Tangle - The debate over physician-assisted suicide.

Episode Date: September 3, 2025

In recent years, several U.S. states and a number of countries have legalized Medical Assistance in Dying (MAID), also known as physician-assisted suicide or physician-assisted death. While definitions vary, the practice generally allows people facing imminent death from a terminal illness to end their lives by administering drugs with support and supervision from a doctor (or team of doctors). In some countries, people with certain chronic illnesses and disabilities are also eligible for MAID. As more states considerlegalizing the practice, proponents and opponents have raised ethical concerns about how MAID is regulated — and whether it should be legal at all. Today’s piece includes detailed discussions of suicide. If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources.Ad-free podcasts are here!To listen to this podcast ad-free, and to enjoy our subscriber only premium content, go to ReadTangle.com to sign up!You can read today's podcast⁠ ⁠⁠here⁠⁠⁠, our “Under the Radar” story ⁠here and today’s “Have a nice day” story ⁠here⁠.Take the survey: What groups do you think should have access to physician-assisted suicide? Let us know.Disagree? That's okay. My opinion is just one of many. Write in and let us know why, and we'll consider publishing your feedback.You can subscribe to Tangle by clicking here or drop something in our tip jar by clicking here. Our Executive Editor and Founder is Isaac Saul. Our Executive Producer is Jon Lall.This podcast was written by Ari Weitzman and edited and engineered by Dewey Thomas. Music for the podcast was produced by Diet 75.Our newsletter is edited by Managing Editor Ari Weitzman, Senior Editor Will Kaback, Lindsey Knuth, Kendall White, Bailey Saul, and Audrey Moorehead. Hosted on Acast. See acast.com/privacy for more information.

From executive producer Isaac Saul, this is Tangle. Good morning, good afternoon and good evening and welcome to the Tangle podcast, a place where you get views from across the political spectrum, some independent thinking, and a little bit of our take. I am your host, John Law, filling in for Isaac. And today, we are going to be talking about medical assistance in dying or made, also known as physician-assisted suicide or physician-assisted death. It's a controversial and sensitive topic, but we are trying to discuss some issues that we find fascinating and politically relevant and topics that our readers and listeners might be interested in. So we're trying this experiment out. Originally, this was discussed on a recent episode of Suspension of the Rules with

Isaac, Ari, and Camille. Today, Ari is going to be giving his take on this issue. We just want to include that before you read today's piece, it does include detailed discussions of suicide. If you are having thoughts of suicide, call or text 988-988 to reach the 98-suicide and crisis lifeline, or go to speakingofsuicide.com slash resources for a list of additional resources. All right, with that said, let's move on to today's quick hits. Here are your quick hits for today. First up, a federal appeals court issued a preliminary injunction blocking the Trump administration from deporting a group of alleged gang members from Venezuela under the Alien Enemies Act. Separately, a federal judge ruled that President Donald Trump and Defense Secretary Pete Hegeseth violated federal law by deploying National Guard members and Marines to Los Angeles in June.

The judge barred the administration from further use of federal troops for domestic law enforcement except in limited cases. Number two, President Donald Trump announced that the U.S. Space Command headquarters will be located in Alabama, reversing a decision by former President Joe Biden to keep the command at its temporary headquarters in Colorado. Number three, Washington, D.C. Mayor Muriel Bowser issued an executive order requiring local coordination with federal law enforcement to the maximum extent allowable by law within the district. Separately, President Trump said he would deploy National Guard troops to Chicago

and Baltimore, though he did not specify the timing of the deployments. Number four, a district judge ruled that Google could not enter deals to make its exclusive search engine on devices and browsers, but rejected a Justice Department request to force the company to sell its Chrome web browser. The ruling followed an earlier determination that Google had illegally monopolized the online search market. And number five, a U.S. military strike killed 11 people on a vessel from Venezuela, allegedly carrying illegal narcotics. The Pentagon has not released further details about the attack. In recent years, several U.S. states and a number of countries have legalized medical assistance

in dying, or made, also known as physician-assisted suicide or physician-assisted death. While definitions vary, the practice generally allows people facing imminent death from a terminal illness to end their lives by administering drugs with support and supervision from a doctor or team of doctors. In some countries, people with certain chronic illnesses and disabilities are also eligible for Maid. As more states consider legalizing the practice, proponents and opponents have raised ethical concerns about how Maid is regulated and whether it should be legal at all. For context, Maid is legal in 11 U.S. states and Washington, D.C., and 17 states are considering legislation to legalize Maid in some form. Oregon was the first state to legalize the practice in

1997, and most other states that have legalized Maid have based their legislation on Oregon's law. Maid is sometimes conflated with euthanasia, but the two are different forms of assisted death. The former involves the patient administering the life-ending drugs themselves, while a health care provider administers the drugs in the latter case. Euthanasia is illegal in all 50 states. The practice of MADE is formally opposed by most major medical groups, including the American Medical Association, American College of Physicians, and World Medical Association, primarily on the grounds that it violates medical providers pledge to first do no harm.

However, some organizations have come out in support of legalizing Maid. For instance, the American Medical Women's Association said in 2018 that it supports the right of mentally capable terminally ill patients to advance the time of death that might otherwise be protracted, undignified, or extremely painful death. While access to made remains relatively limited in the United States,

other countries have adopted far more permissive laws. In 2016, Canadian lawmakers legalized made under strict conditions, including that patients be over 18, mentally competent to consent to death, and expected to die in the reasonably foreseeable future. In 2021, the reasonably foreseeable provision, was removed, allowing Canadians with irremediable conditions, including chronic sickness and

physical disabilities, to seek out-made. The change increased concern among the practice's opponents that some people would pursue assisted death in response to unmet medical, financial, or social needs. However, supporters of the practice have maintained that Canada's laws offer relief to people who are suffering acutely, even if their death is not imminent. Today, we'll break down the arguments for and against made. Then managing editor Ari Weitzman will give his take. We'll be right back after this quick break. All right, first up, let's start with what opponents are saying.

Many opponents of legalizing Maid say that it should be rejected for the same reasons we reject other forms of suicide. Some suggest that assisted suicide undercuts the dignity of life. Others worry that legalized Maid will compel people to choose death over reliance on faulty health care systems.

In first things, Audrey Paul now wrote, Suicide Prevention must be for everyone. It's tempting to imagine that in an end-of-life context, Maid isn't really suicide because the person who requests it was already going to die. But common sense shows that this is false. When someone's suffering from a terminal illness kills herself in any other way, we call this suicide. We mourn these suicides and we rightly try to prevent them, Paul now said. Of course, some people seem to think that

in an end-of-life context, suicide can somehow be a legitimate choice. They imagine that this is a special situation, that suicide is justified when death is proximate and when the final months of your life may involve great suffering. But the reason here faces a terrible problem. It implies that most suicides are legitimate. If we want to take suicide prevention seriously, we can't act as though autonomy and pain management are legitimate reasons for suicide, not in an end-of-life context or any other context. We must insist that suicide is not the answer, even when you're suffering and even when it looks attractive, or we must give up on suicide prevention altogether. Because suicidality almost always involves the kind of

suffering that makes it seem attractive to end your life, Pullnow wrote. Fundamentally, offering mate to the terminally ill implies at least one of two unacceptable conclusions. It implies that we should offer suicide to anyone who wants it, or that we should offer people's suicide on the basis of disability. In America magazine, Noel Simard argued, medical assistance in dying is not what our most vulnerable people need. Expanding the eligibility of maid to persons with mental illness, and the possibility of advanced requests threatens the dignity of the human person and not the common good, while raising many questions that have no easy answer, Simard said. For instance, do we have the tools to measure the suffering of someone living

with mental illness? At what stage of mental illness will be possible to offer made, and who will be entitled to determine that moment? While we know that mental illnesses are often impossible to cure, how can we ensure that all treatment options have been offered, and how can we know that all reasonable treatment options have been exhausted. When a person decides not to be treated for cancer or not to receive dialysis, because the treatment is no longer beneficial or has become too burdensome, it's a personal choice. This choice may be justified, even with the risk that the person's life may end more rapidly, Samard wrote.

In the case of euthanasia, there is no risk. Here is certainty. The person will die immediately. And what about the burden for the person who must carry the proxy or make the decision in that individual's place? The autonomy of the sick person is not absolute. There are limits to the exercise of freedom where the common good or fundamental values, such as the sanctity of life and the person's inherent dignity are jeopardized.

In the New York Times, Louise Perry criticized the perverse economics of assisted suicide. Those who support the legalization of assisted suicide have a bad habit of using a Motte and Bailey style of argumentation. From their easily defended Mont, they insist that a person with a terminal illness who fears a painful, and undignified death should be able to seek medical assistance and the company of his loved ones if he decides to make an early exit. That argument seems logical enough to most of us and compassionate. But then there's the Bailey. What assisted suicide actually looks like in many of the countries that have adopted it, Perry said. Young people with potentially long lives ahead of them are choosing state-facilitated death. There is a very clear problem with assisted suicide in its new guise.

The state, with its almighty power, is tasked with both paying for the support of the old and disabled and regulating their dying. Encouraging citizens to accept this system may seem like a cost-saving measure at a time when the financial burden of their care has never been greater, Perry wrote. For all the problems with the American health care system, its largely privatized structure means that it is less vulnerable to these perverse incentives. The moral peril is greatest in countries like mine, in which a socialized health care and pension system has a strong incentive to winnow out its most expensive users. All right, that is it for what opponents are saying, which brings us to what

proponents are saying. Many proponents of legalizing Maid argue the practice gives crucial autonomy to people facing terminal diagnoses. Some cite personal experiences with Maid, describing it as a dignified end of life for a loved one. Others question why the government should have the power to restrict this choice. In Newsweek, Nita Hanig made the case for assisted dying. Even as more states consider legislation that supports and enhances the practice, confusion and hurdles remain. The U.S. has the most restrictive assisted dying laws in the world.

These laws often stifle patients who are either too sick or not sick enough to qualify for a prescription, Hanig wrote. To be eligible for assistance in dying, a patient must have a prognosis of six months or less to live, which includes patients with painful and protracted but not immediately fatal conditions, like multiple sclerosis. Patients must be capable of administering their own death, either by swallowing the lethal medications or pushing them through a feeding tube or rectal catheter. Yet despite the roadblocks, many patients must contend with, while their health is rapidly declining, there is a reason they persist. For many, an assisted death restores a sense of agency

in a situation that made them feel trapped and powerless, Hennig said. As a society, we must ensure that assisted dying continues to be driven by the needs of terminally ill patients and that it remains one of many ways to have a humane, dignified death. Yet as the population ages, many more people will confront diseases that don't respond to treatment and that are daunting and terrifying in their course. In CNN, Ginger Fairchild wrote, medical aid in dying was a blessing for my husband. My husband, Matt Fairchild, a retired Army sergeant and Gulf War veteran, made the decision to seek medical aid in dying, Fairchild said. I'm grateful that he had the option to end his suffering.

Matt loved life, and at only 52, he didn't want to die. But after he went through nearly a decade of chemotherapy, radiation, hospitalizations, and surgeries in a valiant attempt to cure the skin cancer that had spread to his brain, bones, and lymph nodes, it was a blessing to give him the option to be at home and to take the medication to pass peacefully. My hope is that this option is available to others as well. Unfortunately, for millions of Americans who depend on federally funded insurance and medical facilities, medical aid in dying, is financially inaccessible, in large part due to a

decades-old law that bans the use of federal funds to pay for this end-of-life care option, Fairchild Roep. There is no comparison between a mentally capable, terminally ill person who is going to die no matter what and just wants to die peacefully with his loved ones by his bedside, and a mentally distraught person who prematurely ends their life via suicide, usually alone, often violently. Why should a state border or zip code determine whether you can die peacefully or whether you must die with needless suffering? In city and state, Richard Godfrey called made a long overdue human right. It has long been established in federal law and every state's

law that adults with decision-making capacity have the right to refuse medical treatment, including life-sustaining treatment, Godfrey said. We also have the right to require our health care provider to turn off or disconnect life-sustaining machines and tubes, knowing that the result will be death. With patient consent, a physician can order a high dose of morphine, knowing it will reduce to patient's respiration and likely hasten their passing. I firmly believe that these fundamental human rights cannot be separated from medical aid in dying. I understand that many people, including many legislators, are reluctant or squeamish about dealing with legislating matters related to death. It is an uncomfortable and oftentimes

taboo topic, even though it eventually impacts us all, Gaffreed wrote. But it's outrageous for the government to tell its people that they can't have autonomy over their own lives, just like it's outrageous for the government to tell people who to marry or whether they should carry a pregnancy to term. All right, let's head over to Ari for his take. Managing editor Ari Weitzman here, saying that is it for what the left and right are saying. Thank you, John, and thank you, Isaac for giving me the opportunity to give the My Take Today. Two Fridays ago, Isaac, Camille, and I discussed our reactions to Elena Plot. Calabra's provocative piece in the Atlantic, which is titled Canada is Killing itself for Tangle Suspension of the Rules podcast.

Collaborate's piece was striking in how it straightforwardly delivered details of such a ghastly subject matter. I personally felt pretty disturbed by it, especially by the example of a young man who chose medically assistant in dying or made over cancer treatment out of a desire to avoid pain. I felt innately and viscerally opposed to the idea that death in these cases could be portrayed as treatment. But I was also aware that the article was written skillfully

to be disturbing and that my response to the piece was fundamentally an emotional one. I came away from our podcast discussion, eager to understand more. What don't I know about Canada's laws? How do they compare to the laws in the United States? And most personally, why was my reaction to this essay so strong? I want to explore all these questions today, starting with more background contexts behind legal protections in the U.S. and Canada. Medical assistance in dying is known in some countries like the United States as physician-assisted suicide or just assisted suicide, though practitioners often prefer the term made

to differentiate it from suicide's more clouded connotations. Nine countries, six Australian states and 12 U.S. jurisdictions, including Washington, D.C., have legalized some version of Maine, and each country's laws vary in their implementation. The countries and jurisdictions that have passed their own laws since Switzerland became the first to legalize medically assisted dying in 1937 had diverged from the Swiss system pretty significantly. The opposite is true in the United States. Oregon was the first to allow made, and laws of the 12 jurisdictions that have followed its lead have all had the same core features. The patient must be an adult, 18 years or older, have a terminal

illness with a prognosis of six months or less, be able and willing to consent and ingest the lethal medication themselves. The laws of the United States do not allow euthanasia. The same cannot be said of Canada. Under the Canadian system, consenting adults with terminal conditions have a legal right to a medically assist the death through its track one. The same right is granted to those with quote, irremediable medical conditions through its track two. In 2016, the Canadian Supreme Court codified the legal definition of an irremediable condition in its landmark Carter v. Canada decision. Any medical condition, including illness, disease, or disability, that creates, quote, enduring suffering that is intolerable to the individual in the circumstances of his or her condition,

qualifies. At this point, some readers may be unsettled by the apparent liberality of Canada system. I know this to be the case for me. However, the Carter decision in Canada's 2021 expansion to its two-track system isn't radical in Canada's legal context. In fact, it's downstream of a constitutional right afforded to all Canadians. The legal rights spelled out by the Canadian Charter of Rights and Freedoms, which is similar to the U.S. Bill of Rights, states that all Canadian citizens have a legal right to life, liberty, and security of the person. That last right creates a somewhat troublesome dilemma which the Carter decision wrestled with like this, and I quote from the decision. An individual's response to a grievous and irremediable medical condition is a matter

critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person, end quote. If I were to present the strongest defense of what this ruling has produced, it would look like this. Under the right to security of the person, a Canadian citizen must be granted the ability to access their chosen medical assistance. Therefore, no person suffering intolerably can legally be denied at this right to manage their own suffering. and many thousands of Canadians who are intolerably suffering were given the dignity of choosing

how to end their lives. Yes, one out of every 20 deaths in Canada is now medically assisted. But the rate in the Netherlands is even higher, at slightly above 5%, and 96% of made deaths in Canada are granted to terminally ill patients through Track 1. Furthermore, there's reason to believe Canada is not going to slip down the slope any further. Just like at Belgium, which has the most liberal made regulations in the world, extending euthanasia to minors and the non-terminally ill with psychiatric conditions.

Belgium's rate of medical death has leveled out at roughly 3%. Through a certain lens, Maid can be seen as the result of societal progress. But that just is not how I see it. Canada's death rate through Maid

is surpassed globally by the Netherlands, but by the Netherlands alone. And unlike its European counterparts, Canada's death rates through maid are rising. Meanwhile, its parliament is currently considering expanding access to minors and mentally ill. I don't see this as societal progress. I see a country rushing to normalize a willingness to die. I see a perversion of the language that allows this statement from Canada's 2023 annual report to pass as a subtextual critique of the inadequately few people Canada's doctors are killing each year, and not the morbid paradox that it is.

from the report, and I quote, in 2023, 2,906 individuals who request and made died before their requests for maid could be fulfilled. Let me put that differently. 2,906 individuals who requested to die died before they could be killed. Frankly, it upsets me to see language so effectively marshaled as a societal protective from a harsh reality. Their request for maid for a demand to be killed, a smiling portrait on a three-foot casket, a rainbow band-aid over a gunshot wound, a comprehensible sanitization of an incomprehensible process, an end of all processes. The poet Rainer Maria Rilke likened a death scene to the room with the open window and the fitful noises. I recall being in that room, and I recoil with a thought of voluntarily placing

myself back under the window, even if unappealing sounds could replace fitful noises. With Canada's track two specifically, it upsets me to see logic marshal to such a stunning end, such that a person, legally quite close to any person, cannot be denied the right to be killed under the auspices of medical care. We all have the right to die. Intrinsically, you can exercise that right any time. It is the one eventuality the government has no possible authority over. It's somewhat bizarre that only those who cannot seek that end for themselves, the non-communicative, permanent life support, are barred from legal medical death, both in Canada and the United States. But let's be blunt here. For the rest of us, saying no to life is always an option. And

that's what makes the routine daily yes so powerful. Ultimately, what upsets me most about this issue is the lethal power and the banalities. Claude LaBelle, a disabled man who developed a painful bed sore while visiting the ER in Quebec, a province whose death rate through made is 7.3%. Had an easier time asking the hospital to kill him than he did asking it to provide him with adequate comfort. I had made my peace with being disabled,

with being in a wheelchair the rest of my life, but not in a hospital bed, Lavelle said, after changing his mind. You cannot look these stories in the face and wave them away as mere anecdotes from the vast minority of cases. They are exceptions, but they are the exceptions that prove the rule.

Easing a prolonged and painful passing is one thing. It's something I can support. It's something I support in the United States. In Canada's medical assistance and dying certainly provides for it. But it also provides those who have or should have other treatment options with what is simply the state provided right to be killed. That this can then be called medical care in place of all the potential care not offered is stunningly perverse. It is madness by another name. Well, that's it for my take. So I'm going to pass it back over to John for the rest of the podcast. Thank you.

We'll be right back after this quick break. All right. All right. That is it for Ari's take, which brings us to your questions answered. Today's question comes from Evers in Ann Arbor, Michigan. You did a piece about gerrymandering where you said, that gerrymandering is one of the top three most critical political issues in America. I'm just curious. What other two issues do you think are most critical? And this is Isaac's answer. I'll be honest. This is a really tough one to answer.

Once you made me think about it, I realized that gerrymandering might be my number one issue just because so many other problems are downstream from it. After all, how can we mold the country toward the will of the people if we can't even elect our own members of Congress in a fair and representative way. But the problem of unfair representation is bigger than just gerrymandering. I probably have to put it in an election reform bucket, along with open primaries, rank choice voting, and voter ID laws, and then altogether that would be my clear-cut number one. Then I put immigration and affordable housing as my number two and three issues. Immigration has obviously penetrated the national debate for decades now. The solutions for the

border, including my own, are not simple, and that is just one-half of the equation. We also have to continue to improve our legal immigration system, which allows families to stay together, my best friend just married a woman from Indonesia, and it's remarkable how hard it is to get her U.S. visa, and allows us to attract talent. Earth rates are collapsing everywhere, and we should want immigrants who want to come here for various jobs, to start businesses, to enrich our society, or get educated. At the same time, we have to navigate the ways too much immigration can tear out our social fabric, backseat services and jobs for American-born citizens, or overwhelm the systems we have in place. It's a delicate line to walk. Affordable housing, as number three, is a much more personal preference than anything else. Healthcare could just as easily go here, but housing is a much bigger cost for me personally

and seems much more solvable in the near term. Having rent you can't afford or being unable to buy a home makes everything else, like childcare, health insurance, getting a car, a couple's vacation, and so on, just feel unaffordable too. Here's her under the radar story for today, folks. On Monday, a top official with the United Nations High Commissioner for Refugees reported

that approximately 850,000 Syrian refugees have returned to their homes since the fall of former President Bashar Assad's government in December. The Syrian Civil War began in 2011 and created over 5 million refugees while displacing half of the country's pre-war population of 23 million. Now, however, the U.N. says the return numbers are exceptionally high following Assad's removal, and the number of returned refugees could surpass one million in the coming weeks. The Associated Press has this story, and there's a link in today's episode description. All right, next up is our numbers section.

The approximate proportion of deaths in Canada that were physician-assisted in 2023 was one in 20. The approximate median age of this group is 77. 96% of patients in this group's deaths were determined to be reasonably foreseeable. According to a 1996 Gallup poll, 52% of Americans supported allowing patients to end their own lives with the aid of a physician. In a 2024 Gallup poll, 66% of Americans supported allowing patients to end their own lives with the aid of a physician. In 2001, 49% of Americans said they believed physician-assisted suicide is morally acceptable, while 40% said it is morally wrong. And in 2024, 53% of Americans said they believe that physician-assisted suicide is morally acceptable,

while 40% said it was morally wrong. And last but not least, our have a nice day story. When a young boy was seen walking alone on an elevated monorail at Hershey Park in Hershey, Pennsylvania, a man in the crowd jumped into action. John Sampson, a veterinarian and father of three from Bucks County, PA, climbed on top of the roof of a building adjacent to the monorail and then onto the monorail itself, engaging with the boy before eventually carrying him to safety.

The child had been reported missing after becoming separated from his parents and he was reunited with them after the incident. I just think I'm a guy who was in the right place at the right time and saw a child in need and wanted to help, Samson said. 6ABC has this story and there's a link in today's episode description. All right, everybody, that is it for today's episode. As always, if you'd like to support our work, to readtangle.com, where you can sign up for a newsletter membership,

podcast membership, or a bundled membership that gets you a discount on both. We'll be right back here tomorrow. For Isaac and the rest of the crew, this is John Law, signing off. Have a great day, y'all, y'all. Peace. Our executive editor and founder is me. Isaac Saul, and our executive producer is John Woll. Today's episode was edited and engineered by Dewey Thomas.

Our editorial staff is led by managing editor Ari Weitzman with senior editor Will Kayback and associate editors Hunter Asperson, Audrey Moorhead, Bailey Saul, Lindsay Canuth, and Kendall White. Music for the podcast was produced by Diet 75. To learn more about Tangle and to sign up for a membership, please visit our website at reetangle.com.