UPDATE: On February 6, 2015, Canada’s Supreme Court unanimously struck down the country’s ban on physician-assisted suicide for mentally competent patients with terminal illnesses. Parliament and provincial legislators have a year to draft new legislation.
Roe v. Wade invented a “zone of privacy” where women could retreat to kill their children, so long as the children were not yet born. From that convoluted illogic, a disregard for human life began to erode our collective conscience until today it is applied not only to the beginning of life but to its end as well.
Legalizing abortion sparked fierce debate: When does life begin? What does it mean for society to allow mothers to kill their babies? Is abortion ever acceptable?
Today the right-to-die debate is just as fierce, with similar polarizing questions. In addition, as we have seen in the progression—or regression—of pro-abortion ideology, right-to-die rhetoric is moving from “personal choice” to “social good.”
Organizations that advocate for assisted suicide speak in terms of “dignity,” “choice,” “rights,” and “quality of life.” The arguments are familiar; some who now work at Compassion and Choices, a right-to-die advocacy group, learned their marketing skills at Planned Parenthood, according to Nina Rhea of West Coast Pro-Life. Compassion and Choices was formerly known as the Hemlock Society. The group describes itself as “experts in what it takes to die well.”
The right-to-die debate is white-hot in the US. As of mid-January, legislators in California and New York planned to introduce bills that month. A New York state senator said he was inspired to do so by the widely publicized assisted suicide of 29-year-old Brittany Maynard in November. City councilwoman Mary Cheh introduced legislation in January to make assisted suicide legal in Washington, DC. Compassion and Choices reports that legislators in Colorado, Florida, Indiana, Maryland, Minnesota, Missouri, New Hampshire, Nevada, Pennsylvania, Wisconsin and Wyoming plan to introduce legislation this year as well. The group has also launched campaigns in Massachusetts, Connecticut and New Jersey.
When Maynard moved to Oregon last year to avail herself of the state’s Death with Dignity Act, news desks, social media, classrooms and kitchen tables lit up with the right-to-die controversy. How is terminal illness assumed to lend nobility to suicide, a tragedy from which we usually draw back in horror? Suffering is the ancient imponderable. Not a generation has lived who hasn’t shaken its fist at the sky and questioned the meaning of suffering. More and more, assisted suicide advocates seek approval to answer the question themselves.
In the United States, assisted suicide is legal in four states and one county. Oregon’s 1997 Death with Dignity Act (DWDA) came first, and through 2013 doctors had written lethal prescriptions for 1,173 people, with 752 deaths reported. The state’s annual report gives details in dispassionate terms: some did not use the “medication”; “ingestion status” of others is unknown. The reports note demographics to the first decimal. In 2013, most were 65 or older, with a median age of 71. Most were white (94.4 percent) and 53.3 percent were college graduates. Most had cancer (64.8 percent). At least 96.7 percent had some form of health insurance.
Under Oregon’s DWDA, the patient must be at least 18 years old, a state resident, capable of making and communicating decisions about health care and diagnosed with a terminal illness leading to death within six months. Physicians are responsible to decide if patients meet the criteria and they alone may assist; in fact, anyone else would be guilty of second-degree manslaughter. In the malleable language of legislation, physicians don’t assist a suicide. They provide “medical treatment.”
Washington, Vermont and Montana also have right-to-die laws, with similar criteria and similar protection for physicians. Washington State reports that 549 people received prescriptions and 525 used them since 2009, after 58 percent of voters said yes. Vermont’s law, the Patient Choice and Control at End of Life Act, has been in effect since May 2013, with paperwork completed for two people. In addition to meeting the usual criteria, in Vermont the patient must request the lethal prescription twice verbally and once in writing, with waiting periods between requests.
In Montana, the courts decided the issue. Compassion and Choices and physicians who sought to avoid charges of homicide joined the case of a 75-year-old man with terminal cancer. The court clearly distinguished between a doctor’s roles in prescribing lethal drugs and withdrawing treatment, even though both requests come from the patient. In the former, the drugs, not disease, actively cause death. In the latter, disease is left to its course. In language reminiscent of Roe v. Wade, the court ruled that “the right of personal autonomy included in the constitutional right to privacy, and the right to determine ‘the most fundamental questions of life’ inherent in the state constitutional right to dignity, mandate that a competent terminally ill person has the right to choose to end his or her life.”
In New Mexico, physician-assisted suicide remains legal only in Bernalillo County while a challenge to the court’s decision in Morris v. Brandenberg makes its way through appeals.
Gallup has polled Americans about end-of-life issues yearly since 1947. Since 1996 they’ve asked the question two ways, and response depends on the wording. If asked the original question, “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it,” approval has ranged from 36 to 75 percent since 1947; the 2014 report shows 69 percent in favor. If asked the second version, “When a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patient requests it,” yes responses dropped, varying between 51 percent and 65 percent; in 2014, 58 percent approved. Differentiating the act by the phrase commit suicide obviously gives some pause but a strong majority has supported both ideas for the past 20 years.
Worldwide, assisted suicide debate or legislation has flared in Scotland, New Zealand, Canada, England, France, Wales and Israel. Countries where assisted suicide is already legal are Switzerland, Germany, Albania, Colombia and Japan. The Canadian province of Quebec legalized physician-assisted suicide last year. The grim cousin of assisted suicide, euthanasia, is legal in Belgium, the Netherlands and Luxembourg.
In Canada, a December 2014 Angus Reid Institute poll found that 79 percent either “moderately approve” or “strongly approve” some form of physician-assisted suicide. Support varies with the circumstance. In the case of terminal illness, for example, 82 percent agree. For “a great deal of pain,” 76 percent agree. Fear of “Alzheimer’s and loss of awareness/bathroom functions” came in at 67 percent. At the bottom of the scale, 33 percent approved if a person had lost hope and meaning, with no mention of physical illness, and 15 percent approved if a person wanted to leave a larger inheritance.
In this survey of Canadians, questions regarding the morality of assisted suicide turned up a hard-core 21 percent who believe it is morally acceptable for any reason if the person “freely chooses” it.
As with abortion, what once was abhorrent is now seen as potentially good: the survey found that 77 percent of Canadians believe the debate about assisted suicide is a sign of social progress.
If current laws against assisted suicide delineate motive, most enact harsher penalties for those who coerce or force the act. Such penalties reflect a wise wariness of human nature, captured in a letter to the editor of a newspaper in Langley, British Columbia:
I believe in the value of life, and the idea of assisted suicide being legalized in Canada terrifies me. . . .
We would like to imagine that we live in a society where only those who absolutely want this procedure to take place would be subjected to it, but unfortunately there is always corruption present, and innocent people would be harmed every day. . . .
The law would label as a burden anyone who fits into the category of those expected for euthanasia. The elderly, disabled, and dependent would appear to be a burden on the families and supporters because they choose to live, even if it means possibly a little extra work for those around us. . . . 
The writer strikes a nerve exposed by Ezekiel Emanuel, who served the Obama administration as a health policy adviser. Although Emanuel publicly opposes euthanasia and assisted suicide, he nevertheless floated the idea that there’s a good age to die, generally when a person is no longer able to be creative and contribute to society. For himself, he put the age at 75.
From this pernicious perspective, a person is valued for what he or she can do, not for his or her intrinsic value as a human being. The leap is short between believing natural death with faculties intact is a blessing and believing the feeble and dependent should just get on with it for the good of society. In that light, people in need who require “a little extra work” are seen not as an opportunity to learn the blessings of service and true compassion but as inconvenient, unwelcome reminders of decline and loss of control.
Beyond philosophical considerations, assisted suicide shows its weakness as public policy in the harsh light of soaring health care costs and aging populations. “The reality is that legalizing assisted suicide is a deadly mix with the broken, profit-driven health care system we have in the United States,” said Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund.
“At less than $300, assisted suicide is, to put it bluntly, the cheapest treatment for a terminal illness. This means that in places where assisted suicide is legal, coercion is not even necessary. If life-sustaining expensive treatment is denied or even merely delayed, patients will be steered toward assisted suicide, where it is legal.”
Golden’s grasp of the situation played out in Oregon in 2008, when Barbara Wagner’s insurance company refused to pay for an expensive drug to treat her lung cancer after it returned.
The company did, however, offer to pay for assisted suicide.
 Butts, C. (2014, January 7). Assisted suicide bill returns with new argument. Retrieved January 14, 2015.
 Death with Dignity Act. (n.d.). Retrieved January 14, 2015.
 Death with Dignity Act. (2008, November 4). Retrieved January 13, 2015.
 Patient Choice and Control at End of Life Full Text of Act 39 (18 V.S.A. Chapter 113). (2013, May 20). Retrieved January 13, 2015.
 Baxter vs. State of Montana, 2009 WL 5155363 (Mont. 2009)
 Mungin, L. (2014, January 20). New Mexico doctors can help terminal patients die, judge says. Retrieved January 14, 2015.
 McCarthy, J. (n.d.). Seven in 10 Americans Back Euthanasia. Retrieved January 15, 2014.
 Most Canadians support assisted suicide, but under which circumstances reveal much deeper divides. (2014, December 16). Retrieved January 14, 2015.
 Budlong, B. (2015, January 5). Letters: Assisted suicide bill scary. Langley Advance. Retrieved January 14, 2015, from www.langleyadvance.com/.
 Golden, M. (2014, October 14). The danger of assisted suicide laws. Retrieved January 14, 2015.
[February 9, 2015, Sherry Pinson is director of communications for Life Issues Institute]