Jeffrey A. Singer
New York State lawmakers have passed the Medical Aid in Dying Act (MAID) and sent it to Gov. Kathy Hochul’s desk. If the governor signs it into law, New York will join 11 states and the District of Columbia in enacting a “death with dignity” law. Oregon was the first state to enact a Death with Dignity Act (DWDA) in 1994. Originally passed as a ballot measure in 1994, voters decided by a margin of 60 percent to 40 percent to retain the law with a second ballot referendum in 1997.
New York’s proposed MAID law closely follows the model used in other states that allow physician-assisted death, requiring patients to be terminally ill adults with six months or less to live, mentally capable, and able to make both written and oral requests. Like most states, it permits health care providers to opt out and mandates that death certificates list only the underlying illness. However, New York’s proposal stands out for potentially allowing a much shorter waiting period—possibly under 24 hours—compared to the typical 15-day interval in other states.
Critics have raised concerns that the law’s oversight and safeguards are insufficient to ensure adequate accountability, especially given the gravity of end-of-life decisions—despite including commonly accepted provisions such as witness signatures and a residency requirement.
All US jurisdictions that allow medical aid in dying currently require that the patient self-administer the lethal medication, not a physician or anyone else.
In my book Your Body, Your Health Care, I argue that mentally competent adults have the right to make independent decisions regarding their own bodies, provided they do not infringe on the equal rights of others. I stated, “The right to self-medicate is integral to self-ownership and autonomy.”
In a Reason magazine article last year commemorating the 25th anniversary of Dr. Jack Kevorkian’s conviction on second-degree murder charges for performing euthanasia on a patient suffering from Lou Gehrig’s Disease (amyotrophic lateral sclerosis), I wrote:
Self-ownership includes the right to commit suicide. People have the right to request a physician’s assistance to commit suicide. They also have the right to ask a physician to perform euthanasia. Assuming a physician has accurately informed a patient of the prognosis and the patient gave informed consent, the government should not block physicians from respecting the patient’s request to end their life.
There are two forms of euthanasia: active and passive. In active euthanasia, the physician provides the means to commit suicide and instructs a person on how to do so. Passive euthanasia involves a physician or other caregiver ending a person’s life with that person’s informed consent.
Passive euthanasia is illegal in all jurisdictions in the United States and, if the governor signs the bill into law, will also be illegal in New York.
Unlike Canada, Belgium, and the Netherlands, which permit medical assistance in dying for individuals with mental illness under specific conditions, none of the US “Death with Dignity” or MAID laws cover individuals whose sole underlying condition is a mental illness. Even in those countries, MAID for people with mental health disorders is controversial. As a physician, I understand why.
Suicidal thoughts often indicate an issue that can be treated. Should mental health professionals accept a patient’s desire to end their life without first insisting on treatment? Furthermore, how can they confidently determine when a mental health condition is genuinely untreatable? Additionally, assessing whether a patient’s mental state undermines their ability to make informed decisions presents a significant challenge for practitioners. Therefore, even if states emulated Canada, Belgium, and the Netherlands, most doctors would likely opt out.
I addressed this problem in my Reason article:
There are many thorny medical, psychiatric, and ethical issues that the health professions still need to resolve if they want to be able to help people exercise their right to end their lives without experiencing moral conflict themselves. Lawmakers, too, need to explicitly protect the rights of patients seeking to end their lives and the health practitioners who assist them and establish clear legal boundaries around the issue. However, the principle remains: self-ownership includes the right to end one’s life.
As New York stands on the brink of joining the growing number of jurisdictions recognizing medical aid in dying, it’s essential to remember the principle at the heart of this movement: self-ownership. While difficult questions remain—especially around mental illness and decisionmaking capacity—those complexities shouldn’t obscure the fundamental right of mentally competent individuals to make deeply personal decisions about their own bodies, including how and when to end their lives. Legalizing physician-assisted death for terminally ill adults affirms that right, while allowing space for both professional conscience and patient autonomy. If Governor Hochul signs the bill, New York will take a meaningful step toward a more compassionate, liberty-respecting approach to end-of-life care.