USA 
The current aid in dying landscape in the United States

Guest article by Mary Ewert, Final Exit Network (FEN)*

The threat to end of life choice in the US is higher than at any time in the recent past. With an unfriendly and anti-human-rights federal administration taking power, and voters in the State of West Virginia narrowly approving an amendment to prohibit aid in dying in that state, the barriers to aid in dying freedom seem monumental.

Project 2025 and Physician-assisted suicide (PAS)

The opposition to aid in dying is well-funded and relentless in its efforts to roll back this basic human right that is supported by a majority of Americans. As part of this effort, a new agenda proposed for the incoming administration – Project 2025 – was developed by the Heritage Foundation, a conservative public policy institute.

Although President Donald Trump denies involvement with Project 2025, the Project’s website states that the first Trump administration embraced “nearly two-thirds of Heritage’s proposals within just one year in office.” Many of the current administration’s cabinet picks have connections to Heritage. And the president’s pick to head the Department of Health and Human Services (HHS), Robert F. Kennedy Jr., would be in charge of a proposed overhaul of this major arm of the executive branch of the US government. Project 2025 healthcare-related topics include opposition to aid in dying (Source: “What 'Project 2025' Would Mean for Health and Healthcare” - Medscape - August 12, 2024).

- “[…] Physician-assisted suicide (PAS) is legal in 10 states and the District of Columbia. Legalizing PAS is a grave mistake that endangers the weak and vulnerable, corrupts the practice of medicine and the doctor-patient relationship, compromises the family and intergenerational commitments, and betrays human dignity and equality before the law.”

- “[…] every human being possesses inherent dignity and worth, and our humanity does not depend on our age, stage of development, race, or abilities. The Secretary must ensure that all HHS programs and activities are rooted in a deep respect for innocent human life from day one until natural death: […] euthanasia (is) not health care.”

These statements are unsurprising given the influence of conservative religion among Project 2025 leadership.

Potential threats and FEN’s way forward

There is also concern that a bill restricting what activists and nonprofit organizations can say or do will be reintroduced in a receptive congress. Of particular concern to Final Exit Network (FEN), given its reliance on First Amendment free speech, is the new administration’s threat to target nonprofits with politically motivated investigations, and pass legislation to restrict their activities.

As Final Exit Network enters 2025, we are aware of the potential threat that the new administration poses to FEN and its services. Will we have to make any changes to our current services? Will we eliminate some states that we currently serve, like West Virginia, which just passed a constitutional amendment to ensure they will not have medical aid in dying laws?

First, we will not panic. We will continue to provide our services in all states. The need for our services will not change because the Trump-administration is in charge. Our population is aging. One out of three people over 85 has some level of dementia. For individuals who do not want to live in a demented condition, it is galling to think they are being kept alive against their wishes. People need legal, reasonable, and comfortable choices for how they want to manage their end days.

What FEN does is legal, safe, and peaceful. It is legal for a person to hasten their death and for their family to know they are going to do it. It is not legal to provide the means or physical assistance, neither of which FEN does. Our guides are trained to follow the policies and procedures outlined in the guide program handbook, which is reviewed annually by our board. We provide information that allows people a choice in how and when they die. West Virginians can deny themselves the right to medical aid in dying, though why they would deny themselves a basic civil liberty is a mystery. Yet, let’s remember it is a narrow majority who do. But FEN’s right to speak and educate our clients and the public remains in place.

We will continue to be diligent and thorough in our application and guide processes. We will make sure that clients know their safe and legal options, including medical aid in dying laws, going to Switzerland, and voluntarily stopping eating and drinking. We will make sure that clients are having those difficult conversations with their close loved ones. And we will continue to value both personal autonomy and the social fabric of relationships, while protecting our organization for the long term.

Finally, we plan to spend more time on educating people on the legality and importance of choice in dying. Although we are not active in the political arena – Death with Dignity National Center and Compassion & Choices are the two major US groups active in politics – what we at Final Exit Network do is advocate through our actions. People should understand their options, regardless of what they finally choose to do. Most people today will let nature, or more accurately the medical system, take its course and die in a hospital or in their residence with hospice care. But some will choose to die on their own terms. Final Exit Network is there for those people who make that choice and qualify for our services.

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*Mary Ewert is Executive Director of Final Exit Network (FEN). FEN supports the human right to a death with dignity. They hold that mentally competent adults who suffer from a terminal illness, intractable physical pain, chronic or progressive physical disabilities, or who face loss of autonomy and selfhood through dementia, have a basic human right to choose to end their lives when they judge their quality of life to be unacceptable.

Newsletter 2025-1-3