The tragic paradox of suicide as end-of-life ‘care’

New York Governor Kathy Hochul has an opportunity to stand up for her most vulnerable constituents with a veto of the dangerous Medical Aid In Dying Act (S.138/A.136) which legalizes assisted suicide. It would permit physicians to offer prescriptions for death instead of healing.

New York’s physician assisted suicide legislation was designed for patients who, according to medical diagnosis, have less than six months to live, but research from other states demonstrates clearly that this standard is impossible to define, stick to, and enforce.

The organization I am privileged to work for, Agudath Israel of America, through its Chayim Aruchim division has long advocated on behalf of terminally ill patients helping them make serious decisions on end-of-life care.

These health care decisions, however, should not become a conversation about suicide. The long experience we have working with patients at Chayim Aruchim has taught us first hand that the healthcare system often marginalizes the care of the elderly, elder abuse happens, and patients often are viewed as a “burden.” Doctors often pronounce a terminal diagnosis, only to have the patient defy expectations and continue to live. We have seen patients go on to live long, fulfilling lives in spite of a previously short prognosis.

We remain concerned about the prevalence of depression among patients seeking to end their lives as well as the potential for medical misdiagnoses. We are further concerned over the influence of family members, potential inheritors, and other financial pressures to lead patients to make irreversible decisions toward physician-assisted suicide. If physicians instead are empowered to prioritize care, including mental health care for patients in difficult circumstances — such as those who have just suffered a spinal cord injury — they will be able to guide patients past dark days through a trusting doctor-patient relationship.

It is deeply rooted in the Jewish tradition to believe that every life and indeed every moment of life is sacred. From this perspective, the decision to end one’s life is always tragic. Making official state policies that enable and actually encourage individuals to make this decision raises fundamental questions, none more important than how do we justify this proposal when it amplifies the biases, barriers and risks in our health care system already facing people living with a disability. Furthermore, the proposal provides broad immunities to prescribers, further eroding accountability.

What seems like a compassionate option instead creates a new danger for many New Yorkers. A recent study of states where this policy has been legalized found that assisted suicide has been expanded to include non-terminal illnesses such as mental health disorders like anorexia, often with young patients who could go on to live long lives with proper treatment. Adopting assisted suicide means persons living with disabilities are at greater risk of being offered a fast track to death instead of care when they visit a doctor office or hospital.

There is no need to wonder if these risks are simply theoretical. As the first state to legalize this practice, Oregon also has the longest track record of offering lethal drugs to patients in lieu of standard treatment. According to the Oregon Health Authority annual reports, from 1998 to 2024, only 80 of 3,243 patients (2.5%) who requested lethal drugs were referred for psychiatric evaluations. By offering a quick death, underlying mental health issues are not being properly addressed.  Many patients’ motives for assisted suicide aren’t rooted in fear of pain or dying but are actually about concerns of disability–which can and should be addressed. Other concerns that lead patients to request lethal drugs are losing autonomy (90.1%); less ability to enjoy activities (89.4%); loss of dignity (69.4%); losing control of bodily functions (44.5%); and being a burden on loved ones and caregivers (46.6%), all of which could in many cases be alleviated by good emotional support.

Those who have not worked with suicidal patients don’t realize how frequently suicidal ideation can be reversed. A dramatic example of this was given in a New Yorker article by Tad Friend. He quotes a statement from Ken Baldwin, who survived a jump from the Golden Gate Bridge. He said, “I instantly realized that everything in my life that I’d thought was unfixable was totally fixable – except for having just jumped.”

In a society that allows assisted suicide, even a potentially treatable disease or illness can be interpreted as being “terminal” when it remains untreated. This is the case for anorexia patients as well as diabetics who can’t afford the cost of insulin.

Embracing assisted suicide as a policy is not compassion – we believe it is a profound moral and practical misstep. The Orthodox Jewish community will continue to stand firm in its opposition to this dangerous and disturbing law.