Moral Difference Between Withdrawal and Direct Killing

In December 2025, Governor Kathy Hochul reached an agreement with the New York state legislature to pass the Medical Aid in Dying Act, which would legalize what proponents call "death with dignity" and what critics call physician-assisted suicide. About a dozen other states already permit doctors to prescribe lethal medication to terminally ill patients who request it. The state of Oregon pioneered this practice in 1994 and it has since spread across the Western world.

Now, there are people who have an ailing parent or grandparent or, God forbid, a child who is genuinely suffering—suffering in agonizing ways that make the cessation of that suffering seem like the only humane response. It would be inhuman not to acknowledge the enormous emotional, psychological, and physical burdens of that pain, or to minimize it.

But the question of physician-assisted suicide ultimately is one about medical ethics as upheld by the physician, the distorting market effects of this practice, and social policy. What happens when the state makes it possible for large numbers of people to receive this option from the very person whose profession calls on him to heal and not harm? What happens to the moral foundations of our culture when assisted death becomes something we learn to abide?

The evidence from places like Canada and the Netherlands begins to answer those questions in deeply disturbing ways. What started as a carefully limited option for the terminally ill has expanded dramatically. In Canada, deaths from medically assisted dying rose from 4,480 in 2018 to over 10,000 in 2021—and by 2022 accounted for 4 percent of all deaths in the country. Patients are now approved for reasons of poverty, loneliness, and mental illness. Veterans seeking PTSD treatment are sometimes offered death instead.

The physician and educator Leon Kass warned nearly 30 years ago that once we break the ancient taboo against doctors killing patients, the practice would prove "in principle unregulable." The evidence now seems to vindicate that warning.

To discuss this topic, Mosaic's editor Jonathan Silver is joined by Aaron Rothstein, a neurologist at the University of Pennsylvania and a fellow in bioethics and American democracy at the Ethics and Public Policy Center. They discuss the origins of the modern euthanasia movement, and the disturbing reality of how euthanasia functions once legalized.

This episode of the Tikvah Podcast is generously sponsored by David Bradlow. If you are interested in sponsoring an episode of the Tikvah Podcast, we invite you to join the Tikvah Ideas Circle. Visit tikvah.org/circle to learn more and join.