continues with promoting assisted suicide by quoting State Senator Joanne Comerford, the Senate sponsor of the past assisted suicide bill as stating:

The idea of government restricting the end-of-life options of people in pain “becomes dangerous,”

The reality is that legalizing assisted suicide is dangerous.

The second article interviews several people who had family members die a difficult death and a few people with terminal and chronic conditions who "want the option."

John Kelly

Nonetheless the second article does create some balance by interviewing John Kelly, the Director of Second Thoughts Massachusetts. Weisman writes:

Disability-rights advocate John Kelly, who lives in Boston’s Fenway neighborhood, is director of Second Thoughts Massachusetts, a group opposing what it calls “assisted suicide.” He’s also a quadriplegic who injured his spinal cord in a sledding accident 38 years ago.

Kelly, 64, has testified against medical aid-in-dying legislation and organized a rally against the appeal to legalize it through the Supreme Judicial Court. He condemns a “better dead than disabled” mindset he sees in those distressed about loss of control at the end of their lives.

“Proponents say it’s about pain and suffering,” Kelly said. “But it’s relatively privileged people’s response to their own disability and dependence on others.”

Folks with disabilities often grapple with a lack of access to health care and home care services, he said. “Everyone should receive effective palliative care,” he said. “But we also believe people should be able to stay in their home and have adequate care there. This is really a values discussion masquerading as a medical issue.”

Kelly is also highly skeptical of treating a physician’s six-month prognosis as an exact science.

“People have to remember that doctors are often wrong about predicting when someone will die,” he said.

The Massachusetts Supreme Court is deliberating on the Kligler case that asked the court to find a right to assisted suicide in Massachusetts. That decision is expected soon.

The answer is not medically assisted suicide.

This article was published in the Quincy Sun on August 18, 2022.

John Kelly

By John Kelly, Director of the disability rights group Second Thoughts

38 years ago an accident left me paralyzed below my shoulders. My father was brokenhearted and wished I had died instead. His hopelessness about my life, however painful for me, was but a simple reflection of widespread prejudice against disabled people.

A few years after my injury, Jack Kevorkian became a sort of folk hero for “helping” terminally ill people die through his “self deliverance” machine. It later came out that more than two thirds of his clients were not terminal at all, but disabled people, primarily women, in psychological distress.

Over time, as medicine has focused increasingly on patient “quality-of-life” as a barometer of life-worthiness, death has been recharacterized as a benefit to an ill or disabled individual. Most physicians (82%, a Harvard study recently found) view our “quality-of-life” as worse. Disability advocates have raised concerns about the fate of disabled people like Oregonian Sarah McSweeney and Texan Michael Hickson. Both wanted to live, both were loved by family and caregivers, but they died after hospital personnel denied them treatment based on their disabilities.

Over the last 25 years first Oregon, then additional states and Washington DC established assisted suicide programs for people expected to die within six months. Proponent rhetoric has focused on compassion for people’s physical pain and suffering, and the hope of a choiceful, peaceful end.

The reality, as shown by the top five reported “end of life concerns” in Oregon, hinge not on pain, but on people’s “existential distress,” as one study termed it, in reaction to the disabling features of their illness: depending on and feeling like a burden on other people, losing abilities, losing the respect of self and others (“loss of dignity”), and shame over incontinence.

Prominent bioethicist Thaddeus Pope concedes that “Everybody who’s using medical aid in dying is disabled. And probably you could go to the next step and say the reason they want medical aid in dying is because of their disability.” To Pope, any disability a patient finds “personally intolerable” is sufficient reason to assist their suicide.

In Massachusetts, assisted suicide bills have been put forward every session for the last 20 years. Proponents proclaim strong public support for the measure, but that support is shallow. In the weeks leading up to the 2012 ballot question on assisted suicide, polls showed 64% support.* The ballot question lost, 51%-49%. Now supporters say that 77% of Massachusetts residents support the bill, based on a poll question seeking compassion for terminally ill people “to end their suffering,” with its implication of physical pain.

State House Speaker Ron Mariano declared “We have a very divided House of Representatives. There’s not a 77 percent affirmative vote in the House right now.”

With the end of the legislative session on July 31, the bill died.

Disability rights advocates appreciate the willingness of many legislators to take our concerns seriously. We worry, with death reframed as a benefit for severely disabled people, that increased legalization will bring expansion of eligibility. Pope points out that the US is unique in the world for limiting assisted suicide to terminal people, and that every other jurisdiction, including Canada, offers euthanasia on demand to non-dying disabled people. He predicts that non-terminal disabled people will become eligible in the US. In Canada, disabled people have been euthanized because they were denied needed care or couldn’t find safe housing for multiple chemical sensitivities.

There are unsolvable problems with all assisted suicide laws. First, real choice resides with insurers, whose bottom line favors delay or denial of treatment. Dr. Brian Callister reported trying to refer two patients for life-saving but expensive procedures in Oregon and California, only to hear that the insurers limited coverage to hospice and assisted suicide.

Second, when people feel they have lost their dignity and feel like a burden on others, they are vulnerable to pressure and outright coercion to sacrifice themselves for others benefit. Abuse yearly affects one in 10 elders, exacerbated by COVID-19 restrictions. A self-interested heir can push a patient to make the request, serve as a witness along with a “friend,” pick up the drugs and, because no disinterested witness is required at the death, administer the drugs themselves. The law grants immunity to anyone who assists in the death who say they acted “in good faith.” Deadly abuse goes unpunished and unnoticed.

Third, terminal prognoses are notoriously inaccurate. NPR reported a few years ago that nearly one in five people who enter hospice survive the six-month benefit. Oregon revealed last year that just 4% of patients live past six months, meaning that the difference between 4% and almost 20% represents the body count of people who weren’t really dying. People who oppose capital punishment because of the inevitability of executing an innocent person should take note.

The 2012 Massachusetts ballot results and the patient demographics in states like California show there is a social class, race, and ethnicity component in the use of and support for assisted suicide. A 2013 Pew Research Center study showed that Blacks oppose assisted suicide by 65%-29%, and Latinos by 65%-32%. Majority Latino Lawrence voted 69% against the 2012 question, while white working class towns like Taunton and Gardner also opposed. Wealthier, whiter Massachusetts towns voted heavily in favor. In California, 94% of reported assisted suicides have been by non-Hispanic whites, more than twice the group’s share of the state population. Almost no black people have used the program.

The answer is to address people’s real needs. That means a fully funded Medicare home care benefit to reduce burden and keep people out of nursing homes. It means more and better palliative care. And for people whose discomfort cannot be otherwise relieved, there is the option of palliative sedation, whereby a person is sedated to the point of comfort while the dying process takes place. The answer is not medically assisted suicide. We disabled people demand full civil and human rights, equal protection under the law, equal suicide prevention, and more respect throughout society.

John B. Kelly is the director of Second Thoughts MA.
*Note to readers: in the hardcopy version of this essay, John Kelly wrote that polls showed 68% support for the 2012 Ballot Question 2 weeks before the election. The relevant Suffolk University poll, however, taken September 17, 2012, shows that support at 64%. We made the change to the accurate number.

Massachusetts must reject assisted suicide.

Maria Brown, the Massachusetts state director of LULAC, the largest and oldest Hispanic and Latino civil rights organization in the U.S. wrote an opinion article that was published by the Boston Herald on July 15, 2022. Brown wrote:

Brown: Massachusetts must reject bid to legalize assisted suicide

We are still mourning the approximately 18,000 Massachusetts residents who have died from COVID. In a time so filled with loss, it is senseless and irresponsible that many in our state Legislature are pushing to legalize assisted suicide. As a member of the Massachusetts chapter of LULAC, the nation’s largest and oldest Hispanic and Latino civil rights volunteer-based organization, I strongly oppose the two bills under consideration, S.1384 and H.2381.

The dirty little secret is that assisted suicide is discriminatory. Latinos face significant hurdles accessing health care and the pandemic has magnified them. Both bills fail to even consider the latent discrimination and racism that pervade and have corrupted our health care system.

As a Latina, I have watched this process play out my entire life. My community struggles to access care and is locked out of treatment options. In 2019, a stunningly high 28.4% of Hispanic adults in Massachusetts reported being in fair or poor health, and the pandemic has wrecked us both nationally and locally. The dearth of protections for diverse communities combined with the lack of cultural knowledge and the language barrier has adversely affected my community in ways that can no longer be ignored. Latinos feel overwhelmed by a health care system that doesn’t cater to our needs.

Legalizing assisted suicide would institute a system in which “valued citizens” (the young, healthy and affluent) are encouraged to undergo treatment, and those that society too often only “pretends to value” (the disabled, minorities and the poor) are pushed towards life-ending options. My opposition to these assisted suicide bills is tied to my abiding commitment to expanding access to health care and fighting for equal human dignity.

Instead of providing more options for patients, assisted suicide funnels desperate people who lack a robust support system toward death. Proponents claim the proposed bills include sufficient safeguards, but history shows this hasn’t been true in other places that passed assisted suicide laws. So-called safeguards fail because it is difficult to prove coercion or malice after someone is dead.

Even if the safeguards were perfect, they still wouldn’t stop vulnerable members of society from being guided toward assisted suicide. A report written by the National Council on Disability discusses how society communicates to those with disabilities that they are “worth less” than other people and are a burden to their loved ones.

Assisted suicide encourages these fears, and that is one major reason why most disability groups oppose it. Seemingly neutral rules often lead to people with disabilities killing themselves because of societal expectations. As the report states, “some people who say they want to die will receive suicide intervention, while others will receive suicide assistance. The difference between these two groups of people will be their health or disability status.”

Similarly, those without substantial financial resources face pressure from an impersonal and amoral health care system to kill themselves. Insurance companies routinely deny coverage for lifesaving treatments, but offer to pay for assisted suicide. Patients placed in this situation often don’t have the financial resources and wherewithal to find alternative options.

Legalizing assisted suicide creates these situations because it blurs the line between legal death and murder. Unscrupulous actors will always take advantage of ambiguity, and society’s most vulnerable members, many of whom are people of color, end up getting crushed.

Less than a decade ago in the fall of 2012, the people of Massachusetts rejected a ballot initiative that legalized assisted suicide. Now our Legislature is considering doing what Massachusetts voters were wise enough to reject. The Massachusetts Legislature must recognize and act to oppose these assisted suicide bills and, instead, work towards creating a more equitable health care system that closes disparities in care for people with disabilities and communities of color.

More articles about Massachusetts assisted suicide debate:

• EPC-USA letter to Massachusetts legislators (Link).
• Take Action Now: Oppose the Massachusetts assisted suicide bills (Link). 
• EPC-USA presented oral arguments in Massachusetts Supreme Court assisted suicide case (Link)
  

EPC-USA letter to Massachusetts legislators

June 8, 2022

President of the Senate Karen E. Spilka, Karen.Spilka@masenate.gov
Speaker of the House Ronald Mariano, Ronald.Mariano@mahouse.gov

RE: S.1384 and H. 2381 An Act Relative to End of Life Options, creating an exception to involuntary manslaughter for physician assisted suicide

Dear President and Speaker:

The Euthanasia Prevention Coalition USA supports positive measures to improve the quality of life of people and their families; we oppose euthanasia and assisted suicide. We are aging and disability advocates, lawyers, doctors, nurses and politicians.

Please let S.1384 and H.2381 die this session (192nd General Court), while legislators are deeply divided amid heightened concerns about inequities for people of color and those living with disability. Proponents are trying to sell you a pig in a poke. It’s not about polls, pain or a quick, peaceful death. Instead, it spawns more suicides and provides less healthcare.

It’s Not about Polls

Proponents are touting a recent poll that pegs public support at 77%. As seasoned legislators, you know support drops off as people learn more which is exactly what happened with the 2012 ballot measure. Back then, support was pegged at 60%+, but fell off leading to the measure’s failure. Polling support may be wide but it isn’t deep.

It’s Not about Pain

I’m often asked if I want people to die in pain. You probably have been asked that
question, too. The answer is this is not about letting people die in pain. People don’t use these laws to escape pain.

Dr. Lonny Shavelson, a California doctor who helps people die says promoting “aid in dying” as avoiding pain is a political sales pitch. See webinar minutes 25:24-27:53. He says people choose assisted suicide because they are low energy or afraid of losing control.

It’s Not about a Peaceful or Quick Death

Dr. Shavelson says the idea that assisted suicide creates a peaceful beautiful death is another myth. See webinar minutes 37:35-41:00.

Dying this way can be very unpleasant and even painful. People are given “aid in dying” concoctions that burn their throats and extend the dying period. When drugs that had been used in the past became expensive, death doctors experimented on people with other drug cocktails, some of which burned people’s throats causing them to scream in pain and extended the dying process by more than 3 hours and as much as 31 hours. The FDA does not regulate these drugs because they are compounded. Currently severe burning is expected in 10% of cases with drug cocktails now being prescribed by physicians.

Assisted Suicide Spawns More Suicides and Attempted Suicides.

If you enact this law, more people will die by suicide, more will attempt suicide and more will visit Emergency Departments as a result. This is the collateral damage caused by these laws. They send a message that suicide is an acceptable way to solve problems. Publicity about suicide also leads to more suicides; this is called suicide contagion.

Legalization of Assisted Suicide especially impacts youths. A 2019 report found teen suicides in California increased by 34% since that state legalized Assisted Suicide in 2016. Oregon’s youth suicides increased 79.3% from 2000 to 2018. Research about completed suicides in four states that legalized Assisted Suicide (Oregon, Washington, Vermont and Montana) found it was associated with at least a 6.3% increase in the rate of all suicide deaths.

According to the 2020 Massachusetts Public Health Data Brief, 615 people died by suicide in 2020. There were 591 monthly Emergency Department visits for attempted suicide (7,092 per year) and 4,882 visits per month for suicidal ideation (58,584 per year) during 2019 to early 2020.

A 6.3% increase following enactment would result in more deaths and need for medical care.

• Fatal Suicides 39 more people would die by suicide 
• ED visits, Attempted Suicides 447 more ED visits, following suicide attempts 
• ED visits, Suicidal Ideation 3,690 more ED visits for suicidal ideation
  

Insurance Companies Use Assisted Suicide to Deny Curative Life-Saving Treatment

Insurers stop covering certain treatments due to the availability of Assisted Suicide. Dr. Brian Callister of Nevada says he was stunned when insurance would not cover life saving treatment for his patients who were transferring to California and Oregon, but the company offered to pay for Assisted Suicide instead. These were people who could be cured with the denied treatment rather than being rendered terminal. In effect, Assisted Suicide is being used to shunt people off the curative, restorative medicine track, especially if they cannot afford to pay for treatments out
of pocket.

People of color understand this will be used to provide them poorer care. 

Even with insurance, people of color get poorer hospital care and pain relief according to a New York Times article. They are still disproportionately dying of COVID-19. So, it is unsurprising that Black and Latinx people oppose Assisted Suicide by 2-1 margins ‒ “… the voting results from Ballot Question 2 in 2012 show Assisted Suicide pits wealthier, whiter districts against those with poorer people and people of color according to Second Thoughts – Massachusetts.

In closing, I urge you to let this bill die.

Sincerely,
Sara Buscher, Chair
Euthanasia Prevention Coalition USA

Take Action Now: Oppose the Massachusetts Assisted Suicide bills.

John Kelly Director, Second Thoughts

Second Thoughts MA is a grassroots group of disability rights advocates from Massachusetts and the region who oppose the legalization of assisted suicide as a deadly form of discrimination against disabled people. We demand social justice against laws, policies, and media messages fueled by a “better dead than disabled” mindset. 

We organized in 2012 to help defeat assisted suicide Ballot Question 2. High turnout among black and Latinx voters made victory certain. Since then, we have successfully advocated against three more assisted suicide bills, led a month-long campaign in 2016 against the disability euthanasia movie “Me before You,” and are now advocating against the assisted suicide bills S.1384 / H.2381 in the legislature.

Please! Take Action NOW and oppose bills S.1384 and H 2381!

Reject Assisted Suicide

Insurer control

Real “choice” belongs to insurers, who can deny prescribed treatments at will, even if lifesaving. In Oregon, you can qualify as “terminal” if you can’t afford your treatment, or if treatment stops for any reason. Legalization makes assisted suicide a “medical treatment,” a so-called “benefit” to be extended to ever more people, and that will always be the most profitable and “cost-effective.”

Persuasion –> abuse

Everyone is vulnerable to suggestion and persuasion. Nothing prevents self-interested family members and medical professionals from pushing for assisted suicide. Meanwhile, it is estimated that 1 in 10 Massachusetts older adults are abused every year, and COVID-19 has only made it worse. Nothing in the law can stop an heir or abusive caregiver from steering someone towards assisted suicide, witnessing the request, picking up the lethal dose, and even administering the drug — no witnesses are required at the death, so who would know? The Oregon law has invited every sort of abuse. 

Misdiagnosis

Studies show that 12%-15% of people entering hospice with a terminal diagnosis outlive their prognosis. In 23 years in Oregon, 1900 people have been prescribed lethal drugs, but the survival rate past six months is only 4%. This suggests that a substantial number died by suicide when they were not dying. Oregonian Jeanette Hall wrote the Boston Globe in 2011 that after a terminal diagnosis she sought assisted suicide, but her doctor persuaded her to try more treatment. “If my doctor had believed in assisted suicide, I would be dead,” she wrote. She has now lived more than 20 years post diagnosis. Any other elective “treatment” with such deadly results would never be tolerated!

Not pain, but distress about disability

The Oregon reports show the first five “end-of-life concerns” deal with not pain, but “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. Proponents speak of “quality-of-life.”

Leading California prescriber Lonny Shavelson says, “It’s almost never about pain, it’s about dignity and control.” Palliative care expert Ira Byock said that almost all pain is controllable, and that marketing bills as all about pain “is a bait and switch.” In the eyes of the state, everyone must be seen as having equal dignity. We champion fully funded home and community-based services, for a caring society rooted in mutual aid and interdependence.

Medical Prejudice

In a recent national survey of practicing US physicians, “82.4 percent reported that people with significant disability have worse quality of life than nondisabled people. . . . [T]hese findings about physicians’ perceptions of this population raise questions about ensuring equitable care to people with disability. Potentially biased views among physicians could contribute to persistent health care disparities affecting people with disability.” Do Not Resuscitate orders have been placed in patient files against their wishes. Media messages and movies like “Me Before You” and “Million Dollar Baby” promote the mindset of “better dead than disabled.” 

Racial Disparities

Medical prejudice and neglect results in racial disparities in diagnosis and treatment of diabetes, cancer, and heart trouble. COVID-19 has killed Black, Indigenous, and People of Color (BIPOC) at a much higher rate than Whites. Assisted suicide legalization makes it more likely that Black patients will be “written off” as better off dead, like Black Texan quadriplegic Michael Hickson.

Social Divide

As the voting results from Ballot Question 2 in 2012 show, assisted suicide pits wealthier, whiter districts against those with poorer people and people of color. For long-standing reasons, Black and Latinx people oppose assisted suicide by 2-1 margins. The four most Latinx cities in the Commonwealth – Lawrence, Chelsea, Holyoke, and Springfield – all voted strongly against Question 2. For example, Lawrence voted 69%-31% no. White working-class and more socially conservative towns also rejected the ballot measure by strong majorities. The state must not adopt one social group’s focus on personal autonomy and status over communities that value above all connection and family.

Depression

Assisted suicide laws lead to the denial of suicide prevention services to seriously ill and disabled people, a violation of the Americans with Disabilities Act’s guarantee of equal program access. Assisted suicide laws redefine depression and feeling like a burden as “rational,” rather than as evidence of impairment or need for intervention. Suicide contagion is real and assisted suicide laws send the wrong message that suicide is an answer to personal problems.

Alternative of Palliative Sedation

Anyone dying in discomfort that is not otherwise relievable may legally receive palliative sedation. The patient is sedated to the point where the discomfort is relieved while the dying process takes place. So there’s no need for legalized assisted suicide.

Disability

In a society full of crushing ableism, reported “end of life” concerns all have to do with negative reactions to disability: distress and shame over dependence on others, lost abilities, loss of dignity, feeling like a burden and incontinence. But no one needs to die to have dignity. We champion meaning found in mutual aid and interdependence.

Outside Influence is Unavoidable

In her New Year’s Eve 2019 ruling against a state constitutional right to die, Suffolk Superior Court Judge Mary K. Ames summed up some of the stresses that might hurry the moment when people ingest the poison.

In such a situation, there is a greater risk that temporary anger, depression, a misunderstanding of one’s prognosis, ignorance of alternatives, financial considerations, strain on family members or significant others, or improper persuasion may impact the decision.

Summary

If Massachusetts legalizes assisted suicide, some people’s lives will be ended without their consent, through insurance denials, medical mistakes, and all the various forms of coercion and abuse. No safeguards have ever been enacted, or even proposed, that can prevent this outcome, which can never be undone.

Say NO to Physician Assisted Suicide in Massachusetts

This letter was distributed by the Massachusetts Catholic Conference (Link).

The Massachusetts State Legislature is considering passing into law two deeply troubling bills this session which would legalize Physician Assisted Suicide. The bills, House 2381 and Senate 1384, are identical in text and titled “An Act relative to end of life options”.

“The Catholic Bishops of Massachusetts stand united in our strong opposition to Physician Assisted Suicide. It is an affront to life and a dangerous precedent for determining end of life issues. Physicians are trained to care for the ill, not to hasten death.”

Here are some troubling facts to consider before you act: 

1. The bills would allow a physician to provide a deadly drug mixture to an individual diagnosed with less than 6 months to live that, when consumed, would cause death. NOTE - The diagnosis could be wrong. Countless individuals have outlived that 6-month diagnosis and enjoyed many more precious months and years with family and friends. 
2. No Real Safeguards - A vulnerable individual who is physically disabled, depressed, or fears being a “burden” may be subject to undue influence by others to take the drug mixture, especially if there is a financial benefit as an incentive. 
3. The primary focus of elected officials should be dedicated to legislation providing quality health care, mental health care and palliative care to the sick and dying – particularly in the underserved, poor and minority communities that suffer the most at the time of need. 

How can your voice be heard? 

Call or email your legislators, let them know you are a Massachusetts voter, and say NO to Physician Assisted Suicide! 

• Members of the legislative Joint Committee on Health Care Finance who will be considering these bills can be contacted (Link to Committee members).
• Your individual State Senator and Representative via address and zip code link. (Link here).