Oncologist doctor holding patient's hand in hospital. Showing all love, empathy, helping and encouragement. He has end stage cancer disease. Healthcare in end of life and palliative care concept
Oncologist doctor holding patient's hand in hospital. Showing all love, empathy, helping and encouragement. He has end stage cancer disease. Healthcare in end of life and palliative care concept

The Nationalization of Assisted Suicide Will Have Far-Reaching Consequences

Crossposted at Humanize

Progressive cultural radicals are busily nationalizing their policy agendas by breaking the usual legal comity among the states. For example, California recently declared itself a transgender sanctuary jurisdiction. Its law now actively interferes with out-of-state child custody orders by allowing non-resident gender dysphoric children who make it to California to access puberty-blocking and transition surgeries despite their custodial parent’s refusal of consent.

Assisted suicide zealots have long sought to similarly impose their death agenda throughout the nation regardless of state laws to the contrary. Indeed, not long after Oregon voters legalized doctor-prescribed death in 1994, advocates tried to get the Supreme Court to impose a Roe v. Wade-type constitutional right to assisted suicide.

Happily, in the 1997 case of Washington v. Glucksberg, the Court instead ruled unanimously that no such right exists in the Constitution. Not only that, but in a delicious irony, Glucksberg became the primary precedent cited by the Court in 2022 overturning Roe, thereby denationalizing abortion policy and returning the issue to the states.

But euthanasia advocates never quit. After they failed to sweep the country with legalization efforts—despite decades of advocacy, only 10 states and the District of Columbia currently have legalized doctor-assisted suicide—they have now fashioned a new scheme to open the door to hastened death to any adult in the country with a terminal illness.

Here’s the disingenuous game. When advocates push to legalize assisted suicide, they always promise that “strict guidelines” will protect against abuse. One of these supposed safeguards requires that anyone seeking a lethal prescription be a state resident. In this way, they insincerely assure the wary that the state won’t become a “suicide tourism” destination similar to Switzerland—a country that allows suicide clinics to operate openly, to which people travel from around the world to be made dead.

Such restrictions were always a weak broth. Americans can generally change their residency any time they want. That’s part of living in a free country. And indeed, when Californian Brittany Maynard decided she wanted to commit assisted suicide after being diagnosed with brain cancer in 2014, she readily moved to Oregon, and a few months later, was dead by a legally prescribed lethal overdose.

Now, even that thin impediment is being discarded as states repeal these residency rules. Oregon and Vermont already threw theirs in the trash, and now Democrats in the Colorado Legislature are pushing to similarly allow terminally ill non-residents to travel to the Rocky Mountain State from anywhere in the country (or the world, for that matter) for the explicit purpose of hastening their dying.

If the Colorado proposal passes, Americans will be able to access lethal prescriptions on the west and east coasts and in the heartland, meaning that anyone who qualifies for a lethal prescription under one of these states’ laws will be only a few hours’ drive from accessing assisted suicide. And it won’t stop there. I don’t doubt that within a few years, most state laws restricting assisted suicides to residents will be repealed.

Making this ongoing nationalization of assisted suicide even more fraught, most states that allow doctor-prescribed death are eliminating other safeguards as well. For example, some are reducing waiting periods from the request to dispensed overdoses to merely days. Moreover, some jurisdictions now allow certified nurse practitioners to prescribe lethally as well as doctors.

Some states even allow assisted suicide by Zoom or Skype. This could be the model going forward. The American Clinicians Academy on Medical Aid in Dying—an association of doctors who assist suicides—in 2020 published formal guidelines that allow assisted suicides via the Internet. These guidelines state that examination should include a review of medical records and a video meeting. Any required second opinion can simply be done by phone. And these “examinations” would be able to be done from anywhere in the country.

This nationalization of assisted suicide will have far-reaching consequences. It means that even residents of the reddest states will have ready access to assisted suicide. Moreover, assisted suicides will be facilitated by doctors or nurses who hardly know the patient—and indeed, who never treated the suicidal person for their underlying illness—doctors who may also be ignorant of their family situations and personal mental health histories. And it will open a new advocacy argument for universal state legalization that will assert patients shouldn’t have to travel out of state but should be able to be made dead at home.

It won’t stop there, either. Ultimately, the euthanasia agenda isn’t about terminal conditions. Indeed, countries that have fully swallowed the hemlock theory that killing is a splendid answer to human suffering don’t impose terminal illness limitations on assisted suicide or lethal injection euthanasia. Canada—our closest cultural cousins—allows doctors to kill people with disabilities, the frail elderly, and the chronically sick who ask to die. The mentally ill can be so dispatched in the Netherlands and Belgium. Swiss suicide clinics routinely accommodate people who aren’t terminally ill. Meanwhile, Germany’s highest court ruled that committing suicide, assisted suicide, and assisting suicides are fundamental constitutional rights—regardless of the reasons why the suicidal person wants to be dead.

What can be done about this trend? Not much, I fear. States are generally in charge of their own public policies, which can’t be gainsaid by other states. Yes, Idaho criminalized assisting a minor to leave the state for an abortion, and it’s illegal under federal law to take a child out of state for sexual purposes. But I doubt such laws would pass constitutional muster if applied to adults and assisted suicide. And I suppose that laws could be passed prohibiting lethal prescriptions from being shipped across state lines. But beyond that, more creative minds than mine will have to find ways to thwart assisted suicide nationalization.

So, here we are. Even if most of the states retain their laws against assisted suicide—as they should—they will lose much of their protective value. Indeed, one can foresee the launch of a lucrative niche assisted suicide travel industry, companies that—for a fee—arrange the proper medical approvals, transport suicidal persons to a state where doctor-prescribed death is legal, and after they are dead, return them home in a casket for final disposition. Alas, such is the darkening world in which we now live.

Wesley J. Smith

Chair and Senior Fellow, Center on Human Exceptionalism
Wesley J. Smith is Chair and Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism. Wesley is a contributor to National Review and is the author of 14 books, in recent years focusing on human dignity, liberty, and equality. Wesley has been recognized as one of America’s premier public intellectuals on bioethics by National Journal and has been honored by the Human Life Foundation as a “Great Defender of Life” for his work against suicide and euthanasia. Wesley’s most recent book is Culture of Death: The Age of “Do Harm” Medicine, a warning about the dangers to patients of the modern bioethics movement.