According to Death With Dignity, an organization that promotes legal access to physician-assisted suicide (PAS), 11 states and the District of Columbia have legalized the practice. The organization also reports that pro-PAS bills have been introduced this year in the legislatures of another 17 states. 

New York is one of those states. The State Assembly in Albany passed the “Medical Aid in Dying Act” in April, and the State Senate passed its companion bill on June 9. The bill now awaits action from Gov. Kathy Hochul. 

Legalizing PAS should be opposed in principle, regardless of the degree to which the legislation sanctioning it protects religious and other objectors from participating or otherwise becoming complicit in carrying it out. Nevertheless, assessing those protections in specific proposals is necessary. In many of these bills — including the one on Hochul’s desk — conscience protections are severely lacking.

In a recent email exchange, a colleague at Christian Medical and Dental Associations (CMDA) underscored that while there are provisions in the bill that protect medical practitioners from adverse government action for refusing to participate in PAS, it is not at all clear that objecting employees at private hospitals or clinics that allow PAS on their premises are protected from being punished by their employers. New York lawmakers concerned about protecting conscientious objectors should have made these protections abundantly clear.

Another key concern pertains to mandates surrounding patient referrals and transfers. Legal mandates dealing with PAS, abortion and “transgender medical treatments,” for example, often fail to account for the burdens of moral complicity that can arise for religious medical practitioners and institutions in this context.

The New York bill states that an objecting clinic or hospital “shall” transfer a patient seeking PAS “promptly to another health-care facility that is reasonably accessible under the circumstances and willing to permit the prescribing, dispensing, ordering and self-administering of medication under this article with respect to the patient.” With questions remaining as to how this might be enforced, such mandated transfers could impose a terrible burden on many private health-care facilities, including Catholic and other religiously affiliated hospitals that view any act that aids a patient in seeking assisted suicide as a grave violation of their moral teachings. 

For example, as my CMDA colleague also noted, objecting medical facilities should not be forced to arrange or pay for the transportation of a patient to a facility that will allow PAS, including contacting a transportation service to move the patient. They may passively allow the transfer of the patient and provide the necessary medical records to the receiving facility at the patient’s request, but they should be free of any burden to facilitate it, even if in other circumstances they rightly assume that very same burden. 

It is the dire nature of PAS, and the grounds of the objections to it, that demand the highest level of conscience protections in this circumstance. While New York’s bill does not specify what the transfer mandate entails, it must be acknowledged that it is precisely this kind of ambiguity that leaves faith-based and other hospitals and clinics vulnerable to adverse government action and litigation. 

Let’s take a step back to consider the growing appeal of the “death with dignity” movement by looking north to a more extreme variant of it. The alarming expansion of euthanasia in Canada since its legalization in 2016 — which, according to Cardus, has made the practice “routine” there — should give pause even to those who are sympathetic to “medical aid in dying.” In 2016, 1,018 Canadians were euthanasized, but by 2022 that number had surged to 13,241, making euthanasia the fifth-leading cause of death in Canada. That figure surpassed 15,000 in 2023.

The Cardus report also noted that our northern neighbor’s “[Medical Aid in Dying law] was expanded further, without any additional legal safeguards, to include mental illness as a qualifying condition.” Implementation of that expansion was scheduled to take effect in 2023 but was postponed until 2027, which means the law has the potential to lead to loss of life in Canada at an even higher rate in the future. 

There are numerous ways to approach the question of why opening the door to euthanasia in Canada has led to such a dramatic increase in individual Canadians seeking it out over time. Ultimately, however, we can at least say that when Canadian law recast it as a social good by licensing it and placing it within the field of medicine, it unleashed something that has had devastating societal consequences. 

Legal allowances for PAS in the United States have been more limited than the euthanasia regime in Canada, but the move toward recategorizing the act of killing patients as a form of health care is, nevertheless, also taking deeper root here. 

While legalizing PAS and euthanasia should be opposed outright on grounds of moral principle, it is important also to demand from their proponents full and unequivocal protections for medical practitioners and institutions that object to any degree of participation in carrying them out. For those objecting based on religious convictions, the imperative to safeguard such conscience protections is even more acute. 

Governor Hochul should veto her state’s “Medical Aid in Dying Act” because PAS is morally wrong, contrary to medical ethics, and appropriate for continued legal proscription. The bill’s inadequate conscience protections provide yet another urgent basis for vetoing it. 

 

Nathan A. Berkeley serves as associate vice president for U.S. Strategies at the Religious Freedom Institute.