The Free Press
“We did not want to linger if there was a terminal diagnosis and no quality of life.”
In Nancy Murphy’s family, she said, this was always understood.
So when her sister, Joan, was diagnosed with ovarian cancer in 2015 at age 85, she knew exactly what she would do. Joan was living in Vermont, where the state has allowed terminally ill patients to end their lives with a lethal prescription since 2013.
“Gradually, the disease finally overtook her body,” Nancy, 86, said. “She was lying in the hospital bed in her living room. We had hospice care, and she was just weaker and weaker every day. Then one morning, she said to me: ‘Nancy, today’s the day.’ ”
Nancy called Joan’s children. The next day, her daughter went to fill the prescription for lethal medication, while her sons bought champagne. They took turns toasting her, telling her how much they loved her. “We held her hands and touched her body.” Joan thanked everyone, then swallowed the drugs.
“Within 20 minutes, she was in a coma, and within two hours she was gone,” Nancy told me over the phone, breaking into tears. “It was a blessing for her that she was able to do that, and it was a blessing for us, too, that she could have a peaceful death.”
Would Nancy do the same thing? “Of course,” she told me. But she is a resident of New York, where assisted dying is not yet legal. That’s why, for the past decade, Nancy has been part of a movement to change the law in her home state.
Now, they’re closer than they ever have been. In April, New York’s “Medical Aid in Dying Act” passed the state assembly by a vote of 81 to 67. It has until the end of the legislative session—June 12—to face a vote in the Senate. On Thursday, June 5, Senate majority leader Andrea Stewart-Cousins said she believed there were enough votes for the legislation to pass and “it is likely that it will come to the floor.” Perhaps as soon as Monday, June 9.
If the legislation passes, New York would join the 11 other states that have legalized assisted dying in various forms. (It is also legal in the District of Columbia.) For those who have seen difficult deaths or are daunted by the prospect, the kind of death Nancy describes—peaceful and pain-free—is what they are hoping the law will all but guarantee.
But those opposed to assisted suicide—their preferred term—warn that such laws endanger the vulnerable by reshaping social norms so that, for some, the right to die becomes a duty to die. Moreover, New York’s legislation, they argue, is on the “outer edge” of liberalization, eliminating safeguards that exist in other states where medical aid in dying (MAID) is legal.
I spoke to people on both sides to better understand their concerns. To both proponents and opponents, New York’s assisted suicide bill is not only a matter of individual rights. To put it bluntly, the people who would be eligible to end their lives are already capable of doing so without help from doctors or lawmakers. But this bill would signal medical and societal approval for that choice and, in doing so, have ethical implications that reach far beyond the patients it is designed for.
Dr. Jeremy Boal, 57, a geriatrician from New York who served as chief clinical officer of the Mount Sinai healthcare system between 2017 and 2023, spent the first 10 years of his career running a program for people who were housebound with late-stage diagnoses. “I had a lot of firsthand experience with patients and family members who were near the end of life,” he said. Last November, he received a devastating diagnosis of his own. He has amyotrophic lateral sclerosis, or ALS. People diagnosed with this progressive neurodegenerative disease have an average life expectancy of two to five years and face symptoms like paralysis, and difficulties speaking, swallowing, and breathing.
“Initially, I was in total shock, and I went into a very severe depression,” he told me. “Having cared for a lot of people with ALS in very late stages of their illness, I knew what was ahead for me.”
One thought comforted him: If the symptoms became too much to cope with, he could ask a fellow doctor to help end his life. Though he lives in New York, he knew that he had “the resources and the connections to relocate if I have to”—to a state where medical assistance in dying is legal.
“That grief and fear and dread really started to lift because I felt like I had agency,” he said.
But not everyone can afford to go out of state. That’s why Boal decided to use “the remaining time that I had” to campaign for a change in New York’s law on behalf of state residents with less money and resources.
“I felt like I owed it to my fellow New Yorkers to try to make this available to them as well, and not just sort of selfishly know that I had a way to access it if I needed it,” he said.
But are the less fortunate grateful for his intervention?
Far from offering “peace and comfort,” said Michelle Uzeta, interim executive director of the Disability Rights Education and Defense Fund, legalizing assisted suicide will only endanger “vulnerable communities—poor, disabled, BIPOC, and LGBTQ+ folk” since these are the groups “most at risk of being denied or unable to access care, being steered toward death, and having their lives devalued.”
Still, Boal sees New York’s legislation as of a piece with other states’ MAID laws. “None of the laws have ever been expanded to include people who aren’t terminal or people who just have mental health issues,” he said. He is confident that “there won’t be any abuse.”
For its supporters, assisted dying means giving spiraling people a sense of safety as much as control. (As Nancy put it, “a prescription’s a whole lot nicer than a shotgun.”)
Darren Chervitz, 51, a husband and father of two from Riverdale, New York, was diagnosed with aggressive prostate cancer last July. Since then, he has undergone surgery and a trial at Manhattan’s Memorial Sloan Kettering Cancer Center—and, so far, has been responsive to treatment. For now, Chervitz’s cancer appears to be in remission, though he is at significant risk of recurrence.
“The length of the suffering and the way it’s relentless and how it affects my loved ones over an extended period of time: These are all, I think, valid reasons why someone would say, you know, ‘I’ve had my time on this planet, and I’ve loved it, and I want to go out with some level of control,’ ” he said.
At first, Chervitz said he felt “a little sheepish” advocating on behalf of the terminally ill. “There are other people who have, in my opinion, incredibly more urgent, compelling stories.” Like Boal, he knew he had the resources to go out of state for medical aid in dying if it came to it.
I asked Chervitz if he saw assisted dying as an insurance policy for his worst-case scenario: the cancer returning in terminal form.
“That sounds more selfish than I am,” he said. “This diagnosis, in all sorts of ways, has forced me to take a closer look at my life and try—whether it’s causes I believe in, or important people in my life—just imbue more meaning in my time.”
In other words, in campaigning for MAID, he hopes to find redemption in suffering.
In the last 10 years, the arguments for and against euthanasia have played out across much of the Western world. But not all the legislation is equally lethal. In Oregon and Washington, there are more safeguards and fewer deaths (as a percentage of the population) than in Canada and the Netherlands.
In the states where MAID is legal, a lethal prescription must be self-administered (as opposed to administered by a doctor). The states also have mandatory waiting periods—a fixed amount of time that a patient has after requesting MAID to change their mind.
Richard Doerflinger is a bioethicist in Washington State who has been tracking assisted suicide laws for nearly 40 years. In his estimation, the New York bill may be the worst law of its kind in the United States.
“There is no waiting period in the New York bill. That’s the first time I’ve seen this,” he said, noting that most states with MAID laws have a minimum waiting period. In Oregon, it is 15 days, though a 2023 law allows this to be waived when the patient is expected to die before the waiting period ends.
In New York, any patient could decide “in a moment of despair at first getting his or her diagnosis, ‘Oh my God, I just want to die,’ and sign off, and that’s the end of the process,” Doerflinger said. The patient could request the prescription, have it approved, and be dead within 24 hours.
In Oregon and other states, doctors are responsible for recommending a mental health evaluation if they suspect the patient suffers from “a psychological condition or depression causing impaired judgment.” Meanwhile, New York would require doctors to assess the patient’s “decision making capacity” and ability to make an “informed decision,” and refer the patient for a mental health evaluation only if they suspect he or she lacks these due to a “psychiatric or psychological disorder.” Doerflinger interprets this to mean that, under New York’s bill, “the mental health evaluation is only ordered by the physician if it looks like the psychological condition interferes with the patient’s ability to make a decision or take in information at all.”
But even in states with more explicit guidelines for mental health evaluations, the safeguard is not infallible. For instance, in Oregon, a man with a long history of depression and suicide attempts was given a lethal prescription (which he did not take) after being diagnosed with terminal cancer. In Colorado, young women have been given lethal prescriptions as a treatment for anorexia.
Wherever assisted suicide is legal in the United States, it is only supposed to be available to people who have terminal illnesses. But how do you define terminal? The New York bill defines a terminal illness as an incurable condition that will “within reasonable medical judgment, produce death within six months.” However, the legislation does not specify whether that is with or without treatment.
“So many people living with chronic disease can become terminal if they stop their treatments. And that then expands eligibility pretty significantly,” said Lydia Dugdale, a physician and ethicist at Columbia University, citing diabetes and HIV as examples.
In Oregon, “qualifying illnesses” for assisted suicide are listed as including “anorexia, arthritis, blood disease, complications from a fall, hernia, kidney failure, medical care complications, musculoskeletal system disorders, sclerosis, and stenosis.” In Maine, high blood pressure also counts.
“Why does it matter if depressed people inadvertently get assisted suicide?” Dugdale asks. “Well, as a society, we have always said that we treat depression and we prevent depressed people from killing themselves.” Some people fear that legalizing MAID will create a world in which suicide is seen as a treatment option even if a disease could be effectively managed.
Arguably, this is happening already. Stephanie Packer, a mother of seven from California, was diagnosed in 2012 with scleroderma—a life-threatening autoimmune disease—and given three years to live. She said that when she asked her insurance company about coverage of the treatment recommended by her doctors, her request was denied. But when she asked if they would cover assisted suicide, they said they would for a co-payment of $1.20.
“I have been in and out of hospice for the past six years with predictions that I only had six months or less to live,” she testified in 2024 to the Maryland General Assembly, which is considering its own MAID bill. “Each time, I qualified for lethal drugs and lived in fear that with my next prognosis, treatment would be denied in favor of cheaper lethal drugs.”
It is stories like these that have prompted even progressive lawmakers to oppose New York’s bill.
In explaining her opposition to the New York bill, assembly member Michaelle Solages—a Democrat and chair of the black, Puerto Rican, Hispanic, and Asian legislative caucus—cited “poverty, discrimination, a lack of support” and ultimately “a system that is unequal.”
Rodneyse Bichotte Hermelyn, another Democratic assembly member, added: “While I do support the freedom to choose and freedom to decide in the pursuit of happiness, my concern and opposition of this bill comes from the great risk of targeting vulnerable communities of color, given the historical health disparities that they continue to face.”
Another question is: How much life is really left? And how much of it is worth living? In 2014, New Yorker James Joseph (“JJ”) Hanson, 33, was diagnosed with terminal brain cancer. Multiple doctors told him he had just four months to live. “I’m thankful I didn’t listen to those doctors,” JJ later said. “If I had those suicide pills in my dark moments, I might not be here today.”
Not only did JJ outlive his prognosis by more than three years—he died in 2017—but during his treatment, his wife, Kris, conceived and gave birth to the couple’s second son, Lucas, the little brother to James. “That is the danger with assisted suicide,” Kris said in an anti-euthanasia video. “You’ll never know, if you make that choice: You might have lived like JJ—he had three and a half good years, so many beautiful moments we’ve shared as a family. James has gotten to know his daddy. We have Lucas. The joys we have been able to experience in these three and a half years are too many to count.”
The assumption is that if suffering is in your future, life is not worth living. But what if the prognosis turns out to be better than expected? And what if you can’t imagine how important that time and experience might be?
“What I’m increasingly realizing is that a lot of people are so wed to their right to choose and self-determination, that it almost becomes a little bit of a Darwinian self-fulfilling prophecy,” said Dugdale, the Columbia physician and ethicist. “Like, let’s just have the survival of the fittest, and if you can’t hang and you want to off yourself or get assisted suicide or do something else, that’s fine. I mean, personally, that’s not the kind of world I want to live in.”
Another danger of the New York law is that it would be uniquely free from oversight. In other states, the doctor prescribing MAID must file a report on each case to the state authorities. The New York law requires only that the attending physician record the details in the patient’s medical records. The law does say that a commissioner would review “a sample” of those records and produce an annual report to the legislature about compliance. But who decides which “sample” documents the commissioner reviews? Doerflinger argues that, since those records are not easily available—or even identifiable—to the state, it would have to be doctors administering MAID. How likely is a doctor who didn’t comply with the law to volunteer incriminating records? In Oregon and Washington, the pharmacist preparing the lethal prescription also has to file a report, which at least keeps doctors who fall behind in their reporting accountable. But the New York law has no similar requirement.
Since death certificates would not mention that the patient died by lethal overdose, there would be no way for these causes of death to be reviewed.
“The fact that the patient’s death certificate is going to report the underlying illness as the cause of death is not unique to New York, but what’s unique to New York is that there isn’t any other way to find out which patients underwent this process,” said Doerflinger, the bioethicist in Washington.
In other words, if there turned out to be improper uses of the New York law—or even coercion or abuse—there would be no way of detection.
The bill’s supporters remain confident in the New York law’s safeguards. “We’ve had 25 years of experience with medical aid in dying, so it’s not like it was invented yesterday, and in all those years, there’s no documented case of a person being pressured to use medication,” said Nancy. “There is no documented case of abuse.”
But what constitutes being pressured? In Oregon, nearly half of people who chose assisted suicide give fear of being a burden as a reason. When I asked Nancy about this, she didn’t see it as a problem.
In fact, she thought assisted dying could be a patient’s “gift to their family and their loved ones so that their family can see them die peacefully,” which is how she saw her sister’s death. “It seems pretty rational to me,” she said.
But I think of my friend Dovie.
Dovie, 34, is a New Yorker with a recessive genetic neuromuscular condition called nemaline myopathy, for which he requires an electric wheelchair, a portable ventilator to breathe, and assistance with basic tasks. He has suffered countless health challenges over the years, including severe depression, and has suffered more profoundly than any person I know.
I never think about whether it is “rational” for Dovie to run life’s course. I think about his immeasurable worth: his loyalty, his awe-inspiring courage, his love for his friends and family. I think about his deep intellect and faith. More than anything, I think about Dovie’s gift for bringing out the best in others, simply by being himself and allowing them the honor of caring for him.
In September, Dovie nearly died from hypoxia after his ventilator hose disconnected. Maddeningly, the same preventable catastrophe happened again a few weeks ago, and Dovie has been in intensive care ever since, fighting for his life. Just days before he was hospitalized, he wrote an article for UnHerd opposing New York’s efforts to legalize MAID, which he argued “cheapens disabled lives.”
For those of us who are lucky, the transition from healthy, independent, and hopeful about the future to sick, dependent, and facing imminent death comes late in life—and as a shock to the system. But there are millions of Americans like Dovie who struggle for years in the gray zone, floating between those two categories and living with conditions that require high-quality care and the devoted service of others.
The assisted-suicide advocates I spoke with have many admirable qualities. Chief among them is their strong will and clear-mindedness. But they risk assuming that everyone facing a devastating diagnosis is of a similar disposition. What they might not appreciate is that in insisting on control at the end of life, they are chipping away at the agency of those who have so little to begin with and whose motivations may be compromised by depression, uncertainty, loneliness, ambivalence, grief, poverty, or despair.
We owe these New Yorkers more than we currently give. And much more than a cocktail of barbiturates.
.