Last month, Illinois Gov. JB Pritzker signed into law a bill lawmakers passed called “Deb’s Law” that enables terminally ill patients to request a prescription from their doctor to end their lives. Illinois is now the 12th state in the country to pass a Medical Aid in Dying (MAID) law. The law is named for Deb Roberson, who had an aggressive cancer and advocated for such a law since 2022.
Lawmakers in New York passed similar legislation this summer and sent it to Gov. Hochul’s desk on Dec. 31 and she says wants to sign it with some changes.
The new Illinois law has several built-in safeguards. The patient requesting the prescription must be a mentally competent adult with a terminal illness diagnosis and a prognosis of six months or less to live. It requires two physicians to confirm the prescription, a mental competency evaluation when indicated, and the death certificate must list the terminal illness — not suicide — as the cause of death. The patient must make two oral requests of physicians, with a five-day waiting period between the first and second requests. They must also provide a written request witnessed by two adults.
New York’s bill also mandates that two physicians approve a patient’s request, but it only requires a 24-hour waiting period.
Both the Illinois law and New York’s pending law require patients to self-administer the medication. In both cases, health care providers cannot be coerced into prescribing the drug if they are not morally comfortable doing so.
In MAID, the physician prescribes a lethal medication that the patient may choose to self-administer. Euthanasia, by contrast, involves a clinician administering the lethal agent. Separately, patients may consent to the withdrawal or withholding of life-sustaining treatment, allowing death to occur from the underlying illness.
Illinois’ new law closely resembles the laws enacted by other states. None of the U.S. laws allow advance directives that would enable MAID in the event of future incapacitation. For example, no state law currently allows individuals with progressive dementia to authorize assisted dying in advance, to be carried out once the dementia becomes severe, to spare their loved ones from the burden and cost of caregiving. Patients with severe dementia, however, would be unable to follow a physician’s instructions anyway.
A free society recognizes individuals as sovereign over their own bodies, so long as they do not infringe on the rights of others. That principle necessarily encompasses the freedom to end one’s own life — and to seek medical help in doing so. When a patient is fully informed and gives voluntary, competent consent, the state has no legitimate role in preventing physicians from honoring that decision.
Countries such as Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, and Spain permit medical aid in dying in forms that include clinician-administered euthanasia, patient self-administration, or both, reflecting a broader respect for adult autonomy. In this country, states should consider what those experiences reveal about respecting autonomy at the end of life.
Yet Canada’s experience also provides cautionary lessons. In a tax-funded single-payer system, resource limitations can influence clinical judgment. Investigations have documented cases where clinicians offered MAID as just another routine option, and even instances where disabled veterans seeking costly supports were directed toward assisted death instead of care. Canada’s government monopoly on the health care system can create perverse incentives for physicians and caseworkers to promote euthanasia instead of chronic treatment and support.
Providing MAID for individuals with mental illness can be complex. When, if ever, should clinicians grant death requests from patients who have suicidal thoughts, and must other treatments be attempted first? They also need to assess whether a psychiatric condition is truly incurable — and whether it so impairs judgment that meaningful informed consent is no longer possible. Policymakers should approach this issue carefully.
Illinois chose restraint in confronting a deeply personal question, even as other democratic nations have extended autonomy further. New York is moving in the same direction that indicates how much importance the state places on personal liberty at the end of life.
Singer practices general surgery in Phoenix and is a senior fellow at the Cato Institute. He is the author of Your Body, Your Health Care.
