John Hirschauer joins Brian Anderson to discuss the recently passed legislation in New York that—pending Governor Kathy Hochul’s signature—would legalize Medical Aid in Dying.
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Audio Transcript
Brian Anderson: Welcome back to the 10 Blocks Podcast. I’m Brian Anderson, the editor of City Journal, and joining me on the show today is John Hirschauer. He’s an associate editor of City Journal and he also writes about policy related to mental illness and disability as well as other cultural issues. Today, John’s here to discuss his recent coverage of the debate surrounding assisted suicide in New York. He recently wrote a sharp piece on this for City Journal called, “Say No to Suicide, New York.” John, thanks very much for joining us.
John Hirschauer: Thanks for having me. Brian,
Brian Anderson: The New York State Assembly recently, well actually it was more than the assembly. It was the entire legislature has now passed the Medical Aid in Dying Act as it’s called. I wonder if you could just describe what the current status of that legislation is and what’s in the bill. How would it change the medical landscape in New York in terms of how care is provided for the terminally ill?
John Hirschauer: Sure. So like you said, the bill passed the state assembly in April and then it just recently passed the state Senate earlier this month. The margin was narrower in the Senate than it was in the assembly, and basically the bill heads to Governor Kathy Hochul’s desk, and if it’s signed, it would make New York the 13th state in the country to allow assisted suicide. Now, this is a little bit different from euthanasia where a medical provider would be administering the drug. In this case, people who request the drug have to administer it themselves. There’s no residency requirement in the bill, so theoretically people could come from out of state by other people and if they qualify under New York’s law, they could request and then receive the lethal dose of drugs. In order to be eligible for assisted suicide, a person has to be diagnosed with a terminal illness that gives them six months or less to live by two separate independent physicians.
There is a provision in the bill that if one of the physicians has a suspicion that a person has a psychiatric disorder or is otherwise incompetent that they be referred to a psychiatrist, but there’s no actual requirement that happen. There’s no age threshold or anything else like that. Just as long as there is two independent physicians agreeing that a person has a diagnosis that gives them six months or fewer to live or six months or less to live, they can request the lethal dose of drugs and they have to administer it themselves. They have to not only request it orally, but they have to request it in writing. There are witnesses that have to be present, they can’t be witnesses who are related to the patient or providers at the hospital or people in the patient’s will who stand to benefit from his death. But otherwise, provided that two adults sign off on the witness form and the person is of sound mind, the state allows doctors to prescribe to people a lethal dose of drugs that they would administer to themselves.
Now there’s a little Orwellian line on the witness sheet about having to inform the person that the death will probably take three hours. It might take a little bit longer, but it’s when you actually read the witness sheet, it’s chilling. But as you mentioned sort of the debate over this, obviously this is a subject that arouses intense passions in people because we’re talking about very intense suffering. But in terms of how it would change the landscape for end of life care, I mean right now, like every state, New York has palliative care and hospice care, but by introducing assisted suicide, even if you believe it should be legal for the narrow population that it’s currently applied to, I think you could easily see how this would become less of a choice and more of a suggestion or an imposition on people. The cost of keeping somebody alive for an extended period of time, even for the full six months at the end of their life is much higher than $150 bundle of pills. So you could easily see how this would expand even beyond proponents’ sort of limited imagination of who this would apply to.
Brian Anderson: That does raise the question of a country like Canada where, as you’ve written, this New York proposal does have similar components to what has been put in place in Canada. I wonder if you could talk about the Canadian experience a little bit with assisted suicide. How long has it been legal in that country, and what about the initial safeguards that were put in place there? Have they worked? What have been the results in Canada?
John Hirschauer: Sure. So New York, it seems, deliberate deliberately drew this parallel by naming the bill the Medical Aid in Dying Act, because in Canada, that’s the name of Canada’s euthanasia program. Now, Canada’s situation is a little bit different from New York’s, in that New York, like I said, is just talking about assisted suicide, which is where the person administers the drugs themselves. In Canada, there’s actually euthanasia protocols. So a person will go and see a medical provider who will administer the lethal drugs as sort of à la Soylent Green, but there’s also an option for people to receive, just like New York, a lethal dose of medication that they will take themselves.
Canada actually provides really an interesting or demonstrative example of what happens once you legalize assisted suicide. So in 2016, the Canadian Supreme Court struck down the state’s ban on assisted suicide on the grounds that had violated the charter of Rights and freedoms serve Canada’s national constitution. And so it gave Canada the parliament a year to draft enabling legislation. And Canada, just like New York, decided on a six-month window and said, okay, people with a terminal illness and six months or less to live, they are eligible for the MAID program, but no one else will be. And inevitably, once you start drawing these lines and saying a person with six months or less to live, their suffering is absolutely intolerable and they should have the right to request a drug that will put them out of their misery. And those lines will inevitably be contested by people who say have six months and a day to live or a person even to even push on the point further, a person who has a chronic illness that will kill them in 20 years. But those 20 years cumulatively speaking, involve a lot more suffering. If you’re looking at it from a cumulative perspective, then the person who has just six months to live and now why don’t they deserve to have their suffering ameliorated in the same person, in the same way that a person with six months or less does.
People inevitably started contesting the six-month boundary, and in 2019, the superior court of Quebec struck down the national law again on the grounds that it was arbitrary and it violated the equal protection portion of the charter of rights and freedoms. By 2021, the Canadian government and the provincial government didn’t challenge that ruling. And so in 2021 Canada, the parliament passes a law ,Bill C-7. It really is a remarkable piece of legislation. It allows almost anyone whose natural death is foreseeable or even not foreseeable provided that they have a physical illness that will at some point kill them to request either the medical aid in dying via assisted suicide like getting the pills or being euthanized in an actual clinic. The safeguards that exist there, you can’t have just a mental illness. But there was an example I think the AP reported on in 2022 of a person with serious mental illness who also had a hearing problem and was euthanized for the hearing problem rather than the mental illness. So provided that there’s some physical condition, the state allows people to pursue this course. And so I think it is demonstrative of how once the state admits that some forms of suffering warrant this remedy of suicide, the line is inevitably going to be contested because there’s just a range of tremendous suffering in the world, and it’s almost impossible to draw the line as to say who’s is bad enough, so-called, to qualify.
Brian Anderson: Sometimes slippery slope arguments are fallacious, but in this case it really does seem the logic of this way of thinking about end-of-life choices moves toward a situation where you could have just enormous abuses going on. I wonder, John, the governor, Kathy Hochul has not yet signed this bill into law. What are the contesting forces in the state? The Catholic church has long opposed these kinds of measures. Is Hochul likely to sign the bill or could some of the opposition win the day here?
John Hirschauer: Yeah, her office has been asked for comment about how the governor is going to act, whether she’s going to sign the bill or not, and they haven’t sent a clear signal either way. They said the governor is going to read the bill, which was a little surprising. I was expecting, given the overwhelming Democratic support in both the assembly and slightly less Democratic support in the Senate, but still overwhelming Democratic support in the Senate for the measure that Hochul was going to enthusiastically sign off. But it seems she’s going to be thoughtful about this, and I hope she is. In terms of the forces that are involved, like you say, there’s the Catholic hurch, there are some other family-group nonprofit-type organizations that oppose assisted suicide and other more socially conservative groups that have rallied against this bill. And then you have groups, sort of civil libertarian groups on the opposite side. You have groups that are dedicated to specifically to fighting for medical aid in dying. I think I read a report on a group of people with if not exactly terminal illnesses, sort of chronic illnesses who regularly gather in the state capitol and interface with legislators and have lobbied for years for this legislation to be passed.
In terms of what do I expect Hochul to do? I expect her to sign it. I hope she doesn’t, and I think we can perhaps get into the merits of this, but I just think that even to talk about safeguards with a piece of legislation like this, you’re sort of conceding the premise, right? I mean, we wouldn’t talk about safeguards with regard to homicide laws, making sure that you can only kill one person. The idea of safeguards can seize that for the population in question. It’s a legitimate response, but this is obviously, as I mentioned, just a very emotionally charged issue.
It’s one of those things that it’s easy to talk about on a podcast, and it’s very difficult to live at the end of your life when you have six months or less to live. I recognize that even the idea of a referral to a psychiatrist, for example, I don’t know that that would be an adequate “safeguard” quote because in any other context, right, if you go to a psychiatrist and you say, I want to kill myself, the psychiatrist is going to do something, certainly he might put you in a hospital, he might counsel you not to leave. You might do a whole range of things, but he certainly wouldn’t declare you to be of sound mind. And so I think passing this law would create an entire state of exception, the state where it’s usually in the position of zealously defending life, even noting the exceptions for if you believe that abortion is a human life setting that aside even, but generally speaking, the state is on the side of life, even in democratic states. So it really puts the state in the weird position of sanctioning death when in every other case, I think John Ketcham wrote about this, where the state has all of these anti-suicide efforts directed at teenagers, but it suddenly is going to create a class of people for whom suicide is an acceptable recourse. So I’m hoping that Governor Hochul sees kind of the contradictions that this bill would create in New York and thinks better of it, but I’m not hopeful on that front.
Brian Anderson: In another recent piece, John, that got fair bit of attention, you described Gen Z’s return to religion again or religious belief as a kind of rebellion against mainstream culture. And this is particularly true, you noted, among young men who are seeking kind of structure and community. I wonder how this new attitude contrasts with previous generations’ religious attitudes. Why do you think Gen Z is leading this, might be early to call it a revival, but this shift, and could it result in some pushback in a state like New York against policies like assisted suicide?
John Hirschauer: I don’t think rebellion in general is a good way to get at the truth. I don’t endorse rebellion. It’s natural for young people to rebel. Young people have always sort of been rebelling against their parents. That’s a meme that’s based on a real thing, right? And I think in this case, the places that young men and women today inhabit are sending messages to them that basically no one way of life is better than any other. That your choices basically don’t matter, that you exist to accumulate as many experiences of pleasure as you can, and then when you die, there’s nothing. And that’s one view, certainly, but it’s not the only view, and it’s certainly not the only view that Americans have been exposed to over the long course of American history. And so I think young men in particular, as you say, but I think young women and everyone in generation Z, they’re reacting to a culture that tells them again that nothing matters.
And what they found is one way to react against that is to embrace maybe older forms of worship, older structures and ways of living that involve sacrifice, that involve discipline, that involve joy. Just like exercise, intense exercise done for a long period of time. You can’t become a runner without doing the very difficult first run. But unless you do that first run, you’ll never experience the joy of being a runner. Once you do the hard thing of committing your life to something like Christianity or religious faith, it imposes on you all sorts of burdens. But just like exercise or just becoming a great writer or a great reader, it involves a lot of struggle at first. But you can’t, you ultimately reach levels of joy and meaning that are unavailable if you’re simply sort of just going from one moment to the next without any sort of structure.
So I think yes, it’s driven in part by rebellion, but it’s also driven by, obviously I’m a Christian, so I believe it’s true, and I think that’s the most important thing driving people to it. But in terms of whether it will make a material difference in a place like New York? Like you say, I mean, I think it’s important to be cautious about what’s actually happening. I mean, I of course want to say there’s a revival going on, but when you look at the data, that’s more of an anecdotal thing than an actual thing you see in the data. I mean Generation Z, when you chart out the generations doing it by decade, there’s a consistent decline in Christian identification, specifically beginning in people born in the 1940s and earlier and then on down the decades through the 1990s where it starts at 80 percent and bottoms out in the 1990s at 46 percent.
And Generation Z is notable in this context only for not having abandoned the faith at the same rate as their predecessors did, or as the immediate generation before them did. They’re staying at 46 percent. It’s not like there’s a huge religious revival going on, much as I wish there were one, but that stability across the generations has been enough for the actual overall share of Americans who identify as Christian to remain stable for the first time since Pew started recording this survey, I think in the early two thousands. So it’s notable in that context, will it make a difference in New York? Certainly not on the timescale to affect what Kathy Hochul’s going to do, but in the long run, I think I really do think there are staying powers to these ideas. The Catholic Church, of which I’m a member, not to be too much of a partisan, but it is the oldest institution in the world and it’s survived for a reason. And I just have faith that church, these ideas will be around a lot longer than some of the fads against which people are rebelling now.
Brian Anderson: Well, thank you, John, that was a good walkthrough of this important issue. And we’ll see what Governor Hochul winds up doing. John’s work is available on the City Journal website, so please check out this piece that we’ve been talking about and some of this other writing for the magazine. We’ll link to his author page in the description. The article on assisted suicide is again called “Say No to Suicide, New York.”
I should note, too, as a reminder, we’ve also launched a new twice weekly podcast. It’s called the City Journal Podcast, and it’s hosted by Charles Lehman, and it’s looking at issues in the news with a rotating group of the Manhattan Institute policy experts. New episodes are dropping on Monday and Thursday, so be sure to check it out on YouTube and please subscribe. And if you’ve liked what you’ve heard on today’s podcast, please give us a nice rating on iTunes. John Hirschauer, always great to talk with you, and thanks for coming on.
John Hirschauer: Thanks, Brian.
Photo: Witthaya Prasongsin / Moment via Getty Images
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