Aging Populations and Physician Aid in Dying: The Evolution of State Government Policy

As state governments respond to the needs of their aging populations, an issue of particular concern is health care at the end of life. With the many advances in public health and medical treatment — as well as in education, wealth, and other socioeconomic metrics — Americans are living much longer lives. But many Americans also face prolonged illness at the end of life that can result in great suffering. Often the suffering can be relieved with good palliative care, but for some Americans continued life becomes intolerable.As a result, there has been increased interest in a right for terminally ill individuals to hasten the dying process by taking a lethal dose of prescription medication (i.e., by “physician aid in dying,” commonly described as “physician-assisted suicide”). The existence of such a right has been litigated in the U. S. Supreme Court and state supreme courts, debated in state legislatures, and addressed in ballot proposals at the state level. Voters in Oregon and Washington have legalized aid in dying by public referendum, legislators in Vermont have done so by statutory enactment, and justices in Montana and a trial court in New Mexico have done so by court holding.In this Article, I discuss the trend toward legalization of physician aid in dying and what it tells us about societal morality regarding medical decisions at the end of life — while legal recognition of a right to aid in dying is growing, its greater recognition does not reflect a change in societal views about the propriety of physician-assisted suicide. We are not seeing an evolution in ethical thought. Rather, society is refining its legal rules for end-of-life law so they better reflect the public’s long-standing moral views about death-hastening choices at the end of life.