New Hampshire is debating legalized assisted suicide. Here's how it's worked out elsewhere.

Yahoo

13-02-2025

Signs in the State House express support for the "New Hampshire End of Life Freedom Act." (Photo by William Skipworth/New Hampshire Bulletin)
Lindsey Warren, of Coventry, Vermont, has helped many people end their lives using medical aid-in-dying drugs.
'I've seen so many people happy and relieved that they have choice and dignity in the end of their life,' she said. 'Everyone that I've worked with has been overjoyed that they made it to the day. They're able to choose. They're able to say their goodbyes to their family. And they've been fighting the good fight, but they are really ready to rest and not be in pain and suffering anymore.'
Warren is an end-of-life doula. Her job is to help people navigate different aspects of end-of-life care including medical aid-in-dying, also known as assisted suicide (though she, and other proponents, prefer the term medical aid-in-dying), which is legal in Vermont. This includes guiding them through the eligibility and approval process required of patients for them to receive medical aid-in-dying drugs as well as helping with doctors appointments. She said having the practice legalized is 'absolutely a positive' for Vermont.
'Every step along the way, it's always their choice,' she said. 'And they may decide to, in the end, not ingest (the aid-in-dying drugs) but at least they knew they had that choice and they explored that.'
Warren said she hasn't seen a lot of the common criticisms of assisted suicide – people with disabilities being pressured into it, people with depression and suicidal ideation abusing it – come to fruition, but she has seen long wait times, especially as people from other states come to receive the drugs. She hopes other states, like New Hampshire, will legalize the practice to take pressure off Vermont's system.
And many in New Hampshire share that hope. New Hampshire could soon become the 11th U.S. state to legalize assisted suicide as lawmakers debate the so-called New Hampshire End of Life Freedom Act.
IF YOU OR SOMEONE YOU KNOW is in a crisis, call, text or chat the Suicide and Crisis Lifeline at 988. To reach the New Hampshire Rapid Response Access Point, call or text 833-710-6477. If you need help with grief and loss, the American Foundation for Suicide Prevention offers advice and resources. You can also call the National SAMHSA Helpline, 1-800-662-HELP, with services in English and Spanish, toll free 24/7.
If passed, House Bill 254 would allow adults who have been determined by two doctors to have an estimated six months left to live or are in Medicare-certified hospice care to end their life through aid-in-dying drugs in New Hampshire. The patient receiving the drug must have the mental capacity to understand their options and decision, must be able to self-administer the medication, and must give informed consent. The provider is also required to confirm the patient isn't being coerced.
At a hearing in the State House last month, Rep. Bob Lynn, the Windham Republican who introduced the bill, said it was about 'giving people at the end of their life the freedom to end their life in a dignified way rather than endure continuous suffering.'
At the hearing, advocates said the bill allows people already near death to end their life on their own terms and avoid the suffering they may face in the lead-up to their death. Opponents argued the bill has a number of flaws, including that it would encourage medical providers to give up on treating people facing severe disabilities or other conditions in favor of ending their lives or that it would be abused by people suffering from depression and suicidal ideation.
Gov. Kelly Ayotte said last week she hadn't yet looked at the bill and declined to provide her stance.
'It is a very important issue, and I know that it's an issue that people on both sides of it have deep concerns about,' she added.
If the bill becomes law, New Hampshire would be far from the first state or country to legalize assisted suicide. Between criticisms of the practice being used to euthanize the poor and disabled in Canada and disapproval from the American Medical Association to popularity across the U.S. and a surge of travel to Switzerland, the practice has seen a mixed reception.
Assisted suicide is legal on both New Hampshire's west and east borders, in Vermont and Maine.
In 2013, Vermont became the fourth U.S. state to legalize assisted suicide. Act 39, also known as the Vermont Patient Choice and Control at End of Life law, allows terminally ill patients with a prognosis of six months left to live to receive medical aid in dying in Vermont. The medical aid in dying drugs have to be self-administered, and the patient must be deemed capable of making their own health care decisions and giving informed consent. Vermont's law is very similar to New Hampshire's proposal.
From 2013, when the bill was passed, through June 2023, the most recent data available, 203 people ended their lives through this act, according to the Vermont Department of Health. Eighty-five of those occurred from July 1, 2021, to June 30, 2023. The most common diagnosis cited by patients ending their life was cancer, with 153 cases, or 75%; 26, or 13%, were due to neurodegenerative conditions while 6, or 3%, were end-stage lung diseases like COPD or emphysema.
In 2019, Maine joined Vermont in legalizing assisted suicide through the Maine Death with Dignity Act. The law allows for assisted suicide in patients with an incurable terminal illness that is expected to kill them within six months. Maine's law also requires the patient to be able to self-administer the drug and be of sound mind. In Maine, the patient must be a legal resident of the state, which is not the case in Vermont (though it was prior to May 2023) and New Hampshire's proposal.
In 2023, 80 patients began the process in Maine to receive aid-in-dying drugs, according to the Maine Department of Health and Human Services, though four died before completing the process and nine were still alive at the time of the department's report. From 2019 to 2022, 117 people have been prescribed and taken this life-ending drug in Maine. As in Vermont, cancer is the most common diagnosis for these patients in 2023, representing 42 of them, or 53%. Six of them were diagnosed with ALS and five had heart disease or a cardiac condition.
Including Vermont and Maine, there are 10 U.S. states plus Washington, D.C., where the practice is legal. The others are Oregon, Washington, Montana, California, Colorado, Hawaii, New Jersey, and New Mexico.
In Montana, assisted suicide is legal only through a common law legal precedent established by the Supreme Court case Baxter v. Montana in 2009. All other states legalized it through legislation.
In total, 22% of Americans live somewhere with legal assisted suicide. And it's popular across the country, with 71% of respondents in an August Gallup poll saying they believe doctors should be 'allowed by law to end the patient's life by some painless means if the patient and his or her family request it.'
However, some physicians in the U.S. aren't as supportive. The American Medical Association says that the practice violates its code of ethics.
'Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control and would pose serious societal risks,' the association wrote.
Quebec became the first Canadian province to legalize assisted suicide in 2014. Since then, however, the Canadian Supreme Court has ruled it legal for all Canadians.
After multiple expansions, Canadian law includes some of the world's most permissive policies on assisted suicide. Since 2021, a patient does not have to be terminally ill to receive the drugs in Canada, but rather may be experiencing a long and complicated condition – including disability alone – that impacts their quality of life. The law there also allows a provider to directly administer the drugs rather than require the patient self-administer. (When a provider administers the drug, it's called euthanasia.) Some opponents have called these expansions part of a so-called slippery slope.
The practice has exploded there. Assisted dying now represents roughly 1 in 20 Canadian deaths, according to an annual report released in December by Health Canada with data from 2023, the most recent available. That's 15,300 deaths, or 4.7% of deaths in the country. Most – roughly 96% – had a terminal illness, but a small minority – around 4% – fit into the category of illness with a natural death not 'reasonably foreseeable.' The median age was 77.7.
In recent years, Canada's assisted-suicide policies have garnered criticism for disproportionately being used by the poor and disabled.
An Associated Press investigation in October found that the highest numbers of assisted deaths for patients not facing terminal illness came from the poorest areas. The AP also found medical providers expressing deep discomfort carrying out some of their assisted-dying requests, some of which were avoidable deaths. Additionally, the investigation told the story of someone who was euthanized even after their doctor concluded their suffering was mostly because they were homeless, in debt, and unwilling to accept long-term care, as well as someone who specifically told their doctor that the government's small amount of disability support for their ankle and back injury left them no choice but to request medical aid-in-dying, among others. However, the AP concluded poverty doesn't seem disproportionately prominent among recipients with terminal diseases, which would be the only recipients allowed in New Hampshire under its proposal.
A Spectator thought piece entitled 'Why is Canada euthanizing the poor?' and an article from The Guardian, 'Are Canadians being driven to assisted suicide by poverty or healthcare crisis?', both from 2022, delved into the same concerns.
In 2020, Roger Foley, a man with a neurodegenerative disease, testified to the Canadian Parliament that medical providers attempted to coerce him into assisted suicide by threatening high rates for the care he needed or to forcibly discharge him.
'Assisted dying is easier to access than safe and appropriate disability supports to live,' Foley said.
Assisted suicide is legal in Australia, Austria, the Netherlands, New Zealand, Spain, and Switzerland, among others.
In 1941, Switzerland was the first country in the world to legalize assisted suicide, though euthanasia – having a provider administer the aid-in-dying drugs – is illegal there. While critics deem it 'suicide tourism,' the country permits foreigners to travel there for assisted suicide. This has been praised by participants' friends and families who say it gives them a good option to end their lives on their own terms.
In New Hampshire, the friend of one such person, Hope Damon, who is also a member of the state House of Representatives, told lawmakers the story last month of her friend Michael, who traveled to Switzerland to die.
'We sadly and joyfully celebrated the loss and that he was able to choose to end his life on the terms that were right for him and save his family from watching a heart-wrenchingly sad decline,' she said, urging lawmakers to legalize assisted suicide.
The Netherlands and Belgium have gone so far as to legalize assisted dying for children.
A study from a group of Belgian researchers found that almost all participants they examined wanted their family member with cancer's medical aid-in-dying request to be granted, and some of them even took an active supportive role in the process. A study from researchers in the Netherlands, while older – from 2003 – also examined the impact of the practice on family members, showing that friends and family of cancer patients who died through euthanasia displayed less traumatic grief symptoms, felt less grief in the moment, and had less post-traumatic stress reactions than friends and family of patients who died of natural causes.