Nathan Warell

March 13, 2026

In contemporary politics, it is increasingly common for elected officials to be forced to engage in ethical dilemmas. Weighing their own personal beliefs, the stance of their political party, and the general ideals of their constituents often results in an uncomfortable situation in which a large number of people believe the decision to be immoral. This is true in the discourse of options available for those in need of end-of-life care. The name of this practice itself is disputed, with proponents preferring names such as Medical Aid in Dying (MAID), dying with dignity, or the right to die, while those in opposition commonly refer to it as assisted suicide, physically assisted suicide, or euthanasia. No matter the name, the practice is defined as a “qualified patient with a terminal disease to request that a physician prescribe aid-in-dying medication that will allow the patient to end the patient’s life in a peaceful manner” by a recently passed Illinois law legalizing the practice within the state [1]. A terminal disease is defined as an illness in which the life expectancy, declared by a physician, for the patient is less than six months. This is a highly debated subject in which various organizations, religious groups, and individuals have drastically different opinions in one direction or the other. This article will attempt to dissect the common arguments from both sides, primarily referencing the Illinois law; however, additionally examining other states’ and countries’ law as appropriate. 

The main argument of proponents of MAID rests in consent and dignity, in alignment with other end-of-life care statutes that have been the medical standard for decades. Because a qualified person is able to refuse intensive medical care through a Do Not Resuscitate (DNR) order, also called an Allow Natural Death (AND) order, there exists precedent for a patient to consent to medical care–or lack thereof–that would result in their own death, even if the patient’s life could be sustained through treatment. By this standard, a patient in good mental standing should be able to consent to their own death when there is no likelihood for life beyond six months. This “respect for patient autonomy,” as well as sympathy for those in pain in their final months, is the driving force in ethical argumentation with regard to the practice [2]. 

Additionally, advocates for the right to die argue from a place of moral superiority, believing MAID to offer an end to suffering to those already at the end of their lives. The advocacy organization Death with Dignity is a primary example of this type of argumentation. The group, founded in Oregon, echoes other points about autonomy and consent, but forges a strong emotional appeal. Their website mission statement includes a wish to “ensure people with terminal illness can decide for themselves what a good death means,” implying a medically assisted death is, to some people, a more respectable death than death by natural causes. This further enters into a query that some deaths are good and others bad, and that medical aid in dying is a “better death” than dying of a terminal illness or of natural causes. Death with Dignity persists with this line of thinking by claiming “history is on [their] side,” again implying that the incorrect position is to be against medically assisted death [3]. This ethical standpoint, and apparent defense of the moral high ground, opens a dialogue of moral ethics of end-of-life care, with many groups in opposition to the stance taken by right-to-die activists. 

Finally, advocates for this legislation argue that the safeguards implemented prevent misuse or misperceptions, leaving the only recipients those who are terminally ill and those that qualify for the prescription. Under the recent Illinois law, a patient previously deemed terminally ill, that is, with a predicted lifespan of six months or less, may orally request this prescription to his or her physician, followed by a written request to the same physician. The written request must have two witnesses, one of which may not be a family member (blood related or by marriage), a recipient of the patient’s estate, a healthcare insurance employee, the attending physician, or an interpreter (if used). The patient must then re-request this prescription at least five days after the initial oral request. This is common amongst states that have legalized MAID care; this aims to prevent rash action and to ensure this is the true wish of the patient. By the time a second request has been made, the attending physician has confirmed the patient’s terminal illness and determined the patient has the mental capacity to make an informed decision. During the second oral request, the physician shall give the patient an opportunity to rescind the request. The physician is additionally responsible for ensuring the patient has not been coerced in making this decision, although no legal punishment shall fall onto the physician if it is discovered coercion was involved. Finally, the physician is responsible to ensure the patient is informed of all alternate treatment options, including hospice, palliative care, and other comfort based care options. The patient is encouraged to take the oral medication in a private setting, with family present. The patient’s estate, will and life insurance cannot be negatively impacted by the choice to end his or her life through MAID [1]. Proponents of physician aided death argue that the extensive process to be prescribed the medication and the safeguards implemented limits the possibility of malpractice or misuse. Those against the practice argue that there can never be enough safeguards to ensure malpractice does not occur, further citing the lack of punishment within the bill if coercion is discovered.

It seems Americans are increasingly in support of comprehensive end-of-life care options, as thirteen states now approve or plan to approve the practice. The Illinois law to legalize Medical Aid in Dying passed the state senate with an astounding fifty-four years  to one solitary nay from Republican Senator Jason Plummer. 17 of the 19 Republican Senators in the chamber voted in favor of the act. Furthermore, in Delaware, passing a similar bill in 2024, saw overwhelming support for MAID, with 72% of residents in favor of expanding end-of-life care to death in a 2020 poll [2]. It is important to clarify that this poll took place during the uncertainties in the medical field in relation to COVID-19, which may or may not have impacted the validity of the survey. Additionally, this Delaware bill did not have the near universal legislative support found in Illinois, with both the house and senate passing the measure by four and three votes respectively, with some Democrats in both chambers joining all Republicans in opposition [4]. The Democratic supermajority allowed for the bill to pass despite bipartisan opposition. 

Although medical aid in dying can be viewed as a way to relieve unneeded pain from ill individuals, a minority of Americans see clear and evident issues with what they view as physician-assisted euthanasia. The terminally ill are amongst the most vulnerable group, and therefore society ought to protect them to the best of its ability. The concept of promoting premature death contradicts preconceived notions of healthcare and care for the sick and elderly. This line of thinking is commonly found in those eligible for MAID care, as one study reports over a quarter of eligible patients–that is the terminally ill with access to a physician willing to prescribe end-of-life medication–refuse on ethical or religious grounds [5]. It should be noted that this study was conducted only in Colorado and surveyed 300 people. It remains the ethical and religious rationale to impact a person’s decision on whether or not to receive MAID.

As stated, religion is an additional layer to the conversation surrounding premature death. Although the Catholic Church is the loudest critic, both Islam and Judaism forbid the practice as well. In November, 2025, newly elected Pope Leo XIV invited his home state’s governor JB Pritzker to the Vatican for a conversation involving a number of topics, including the then recently passed–and awaiting signature–End-of-Life Options for Terminally Ill Patients Act, of which the Pope asked Pritzker to veto. Less than a month later the bill was signed into law. When asked about the conversation Pope Leo said “We were very clear about the necessity to respect the sacredness of life from the very beginning to the very end,” emphasizing the Church’s position on medical euthanasia [6]. This comment comes after the Holy See’s letter entitled “Samaritanus bonus,’ on the Care of Persons in the Critical and Terminal Phases of Life,” approved by Pope Francis, which emphasizes the church’s rejection of assisted suicide, in favor of pallative care until natural death [7]. Catholic doctrine remains antithetical to assisted suicide for two main reasons: the protection of the sanctity of life and the call to care for the sick. Protecting the sanctity of life has been in the mainstream of Catholic ideology since the mid twentieth century, as abortion became more accessible, and the church remains firm against all instances in which life ends prematurely. MAID further violates a Corporal Work of Mercy, referring to a charitable act defined by Catholicism that addresses the needs of others. One such work is Caring for the Sick, and the Vatican has been clear that MAID violates this work [7].

Beyond religious and ethical objections to physician-assisted suicide, there exists objective oppositions to the practice, more open to debate and discussion. The first rests in a person’s ability to make the objective decision to end their own life. Rates of depression and suicidal ideations are more common amongst people with terminal illness, with one study finding 13% of Pallative Care patients being diagnosed with Major Depression Disorder [8]. Furthermore, many people eligible for MAID have experienced intense hardship in their own health, as well as the health of their loved ones when applicable, which may negatively impact their own mental health: “we encountered a series of elderly men who took their own lives with the belief that they had cancer. Five of the eight had major depression, four had a past personal history of cancer, and six had lost wives to painful debilitating conditions” [9]. It is reasonable to assume these men’s past experiences with health, either their own or their loved ones, impacted their mental health and ultimate decision to commit suicide (absent of MAID). There exists substantial, sensible argumentation that these men were not in the correct mental state to consent to a physician assisted death. From this brings the argument that if mental health issues are consistently higher amongst the terminally ill, and mental health issues can go undiagnosed–as seen with four out of eight of these men–then a terminally ill patient cannot consent to his own death, as he one cannot ensure he has the mental capacity. Proponents of this logic argue that MAID and DNR orders are inherently different as the former implies a willingness to die, while the latter is more akin to a content attitude toward a natural death. Additionally, DNR orders imply that if the patient were to survive, the already dim quality of life would further decrease (i.e. broken ribs from CPR in addition to chronic illness), not prescribing a medical aid in dying would not have this effect. 

Another argument lies in whether a patient’s ability to afford increasingly expensive palliative or hospice care may impact his or her choice to seek medical aid in dying. This subject arises due to a provision in most MAID legislation that forbids the withholding of life insurance due to a patient’s choice to end their life through MAID. The discussion is based on the larger issue of increased healthcare costs, especially amongst those in need of hospice care. In order to avoid the financial burdens of end-of-life care on themselves or on one’s family, a person may choose a physician’s assisted death. There lacks a peer-reviewed meta-analytical study to confirm or deny this argument, however, the state of Oregon maintains a statistic asking if those prescribed life-ending medication did so for “financial implications of treatment,” of which only 6% answered affirmatively since 1998 [10]. This is an isolated statistic and more research must be done prior to any definitive claims to be made. 

There are many angles, opinions, and viewpoints in discussion surrounding end-of-life care, and as the practice becomes more common throughout the Global West, the discussion is ought to continue and enter the mainstream. It is likely the argumentation will come down to consent and dignity of the terminally ill against the protections of life and mental health of the most vulnerable. As jurisdictions continue to legalize MAID, debate surrounding a person’s right to bodily autonomy in their final months, against protecting the terminally ill from exploitation and premature death will continue. 

Image Credit: https://www.flickr.com/photos/115089924@N02/16256199615

Works Cited

[1] LegiScan. 2025. “HB1328 — Illinois General Assembly.” Accessed February 21, 2026. https://legiscan.com/IL/bill/HB1328/2025

[2] JAMA Network. 2025. “Title of Article.” JAMA. Accessed February 21, 2026. https://jamanetwork.com/journals/jama/article-abstract/2823619#

[3] Delaware General Assembly. 2025. “Bill Detail — Delaware General Assembly.” Accessed February 21, 2026. https://legis.delaware.gov/BillDetail?LegislationId=79026

[4] Death with Dignity National Center. n.d. “About Death with Dignity.” Accessed February 21, 2026. https://deathwithdignity.org/about/

[5] Hamer, Mika K., Christine M. Baugh, Dragana Bolcic-Jankovic, Elizabeth R. Kessler, Vinay Kini, Hillary D. Lum, Julie Ressalam, and Eric G. Campbell. 2024. “Conscience-Based Barriers to Medical Aid in Dying: A Survey of Colorado Physicians.” Journal of General Internal Medicine 39 (16): 3138–45. https://doi.org/10.1007/s11606-024-08782-y

[6] Vatican News. 2025. “Pope Leo Asks for 24 Hours of Peace Worldwide at Christmas.” Vatican News, December 2025. https://www.vaticannews.va/en/pope/news/2025-12/pope-leo-asks-for-24-hours-of-peace-worldwide-at-christmas.html

[7] Congregation for the Doctrine of the Faith. 2020. Samaritanus Bonus: On the Care of Persons in the Critical and Terminal Phases of Life. Vatican City: Vatican. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20200714_samaritanus-bonus_en.html

[8] Journal of Pain and Symptom Management. 2013. “Article S0885-3924(13)00152-8.” Journal of Pain and Symptom Management. https://www.jpsmjournal.com/article/S0885-3924(13)00152-8/pdf

[9] Wiley Online Library. 1994. “Article 10.1111/j.1943-278X.1994.tb00812.x.” Journal of Religious Ethics. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1943-278X.1994.tb00812.x

[10] Oregon Health Authority. 2024. Oregon Death with Dignity Act: Data Summary, Year 27 (2024). Salem, OR: Oregon Health Authority. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year27.pdf