Why I Oppose the NY Medical Aid in Dying Act

The slippery slope is real, autonomy is not absolute

The NY Medical Aid in Dying act passed the NY Assembly last week by a narrow margin and has now moved on to the New York Senate.

Some doctors support the bill

At the last meeting of the Medical Society of the State of New York, the Society reaffirmed its support for a bill in the NY State legislature supporting physician assisted suicide, the NY Medical Aid in Dying Act. The supporters of this measure claim that the procedure has been legal in 10 states and “there has never been one credible case of one of these laws being misused,” so it must be ok (1). They also point out that laws such as Oregon’s Death with Dignity Act (1997) have multiple safeguards in place, such as mandatory waiting periods, psychological evaluations, and a need for 2 doctors to agree to honor a request. Similarly, the New York law allows “terminally ill adults – capable of making their own health care decisions – with a prognosis of six months or less to live, to request a prescription that they can self-ingest to die peacefully in their sleep.”

I opposed the Medical Society resolution in support of NY Medical Aid in Dying Act. I was not alone. Many physicians feel that it is not our calling to help people die. It is our calling to alleviate pain and suffering, and a part of that responsibility is to provide comprehensive and compassionate care to people at the end of life. The “mercy killing” of patients has been frowned upon for centuries for many reasons. Hippocrates included it in his oath:

“With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.

Nor shall any man's entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so.”

Physicians have historically tried to live by the motto: do no harm. We recognize that the tools we have at our disposal – powerful drugs, anesthesia, surgery, radiation and more can do tremendous harm to patients as well as good. We vow to try to do our best to prevent harm.

Suicide by anyone, ever, has always been seen as a failure of some kind – either a failure of loved ones and caregivers to recognize and prevent suicide or a failure of the suicidal individual to seek help – except, apparently, when it isn’t.

Reports from the Assembly

Reports from the NY Assembly (1) indicate that individual stories of loved ones dying in pain was an important part of the legislative process. Such stories are heart rending and painful to hear, but there are at least 2 things wrong with using such stories as evidence to support state approval for medical aid in dying.

First, each experience is a single experience of a single individual or family. Their experience may have been difficult, but it ignores the millions of people who die with traditional medical care or Hospice care without excessive pain and suffering. This is called “anecdotal evidence” and physicians and scientists everywhere try to avoid making assumptions about the truth based on such evidence.

The second problem is that the stories are being told by the surviving family, not the individual who experienced the death. Those individuals telling the story are living with fear. They are afraid that they too will someday die a painful death. Fear is not the best emotion to drive important decisions.

Conscious and aware human beings have been dying for thousands of years with minimal medical assistance. In fact, when looked at historically, modern people have had the most comfortable deaths that people have ever had. Current day Americans have had more medical help dying a natural death than almost anyone on Earth has ever had. I believe that with good medical care, pain can be alleviated or minimized in almost every case.

Groucho Marx once said, “I’m not afraid of dying, I just don’t want to be there when it happens.” Like groucho, many people supporting Medical Aid in Dying, which should be called Physician Assisted Suicide, are afraid of dying. Nothing strange there except that they would like the government to protect them from the pain of dying. There is no limit to the fears people have, and no limit to the attempt to have government protect us from everything, but we cannot be protected from dying, or pain.

In recent letters to Syracuse.com, 2 different physicians with experience in Hospice and palliative care gave opposing opinions about the matter (2,3).

Dr. Judy Setla, medical director of Hospice of CNY, was supportive of patient autonomy. She wrote, “It is high time that terminally ill New York state citizens have the freedom to decide how they die.”

Dr. Paul Sansone, a hospital specialist in palliative care, wrote, “The data from Oregon show clearly that the primary and overwhelming reason people seek to end their lives by ingestion of a lethal dose of medication is related to autonomy (91% of the time), and declining ability to engage in enjoyable activities (90%). Much less common is intolerable suffering, or fear of future suffering, at 27% of the time.”

Arguments about pain and suffering in dying are the emotional stories that grab our attention, but the majority of people using these systems to end their lives do so because they want to avoid the pain and suffering, not because they are experiencing it.

They don’t care and they hope you don’t see it.

Many of the arguments in favor of assisted suicide concern individual autonomy. I certainly believe in autonomy, but in our society, we don’t let people do anything they want. There are rules and barriers. You can’t steal a loaf of bread just because you are in need of food (sorry Jean Valjean). You can’t kill someone else, even if that person asks you to do so. Allowing assisted suicide is a bridge too far.

Some people who support physician assisted suicide support patient autonomy to the point that they really don’t care about the slippery slope. If they could get it approved, they would allow anyone to request and be rewarded with assistance in dying any time anywhere. All the “guard rails” in the bill, like age restrictions, physician evaluation, and the need for psychiatric evaluation are smokescreens added to disarm opponents.

According to recent reports from Oregon (3,4) the number of assisted suicides has been going up year by year. The age of the people in the program has been going down and there have been very few psychiatric evaluations done before being accepted into the program. Rules about the requirement to have 6 months or less to live have not been enforced or even evaluated. That is the definition of the slippery slope.

Part of the problem when evaluating the Oregon experience is that reporting and statistical analysis of the results of the program are not required. There may be many unreported cases.

The New York law is interesting

In New York’s proposed law there are a couple of interesting clauses. For instance, there is the statement that the law,

“provides that a patient who requests medication under the article will not, because of that request, be considered a person who is suicidal, and self-administering medication under the article shall not be deemed to be suicide for any purpose…”

George Orwell would be proud. Physician assisted suicide is not suicide, it is a natural death.

Another part of the law states that:

“the attending physician may sign the qualified individual's death certificate. The cause of death listed on a qualified individual's death certificate who die after self-administering medication under the article will be the underlying terminal illness.”

I have signed many death certificates, and it is sometime difficult to be sure of a cause of death, but not in this case. If someone dies from ingestion of a lethal dose of drugs, how can the cause of death be an underlying disease? Proponents of the legislation are bending over backwards to avoid admitting that they are empowering physicians to enable patient suicide.

Also, as in the Oregon example, transparency is not the goal. The New York law states:

“The information collected under the section shall not constitute a public record available for public inspection and shall be confidential and shall be collected and maintained in a manner that protects the privacy of the patient, his or her family, and any health care provider acting in connection with such patient under the article.”

As a result, we may never know the actual results of the law.

Daniel Kahneman

In an April 20 NYT story, (4) two philosophy professors try to elicit a lesson for us from the suicide of Nobel laureate Daniel Kahneman, age 90. Kahneman killed himself by moving to Switzerland, where assisted suicide is legal. He was healthy and had all his faculties, for a man his age. He wanted to avoid the “miseries and indignities” of the last years of his life. His life ended on schedule on March 27, 2025.

Kahneman was a celebrated economist. His ideas and his book Thinking, Fast and Slow created a new way of thinking about the economic decisions that people make every day. The book was on the NYT best seller’s list for months. His work created a paradigm shift in economics.

I was most interested in his response when asked why he chose to end his life.

An interviewer reminded him that he was renowned and had accomplished a great deal in his life and asked about his decision. He responded, “Other people happen to respect it [my work] and say that this is for the benefit of humanity… I would say if there is an objective point of view, then I’m totally irrelevant to it. If you look at the universe and the complexity of the universe, what I do with my day cannot be relevant.”

Here is a brilliant man, not just accomplished, but a man rewarded and lauded for his accomplishments, who feels that in the great scheme of things he did not accomplish much and his life is not “relevant” and is therefore expendable should he choose to end it. He accomplished so much and wonders if he accomplished anything at all.

I have had the same feeling: after 50 years working as a physician, I sometimes think that I accomplished little. I am not sure that I helped anyone. How much hope is there for those with less accomplishment? Should we value our lives by this standard?

This article is followed by the obligatory reminder that, “If you are having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline….” They should have also included the phone number and web page for the clinic in Switzerland which so willingly helped Dr. Kahneman end his life. Why not? If it was ok for him, why not make the service more widely available?

It is clear that many people are sincerely concerned about the problem of natural death. They don’t want to suffer, and they don’t want anyone else to suffer. That is understandable. Their sincere and heart-felt advocacy for patient autonomy is important, but it should not be the deciding factor in society-changing legislation.

I still oppose the NY Medical Aid in Dying Act. The slippery slope is real.

I would love to hear from readers about this issue. I have my opinions, but I’d like to hear others. Let me know what you think.

Jef Sneider

Syracuse, NY

May 2025

1. Why Passing the Medical Aid in Dying Act Is a Top Priority in 2024, SENATOR BRAD HOYLMAN-SIGAL AND ASSEMBLYMEMBER AMY PAULIN, January 16, 2024

2. Extend freedom to make medical decisions to how one chooses to die (Guest Opinion by Dr. Judy Setla)

3. Medical aid in dying puts all groups at risk (Commentary by Dr. Paul Sansone) Published: Apr. 04, 2022, 12:47 p.m.

4. There’s a Lesson to Learn From Daniel Kahneman’s Death, April 14, 2025

5. Physician assisted suicide in Oregon, 2008:

6. A review by Oregon Right to Life