The Harms of Expanding Physician-Assisted Suicide

Currently, nine states and the District of Columbia have passed laws in the U.S. to legalize and regulate the practice of physicianassisted suicide (“PAS”). Proponents initially garnered public support by portraying PAS as distinct from suicide, framing it as a rare mechanism for patients with terminal illness to achieve a peaceful death, enhance autonomy, and reduce suffering. Original state laws contained numerous eligibility requirements designed as safeguards to provide stringent limits. However, over the past few years proponents of PAS have systematically worked to expand PAS and erase these limits by increasing eligible providers, reducing waiting periods, and eliminating residency requirements. In addition to these modifications, proponents of PAS assert the U.S. should adopt more lenient models used by other countries. More than simply theoretical discussions, proponents have taken steps to challenge current laws through proposed legislation, litigation, and using clinical practice to circumvent legal requirements. This Article provides an overview of four proposed substantive changes in eligibility requirements for PAS, including: (1) permitting assistance with administration or allowing euthanasia; (2) changing the requirements around patient decision-making capacity; (3) eliminating the requirement for terminal illness; and (4) allowing PAS for mental illness. Revisiting the history of PAS, this Article provides a critical analysis of the ethical arguments behind permitting PAS and explains the harms of radically expanding PAS.