New York’s Latest Assault on Human Dignity
For nearly a decade, New York has sought to legalize so-called medical aid in dying (MAiD), and it seems the state is finally nearing the end zone: the New York State Assembly and Senate both passed the Medical Aid in Dying Act, and the bill is awaiting Governor Kathy Hochul’s signature. New York will soon become the twelfth state to legalize assisted suicide, and others will soon follow.
Futile Care
Christians oppose assisted suicide for many reasons. However, before I address our concerns regarding this specific bill, I want to acknowledge the suffering of those with terminal illnesses. Christians lament suffering. As a pastor, I have been at the bedside as people suffer in their final days. I have offered counsel to the terminally ill. I have had to make decisions regarding futile care in my own family. I have stroked the hair of my loved ones as they have passed from this world to the next. Christians do not want people to suffer, nor do we want to extend agony or ignore the trauma that can occur at the end of life. Christians realize that suffering is a condition of the fall, a condition that Jesus fully embraced as our suffering savior.
All of this said, our opposition to assisted suicide is not one of cruelty, but of compassion.
Compassion and Autonomy?
The New York bill rests on two foundational premises: first, it is compassionate to end suffering, and second, the principle of autonomy allows people the right to make their own choices regarding end-of-life care. Compassion and autonomy are the foundational principles that are said to motivate this legislation, according to Senator Jessica Scarcella-Spanton.
However, the bill undermines both compassion and autonomy. Compassion is fundamentally a relational virtue—when a person is moved to relieve another’s suffering, he, too, is transformed by this act. Genuine compassion cultivates greater compassion within the caregiver, thereby fostering greater charity. But we must ask: how does helping to hasten someone’s death make the assistant more loving? It is difficult to see the connection. Imagine the potential damage to a physician’s soul if he is repeatedly asked to end his patients’ lives. Genuine compassion acknowledges our inherently social nature and recognizes that our responses to suffering shape not just the individual being helped, but the one administering the aid. Therefore, when we redefine compassion to include ending life rather than walking with people through suffering, we alter not only individual caregivers but the moral foundation of our collective social bonds.
Second, autonomy extends far beyond mere self-determination, a key principle underlying the New York bill. While we humans possess rational agency and the capacity for choice, this freedom is properly bounded by our responsibility to promote human flourishing. Autonomy, rightly understood, isn’t simply “self-law” (auto and nomos) but freedom exercised under the principles of harm-to-none and charity-to-all. New York’s legislation embraces a reductionist view of autonomy that dangerously ignores the complex web of relationships and responsibilities that define human existence. Our decisions never affect only ourselves—they ripple outward, influencing our families, communities, and broader society. By treating autonomous choice as an absolute right regardless of its effect on others, we damage our collective moral ecology, weakening the social bonds and ethical frameworks that sustain our communities and protect our most vulnerable members. These ethical concerns form the basis of my argument as I present several reasons why the foundational premises of New York’s legislation should trouble all citizens, regardless of their political or religious affiliations.
Defining Coercion: An Ever-Shifting Burden
First, the bill states that patients who suffer from a terminal illness or condition may request a prescription to end their life “based on an understanding and acknowledgment of the relevant facts.” The decision must be made voluntarily and without coercion, and the patient must be fully informed before making it.
Thus, a physician and psychologist must determine the patient’s motives in making requests for life-ending drugs. But this raises the question whether it is fair to ask medical professionals to determine what constitutes coercion. Coercion can take many different forms and be quite subjective. Can an innocent question about medical expenses be seen as coercive? Can a loved one’s comment in a moment of grief be interpreted as coercive? What about a dying person’s real or perceived guilt? It is unclear who determines what constitutes coercion, and thus, it seems troubling to place this burden on healthcare workers.
We must also consider the conscience of those who are asked to make these determinations. Physicians already deal with tremendous pressures and expectations. It is hard to fathom the psychological effects on physicians who are asked to determine the subjective nature of coercion while the patient and family members are dealing with grief. New York’s legislation claims to be compassionate while it undermines compassion for all those committed to the Hippocratic Oath.
Conscience Rights
Second, consider the moral dilemma facing physicians with sincere religious objections to assisted dying. While the legislation purports to protect conscience rights, it requires physicians to transfer or arrange the transfer of patients to providers willing to prescribe lethal medications. Unlike typical medical transfers designed to match patients with appropriate specialists or treatments that align with standard care, these transfers create a unique ethical tension: the referring physician must actively connect a patient with someone who will facilitate an action they believe violates the core medical principle of “do no harm.”
This is fundamentally different from other conscience protections in healthcare, which typically do not require direct facilitation of the objectionable procedure. For example, the Church Amendments and other federal protections for conscience generally protect healthcare workers from being compelled to participate in procedures they find morally objectionable without obligating them to make referrals. Yet physicians who hold sincere objections to medical aid in dying may experience moral distress when required to initiate a chain of events leading to what they view as patient suicide, even when they are not the ones prescribing the medication.
Moreover, conscientious physicians are placed in an untenable position: they must either violate their deeply held convictions by facilitating access to lethal drugs or turn their patients over to others who will. Thus, some may feel compelled to avoid giving a full diagnosis in borderline cases, while others may be less transparent about prognosis to avoid triggering the law’s provisions. While not being mandated to refer is not technically “abandonment” in the legal sense, this requirement fails to fully respect the moral agency of healthcare providers. True compassion must consider the well-being of all parties involved in these difficult situations, including physicians and other healthcare workers. Thus, for a bill to be sold as “compassionate,” one must also consider compassion for physicians and healthcare workers.
Soothsayer or Surgeon?
Additionally, the bill states that a person must be within six months of death in order to qualify for assisted suicide. While physicians may provide a best guess as to someone’s remaining lifespan, no one can be sure when death will occur. I have witnessed patients who were expected to die within months go on to live for another year (or more). It is an undue burden to ask our physicians to determine when a life will end.
The bill also states: “Medical aid in dying means the medical practice of a physician prescribing medication to a qualified individual that the individual may choose to self-administer to bring about death.” The principle is that of autonomy; the patient will self-administer the drugs to take his own life. But how autonomous is this act? Humans are relational creatures; we do not live on an island. A doctor must write a prescription, a pharmacist must fill the order, an insurance company must pay for the drug, an attendant must remove the body, etc.
Moreover, in my experience, at the end of life, many people do not have the faculties to administer their own medications; thus, many patients will need someone to actively participate in their death. While §2899-f (3) explicitly forbids anyone but the patient to administer the drugs, how can this be policed? While some terminally ill patients maintain their physical capabilities until very near death, studies from Oregon and Washington show that a significant number of patients who receive prescriptions never use them, suggesting that physical capacity may indeed become a barrier for some. This raises legitimate questions about oversight and implementation in cases where patients’ abilities may be compromised. The act of a third party administering fatal drugs would fundamentally change the nature of the act itself. While the New York bill seeks to promote patient autonomy and choice, it is overly optimistic about the capacities of those nearing death.
Who Pays the Bill?
The bill indicates that third-party providers must offer the services associated with medical aid in dying. Religious institutions and religious non-profits of a certain size must offer healthcare to their employees. While the bill addresses insurance issues broadly, further clarification may be needed regarding whether religious institutions would be required to include coverage for these life-ending medications in their health plans. The bill prohibits insurers from denying other services based on a patient’s choice about medical aid in dying but doesn’t explicitly address whether institutions with religious objections must include such coverage in their plans. Similar to the Little Sisters of the Poor case regarding contraception, what are the provisions to ensure religious institutions are not contributing to acts they find immoral? While New York legislators want to celebrate this bill as honoring patient autonomy, they fail to acknowledge that healthcare is not only about the patient. Healthcare includes all of us who pay premiums.
A Better Vision
Genuine compassion calls us to a richer vision of end-of-life care than merely eliminating suffering. Palliative care embodies the relational nature of compassion because it transforms not only the recipient but also the caregiver, thus fostering greater charity throughout our community. Unlike assisted suicide, palliative care maintains the bond between caregiver and patient, strengthening rather than weakening our social bonds.
Moreover, palliative care honors a proper understanding of autonomy. It allows the dying to exercise meaningful agency as they make essential choices about ending burdensome treatments while recognizing that autonomy is not merely unrestricted self-determination. Palliative treatment recognizes one’s freedom while maintaining our responsibilities to one another. When we embrace a vision of compassionate and bounded autonomy, we create a sacred space where the dying are neither abandoned nor rushed toward death.
We need to think deeply about end-of-life care because it is only a matter of time before medical aid in dying for the most vulnerable will come to your state. People everywhere should be concerned when death is considered the best option to express compassion and autonomy.
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