Pat Ames is 71 and healthy, and expects to stay that way for years to come. But she’s put a lot of thought into how she wants to die — and when: “If I can’t care for myself,” the Idaho resident said, “I want to be gone long before then.”
Ames has signed papers directing medical providers not to resuscitate her if she stops breathing or her heart gives out. She’s told her younger brother of her plans. And she’s got a passport and money she set aside years ago so that if it comes down to it, she can travel to a country where physician-assisted suicide is legal, even when death is not imminent.
“I will hop on a plane and end it under my conditions,” she said. “Looking out a window at a forest.”
More U.S. states are making physician-assisted suicides available — although only under narrow circumstances — and both defenders and critics of the practice say they see a growing discussion among baby boomers, who are mostly in their 60s and 70s, about what role, if any, it should play in end-of-life decision-making.
Oregon, the first state to enact an assisted-suicide law in 1997, extended the practice to nonresidents in 2023. Delaware, Illinois and New York legalized assisted suicide in recent months. And at least 15 states are expected to weigh similar legislation this year, although it is permitted only when people are terminally ill with just six months or less to live. They also must be mentally competent — disqualifying anyone with advanced dementia — and be able to ingest the prescribed life-ending drugs on their own.
Other countries, including Canada, Belgium and the Netherlands, have made the practice even more readily available, allowing doctors to administer lethal injections to patients who doctors say face unremitting suffering with no hope of improvement, whether death is imminent or not.
Some experts say the debate over assisted suicide — which has been ongoing for decades — is being pushed to the fore as baby boomers see their own parents die and contemplate what they view as the array of imperfect options before them. While polling has shown that a majority of Americans favor thelegality of the practice for terminally ill patients, people are more split on the morality of it in general, and it is unclear whether people would favor allowing physician-assisted suicide when death is not certain.
“I think people are looking for a solution,” said Jamie Towey, president of Aging With Dignity, a group that opposes physician-assisted suicide. “No one’s under any illusions that the American health care system does death very well.”
Some boomers want to maintain their autonomy and avoid the perceived loss of dignity that can accompany inexorable decline, according to interviews with more than a dozen older adults, advocates and experts in bioethics and palliative care. Others want to spare their children the often-overwhelming responsibilities of caregiving, or to preserve and pass down assets that would otherwise be gobbled up by end-of-life care.
Physician-assisted suicide is rare in the United States; more than 3,000 end-of-life prescriptions were issued in 2024, well under 1 percent of all U.S. deaths, according to state reports. But combined with euthanasia, these types of deaths account for 5 to 6 percent of all deaths in Canada and the Netherlands. Of those, the overwhelming majority — 96 percent and 86 percent, respectively — involved people close to death or those living with cancer, neurological disorders and other conditions.
Experts say it’s become less taboo to talk about physician-assisted suicide since Jack Kevorkian turned it into a hot-button topic in the 1990s. The pathologist known as “Dr. Death” spent decades campaigning for the legalization of euthanasia and helped more than 130 patients die by suicide from 1990 to 2000.
It’s now seeped into the public discourse, with such actors as Helen Mirren and Susan Sarandon weighing in after performances that touched on the topic. (Sarandon has said she supported people’s right to consider it, but that she “couldn’t have done it. Personally, not in a million years.”)
The issue is “much more in the U.S. public consciousness today than ever before,” said Thaddeus Pope, a bioethicist and professor at Mitchell Hamline School of Law in Minnesota, who supports the practice.
Physician-assisted suicide raises a litany of complex medical, ethical and religious concerns. Opponents say it devalues life, normalizes suicide and risks becoming the default response to a host of socioeconomic ills.
Critics say the laws could be used against vulnerable populations seen as a financial burden for families, insurers or the government — creating “perverse cost-savings incentives,” Towey said. That could make older adults or those with disabilities feel they have a “duty to die” to avoid being a burden, Towey said.
It creates a “two-tiered health care system that results in death to the socially devalued group,” said Ian McIntosh, with Not Dead Yet, a disability rights group that opposes the practice. “Those without disabilities receive suicide intervention; those with disabilities, assistance with their suicide.”
Media reports have called attention to instances where people requested such assistance for conditions that might have been resolved with more funds or better housing — such as a homeless man in Canada who didn’t want to enter long-term care, or another Canadian too injured to return to work who said his government payments fell short.
“You think, ‘Well, wow, is this the way we’re solving social problems?’” said Lydia Dugdale, a physician and medical ethicist at Columbia University.
In Canada, 4.4 percent of the 16,499 people who died in 2024 with medical assistance were not facing “reasonably foreseeable” deaths, government data shows. Of that group, 45 percent cited isolation as one example of their suffering, while 22 percent of those with foreseeable deaths reported the same, according to their health care practitioners. Half of both groups cited their perceived burden on family, friends and other caregivers as a source of suffering, as well, practitioners said.
A spokeswoman for Health Canada, Karine LeBlanc, acknowledged the “complex and deeply personal” nature of such end-of-life decisions. Still, she said, the nation’s assisted-suicide program was “designed with safeguards to affirm and protect the inherent and equal value of every person’s life” and that “lack of access to social supports or to health services would never make a person eligible.” The requester must be told of ways to relieve their suffering and offered consultation with providers of services such as counseling, palliative care and disability support, LeBlanc said.
Few expect the United States to replicate the standards of other countries.
Ames said she read an article online last year about the Kessler twins — popular singers and dancers in Europe who performed with Frank Sinatra — who died together in Germany at age 89, by assisted suicide. She was surprised that the comments were not all negative.
“It’s a change,” Ames said. “I’m glad that at least it’s a topic now that one can talk about without a whole lot of shame and a whole lot of guilt.”
Frustration with elder care
The majority of those who undergo assisted suicide in the United States are older, college-educated, White people with cancer, available state data shows.
But cost has been a concern for at least some of those terminally ill patients. Physicians for 35 out of 376 people in Oregon in 2024 cited “financial implications of treatment” as an end-of-life concern for their patients. So did at least 50 people out of 545 in Washington state in 2023.
A spokesman for Oregon’s health authority, Jonathan Modie, said it tracks six end-of-life concerns; cost of treatment has always been the least-cited one, though it has increased recently.
Interest in assisted suicide raises questions about access to health care and social supports, some bioethicists say.
The United States spends nearly twice as much on health care per person compared with nine other industrialized countries, according to 2021 data from the Peterson-KFF Health System Tracker. It spends 30 percent less on long-term care: From 2013 to 2021, such spending accounted for 5 percent of growth in overall health care spending in the U.S., versus 19 percent for the nine countries.
“In a perfect world, you would have subsidized long-term care so that people weren’t going bankrupt or being warehoused somewhere,” said Helene Starks, a palliative care expert and University of Washington associate professor of bioethics and humanities.
The United States also spends more on medical treatment and testing, such as MRIs, than on social services, including home aides that can keep seniors living at home, Starks said. For every $1 spent on health care, about 90 cents is spent on social services in the U.S., compared with the average $2 spent on social services across more than 30 other industrialized countries, according to a 2019 report from the National Academies of Sciences, Engineering, and Medicine.
“We prioritize technology and intervention,” Starks said. “And old age more than anything else is about care.”
Advocates of U.S. spending on health care would note that the major discoveries the country has produced have led to better treatment and extended lives. The United States also faces large federal budget deficits and significant entitlement obligations, making further spending on long-term health care a fiscal challenge.
Cost is one reason Gayle Miller, 62, said that she would consider physician-assisted suicide for herself. The retired community college professor from Illinois says the topic comes up frequently in conversations with friends who, like her, are caring for aging parents and privy to the emotional and financial toll it exacts. They exchange information about the cost of assisted-living facilities, insurance and doctor recommendations.
Miller said she and her sister are primarily concerned with ensuring that their mother, who lives in a long-term care facility with dementia, is safe and out of pain. Still, “she’s miserable,” Miller said, and will openly say, “‘I’m just waiting to die.’”
The expense of “just warehousing somebody who has a prognosis only of decline” also weighs on Miller, whose father was a mechanic. Her mother doesn’t qualify for government help through Medicaid, the public health insurance program for those with low incomes, though Miller expects she may within a few years.
As she contemplates the potential of assisted suicide in her own life, Miller said she would never “want to make policies that force people to consider those options, but I just feel like I would love to have it as an option for me.”
Other options
Assisted-suicide critics also call for improvements for end-of-life care, including greater access to hospice and offerings to better manage pain and discomfort.
“Someone shouldn’t have to choose between unbearable suffering and death,” said Sarah Zagorski, with Americans United for Life.
Some call for societal changes — such as for Americans to place higher value on caregiving or to involve entire communities in elder care.
“Isn’t there dignity in spoon-feeding your grandmother until she can no longer eat?” asked Dugdale, the physician, who also wrote “The Lost Art of Dying: Reviving Forgotten Wisdom.”
Adults can already influence certain end-of-life decisions. They can file advance directives instructing hospitals not to revive them if they stop breathing. They can decide not to go to the hospital, cease taking antibiotics or discontinue dialysis, Starks said.
Some simply stop eating and drinking. It’s a legal alternative to physician-assisted suicide that’s sometimes described as a more natural death than a medically induced one. It also affords patients time to change their mind and resume eating, experts say.
Robert Lutz, a 77-year-old who lives in Marin County, California, wouldn’t take that route. He wishes there was an option that would let healthy people request assisted suicide for some time in the future, similar to an advance directive. The person would have to wait a certain number of years, and have to meet a host of criteria before it could be carried out, he suggested. But it would offer an assurance that they “won’t have to suffer needlessly, die an undignified death, or bankrupt their families,” he wrote in a self-published book.
Lutz is healthy and wants to remain that way for as long as possible. But he said he started planning for his eventual death after watching his siblings live out their final years with Alzheimer’s. It was “a horrible ordeal,” the former longshoreman and clinical psychologist said. “My brother was agitated and had no bowel control. My sister was just constantly crying and anxious.”
When he visited assisted-living facilities — including one where his brother lived — he came away thinking he would never want to live there. Nor, he says, does he want to be a burden on his adult children, should the day come that he needs someone to care for him day-to-day.
He knows the way he’s planned out his death isn’t for everyone. “But there’s a peace with feeling like I have some control,” he said.
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