Euthanasia Ethics: The Key Arguments, Evidence and Thinkers

In the spring of 2001, a lawyer named Harriet McBryde Johnson went to a lecture in Charleston, South Carolina. She used a power wheelchair because of a muscle-wasting disease she had lived with all her life. The speaker was Peter Singer, a famous Australian philosopher then teaching at Princeton.

Singer has argued that parents should be allowed, in some cases, to end the lives of babies born with severe disabilities. Johnson was there for Not Dead Yet, a disability rights group that opposes legal assisted suicide. In the question time, they argued "for 10 long minutes." She was shaking with fury afterwards, she wrote, but mostly at the 200 people who had listened politely. Singer himself had been "so respectful, so free of condescension."

That December, she sent Singer a copy of her yearly letter to friends. He replied with what she called "the nicest possible e-mail message." They argued by email, back and forth. Then he invited her to Princeton University. On a cold Monday in late March 2002, she spoke to 150 students against his views on infanticide. In the evening, over dinner, the topic was assisted suicide.

During dinner, her right elbow slipped and she could not reach her food. The man on her right was Singer. She whispered: "Grasp this wrist and pull forward one inch, without lifting." He did it "to the letter." Her point was quiet but sharp: most of the help disabled people need is ordinary human help, not medical skill.

Johnson told the story in The New York Times Magazine in 2003, under the title "Unspeakable Conversations" (Johnson, 2003). It is one of the best short guides to this debate, because both people in it are serious, polite and sure they are right.

That is what euthanasia ethics is about. It is not good people against bad people. It is good values pulling against each other.

• Freedom: your life is yours to shape, right to the end.
• The value of life: no one should deliberately end a human life, even out of kindness.
• Mercy: we should not leave people in suffering that cannot be relieved.
• Protection: the law must guard people who are ill, old, poor, disabled or depressed from pressure.

Three terms help. Voluntary means the person clearly asked. Non-voluntary means the person could not ask, such as a baby or someone in a coma. Involuntary means against the person's wishes, and nearly everyone agrees it is wrong (SEP). For the difference between euthanasia and assisted dying, see types of euthanasia.

This page sets out each side's best arguments, the research that tests them, and what courts and religions have said. It does not tell you what to think.

The strongest argument is autonomy: the right to govern your own life. Supporters say that if we can make other big life decisions, we should be able to make this one.

In 1859, the English philosopher John Stuart Mill put the idea in one line:

"Over himself, over his own body and mind, the individual is sovereign." — John Stuart Mill, On Liberty (Gutenberg)

Mill's harm principle says society may stop you only to prevent harm to others. On this view, if ending your own life harms no one else, the state has no good reason to forbid it.

The right to control your body. In most countries, a competent adult can refuse any treatment, even if refusing means death. Supporters ask: if you can refuse a machine that keeps you alive, why not ask for help to die? A person who understands their illness can consent to risky surgery. Supporters say the same principle of informed consent can apply here.

Your own idea of a good life. In 1997, six famous philosophers sent a brief (a written argument) to the US Supreme Court. They were Ronald Dworkin, Thomas Nagel, Robert Nozick, John Rawls, T.M. Scanlon and Judith Jarvis Thomson. They argued that most people see death as "the final act of life's drama." People want that act to reflect their own beliefs, "not the convictions of others" (The Philosophers' Brief, 1997).

A voice on video. In November 1992, Sue Rodriguez, a Canadian woman with ALS (a disease that slowly paralyses the body), sent a video message to her country's Parliament. She asked:

"If I cannot give consent to my own death, whose body is this? Who owns my life?" (Wikipedia: Sue Rodriguez)

She lost her case at the Supreme Court of Canada in 1993, by five votes to four. Twenty-two years later, in Carter v Canada (2015), the same court ruled unanimously the other way (Carter v Canada).

Mercy. The second argument is compassion. In Carter, the court described a person who could face ending life early or suffering until a natural death. "The choice is cruel," it said.

What are the limits of autonomy?

Critics accept that autonomy matters. They question whether it can carry this much weight.

Is the choice truly free? A choice made under pressure, during depression, or without good care may not be fully free.

Mill himself set a limit. He said a person may not sell himself into slavery: "It is not freedom, to be allowed to alienate his freedom" (Mill, On Liberty). Critics say death ends all future freedom in the same way.

Can having a choice harm you? In 1992, the philosopher David Velleman wrote "Against the Right to Die." He argued that for some patients, just being offered the option is a harm. This is true, he said, even if they choose well (Velleman, 1992). Once the option exists, staying alive becomes something you must justify, to yourself and to the people caring for you.

Think of a guest told "you may leave any time." They may feel free. Or they may start to wonder whether the host wants them gone.

The sanctity of life is the main argument against euthanasia. It holds that human life has value in itself, so it should never be deliberately ended.

On this view, life's worth does not depend on its quality or usefulness. A life with great suffering or disability is still fully valuable.

Religious roots. Most religions teach that life is a gift from God, and only God may end it.

Secular roots. You do not need religion to hold this view. The German philosopher Immanuel Kant argued that a person is "not a thing" to be used "merely as means." In his view, ending your life to escape pain treats yourself as a tool (Kant, Groundwork). Others argue that a firm rule against killing protects everyone, and that every exception weakens it.

Medicine's own ethic. In 1989, the American physician and thinker Leon Kass argued that medicine has its own inner purpose: health and the care of the sick. From that purpose, he wrote, comes a clear rule: "Doctors must not kill" (Kass, 1989). Patients, he argued, must be able to trust that their doctor will never aim at their death.

Exceptions. Many who hold the sanctity view accept some killing, such as in self-defence. The debate is whether relieving suffering can be another exception, or is different in kind.

What about quality of life?

Quality of life arguments say that when life becomes too heavy a burden, a person should be able to choose to end it. The sanctity view replies that life has value whatever its quality.

Who decides? Most ethicists agree that only the person living the life can judge its quality. But that judgment can be shaped by treatable depression. The hard part is knowing when it is settled.

No fixed line. There is no objective point where suffering becomes unbearable. Some people live through extreme hardship. Others find lesser conditions intolerable. Harriet McBryde Johnson's question to Singer goes to the heart of this: "Are we 'worse off'? I don't think so" (Johnson, 2003).

Most laws and doctors draw a line here. Stopping treatment (for example, turning off a ventilator at a patient's request) is widely legal and accepted. Some call this "passive euthanasia," though many doctors dislike the term. Actively ending a life is legal only in some countries.

In 1975, the American philosopher James Rachels challenged this line in the New England Journal of Medicine (Rachels, 1975). He argued that active euthanasia is often more humane than a slow death, and that the difference between killing and letting die "itself has no moral importance."

His famous thought experiment imagines two men who each want a young cousin dead for money. Smith causes the death. Jones plans to, but the boy has an accident, and Jones simply stands by and does nothing. Rachels asked: is Jones any better? Most people say no. If so, he argued, "letting die" is not automatically better than "killing."

The other side has strong replies. In Vacco v Quill (1997), the US Supreme Court upheld New York's ban on assisted suicide. It said the two differ in cause and intent. When treatment stops, the disease causes death. When a doctor helps a patient die, the doctor intends the death (Oyez: Vacco v Quill).

The story did not end there. On 6 February 2026, New York's governor signed a Medical Aid in Dying Act. It took effect on 5 August 2026 (NY State Department of Health). The court had said states may ban assisted suicide. It never said they must.

The Catholic Church also accepts the line. It allows patients to refuse "extraordinary and/or disproportionate means," saying this "is not the equivalent of suicide or euthanasia" (Samaritanus bonus, 2020).

Ask yourself: if two actions lead to the same death, does it matter whether a hand moved or stayed still?

The doctrine of double effect separates what you intend from what you foresee but do not intend. It goes back to Thomas Aquinas, a 13th-century Christian thinker, writing about self-defence (SEP: Double Effect). A classic version has four conditions:

1. The act itself must be good, or at least neutral.
2. You must intend only the good effect, not the bad one.
3. The bad effect must not be the means to the good effect.
4. There must be a serious enough reason to allow the bad effect.

Catholic teaching uses double effect to allow strong pain relief while forbidding euthanasia. The key is intent: aiming at death (euthanasia) versus aiming at comfort and accepting that death may come (palliative care). The Vatican also accepts deep sedation near death when it is medically needed, the patient consents and "any intention of euthanasia is ruled out" (Samaritanus bonus).

What the research shows. Many people believe that strong pain relief at the end of life usually shortens it. The evidence does not support this. A 2003 review in Lancet Oncology found no evidence that starting or increasing strong painkillers or sedatives brings death sooner (Sykes & Thorns, 2003). A study of 237 patients in a London palliative care unit found only two cases where double effect might even apply (Sykes & Thorns, 2003). Evidence: strong for well-adjusted symptom relief.

This matters because fear of "killing the patient" can lead to too little pain relief. The authors warned that the doctrine itself may discourage good symptom control.

Philosophers use different frameworks, or "lenses," for moral questions. None gives a single answer.

Utilitarianism: what produces the best outcome?

Utilitarianism judges actions by their effects on overall well-being. If suffering cannot be relieved, a chosen death may be the best outcome. But utilitarians must also count effects on families, health budgets and trust in doctors. If legal euthanasia slowly pressured vulnerable people, the same theory could oppose it. So a utilitarian's answer depends on the evidence (see the slippery slope section below).

For most of his career, Peter Singer was a "preference utilitarian." He asked what each person wants for their own future. That is why he supports voluntary euthanasia, and why his views on newborn babies, who cannot yet have such wishes, are so controversial. In 2014 he said he had moved to a version that weighs pleasure and pain instead (Wikipedia: Peter Singer).

Kant and duty-based ethics: what are my duties?

Deontological ethics focuses on duties and rules, not results. Kant's version produces arguments on both sides.

• Competing duties. The duty not to kill seems to forbid euthanasia. Duties to relieve suffering and respect choices may support it.
• The universal law test. Could "end life when suffering is unbearable" be a rule for everyone? Some say yes, because it respects rational choice. Kant said no. He argued that a rule letting self-love end life "would contradict itself," because the same feeling exists to push us to improve life (Kant, Groundwork).
• Absolute rules. Some hold that killing an innocent person is always wrong. Others reply that the rule forbids wrongful killing, and a requested, merciful death is not wrongful.

Virtue ethics: what would a good person do?

Virtue ethics asks what a person of good character, with compassion, wisdom and courage, would do. A compassionate person cannot ignore suffering. But compassion also means staying present and not abandoning the dying. One wise doctor might see helping a patient die as the brave, kind choice. Another might see it as a failure of care.

Care ethics: what does this relationship need?

Care ethics focuses on relationships. It asks what care requires in each situation. Sometimes care means fighting for life. Sometimes it means accepting death and making sure the person is comfortable and not alone.

Dame Cicely Saunders founded the modern hospice movement in London in 1967. She opposed legal euthanasia, but she accepted that both sides were against needless pain and loss of dignity (Wikipedia: Cicely Saunders). She also gave medicine the idea of "total pain": suffering that is physical, emotional, social and spiritual at once. Her best-known words sum up care ethics:

"You matter because you are you, and you matter to the end of your life." — Dame Cicely Saunders (King's College London)

The slippery slope is the most common objection. It says that allowing euthanasia in narrow cases will lead, step by step, to wider use and abuse.

It has two versions (SEP). The logical slope says that if suffering justifies euthanasia for a dying adult, the same reason must apply to adults who are not dying, or to children. The practical slope says that in real life, rules loosen, safeguards fail, and vulnerable people are pressured.

Think of a ramp versus a staircase. Critics see a smooth ramp with nowhere to stop. Supporters see a staircase, where each step needs its own separate decision.

What the evidence shows against the slope

Vulnerable groups. In 2007, Margaret Battin and colleagues reviewed Oregon data from 1998 to 2006 and four Dutch national studies. They checked ten at-risk groups, including older people, women, the poor, disabled people, minors and people with psychiatric illness. None had higher rates. The only group with a higher rate was people with AIDS (Battin et al., 2007).

A wider review. A 2016 review in JAMA by Ezekiel Emanuel and colleagues covered the US, Canada and Europe. It found that euthanasia and assisted suicide made up between 0.3% and 4.6% of deaths where legal. In no country did it find evidence that vulnerable patients received them at higher rates than the general population. It concluded that existing data "do not indicate widespread abuse" (Emanuel et al., 2016).

Life-ending without request. In the Netherlands, some doctors ended life without an explicit request. These cases fell from 0.8% of deaths in 1990 to 0.2% in 2010 and 0.3% in 2015 (Onwuteaka-Philipsen et al., 2012; van der Heide et al., 2017). Defenders point out that this fell after legal regulation, not before.

What the evidence shows for concern

The critique of the "no evidence" finding. Ilora Finlay is a palliative care doctor and a member of the UK House of Lords. In 2011, she and a colleague argued that vulnerability is not only about race, income or education. It also comes from emotional state, loss and personality, which exist in every group. They also noted that in Oregon, most users are older people (Finlay & George, 2011).

Belgium. A 2010 study in Flanders, Belgium, found that in 2007, 2.0% of deaths involved life-ending drugs given at the patient's explicit request. Another 1.8% involved such drugs without an explicit request. In 77.9% of those cases, the decision was not discussed with the patient. Most of these patients were over 80 and in hospital (Chambaere et al., 2010). The authors linked these cases to unpredictable illness and to misunderstandings about pain medicine. Critics see the figures as serious.

Eligibility has widened. In Belgium and the Netherlands, criteria have grown over time. They moved from terminal illness to chronic conditions, from physical to psychological suffering, and from adults to minors. Belgium removed its age limit for minors in 2014. Canada dropped its rule that death must be "reasonably foreseeable" in 2021, after a Quebec court struck it down (CBC News). Critics say this is the slope in action. Supporters say each change was debated openly and voted on.

The latest numbers:

• Netherlands, 2025: 10,341 reported cases, or 6% of all deaths. 499 involved dementia, 174 involved mainly psychiatric suffering (45 fewer than in 2024), and 475 involved several conditions of old age together. Reviewers found that doctors failed the legal care criteria in 7 cases (RTE, 2026).
• Belgium, 2025: 4,487 cases. In 24.9%, death was not expected in the near future. One case involved a minor in each of 2024 and 2025. No case was referred to prosecutors (Belga, 2026).
• Canada, 2024: 16,499 people received medical assistance in dying (MAID), or 5.1% of all deaths. 732 (4.4%) were people whose death was not reasonably foreseeable (Health Canada, 2025).

Loneliness and social need. In Canada, 44.7% of people whose death was not foreseeable named isolation or loneliness as part of their suffering. Among people who were near death, the figure was 21.9% (Health Canada). In 2024, an expert committee set up by Ontario's Chief Coroner reviewed some of these cases. Members raised concerns in cases where social isolation, addiction or mental illness had not been fully explored (Ontario Chief Coroner, 2024).

Where the evidence leaves us. The evidence against abuse in the strict sense (people killed against their will) is fairly strong in the places studied. The evidence on expansion is clear: rules have widened. Whether that widening is a slope or a fair extension of the same principle is a question of values, not data. Evidence: mixed. For more numbers, see statistics.

Many people assume the main reason is pain. Research consistently shows otherwise. The 2016 JAMA review found that "pain is mostly not reported as the primary motivation" (Emanuel et al., 2016).

Oregon, 2025. 637 people received prescriptions under Oregon's Death with Dignity Act. Among people who died under the law that year, the most common concerns were (Oregon Health Authority, 2026):

• Losing autonomy: 89%
• Being less able to do things that make life enjoyable: 89%
• Loss of dignity: 65%
• Losing control of bodily functions: 53%
• Being a burden on family, friends or carers: 40%
• Pain, or worry about pain: 37%
• Cost of treatment: 6%

Most (92%) were in hospice care. Their median age was 76, 94% were white, and half had a university degree. Only two people (0.5%) were referred for a psychiatric or psychological assessment.

Canada, 2024. The most common source of suffering was loss of the ability to do meaningful activities (95% or more). About half named feeling like a burden on others (Health Canada).

This data cuts both ways. Supporters say the law is used mostly by well-off, well-cared-for people who value control. Critics say "burden" and "dignity" are social feelings, shaped by how we treat sick and disabled people, and should be answered with support.

Can depression be missed?

Yes, sometimes. In 2008, a study in Oregon assessed 58 people who had asked for aid in dying. 15 of them (about 1 in 4) met the criteria for depression. Of 18 who received a prescription, 3 were depressed. The authors concluded that most people using the law were not depressed, but that it "may fail to protect some patients" (Ganzini et al., 2008). Evidence: early (a small study), but it is often cited because it is one of very few that assessed patients directly.

Euthanasia is never an answer to depression. Depression is treatable, and it can make the future look darker than it is. If these questions feel personal to you right now, please talk to someone today.

Does the wish to die stay the same?

Not always. In 1999, Harvey Chochinov's team in Canada asked 168 people with advanced cancer to rate their "will to live" twice a day. The middle (median) changes were small. But the biggest swings were large: on average, 33 points on a 100-point scale within 12 hours, and 68 points within 30 days. Depression, anxiety, shortness of breath and sense of well-being drove the changes (Chochinov et al., 1999).

This is why most laws require a request to be enduring: repeated over time, with waiting periods. Critics say a few days or weeks may still not be enough.

Both sides agree that good care matters. They disagree about whether it removes the need for assisted death.

How badly people can die without good care. The SUPPORT study (1995) followed 9,105 seriously ill adults in five US hospitals. Only 47% of doctors knew when patients wanted to avoid resuscitation. For half of conscious patients who died, families reported moderate to severe pain at least half the time. A large effort to improve communication changed none of this (SUPPORT, 1995). Evidence: strong (a very large trial), though from the early 1990s.

What early palliative care can do. In 2010, Jennifer Temel's team studied 151 people with advanced lung cancer. By chance, half got early palliative care on top of normal cancer care. The other half got normal care alone. The palliative care group had better quality of life, fewer depressive symptoms (16% vs 38%), and less aggressive treatment at the end (33% vs 54%). They also lived longer: a median of 11.6 months vs 8.9 months (Temel et al., 2010). Evidence: strong for this group, from one hospital and one type of cancer.

What dignity therapy can and cannot do. Dignity therapy is a short talking therapy. A dying person records what matters most in their life, often as a document for their family. A 2011 trial with 441 patients found it did not reduce measured distress more than other care. Whether it eases depression or the wish to die is still unproven. But patients said it helped them, improved their sense of dignity and changed how their family saw them (Chochinov et al., 2011). Evidence: mixed.

What patients say they want. In 2010, the surgeon and writer Atul Gawande described what surveys of dying patients keep finding. Besides avoiding suffering, people want to be with family, to be touched, to stay mentally aware, and not to be a burden. In his words:

"People have concerns besides simply prolonging their lives." — Atul Gawande, "Letting Go," The New Yorker (Gawande, 2010)

He told the story of La Crosse, Wisconsin. From 1991, local doctors made a habit of asking patients a few plain questions about the care they wanted near the end. By 1996, 85% of residents who died had written instructions, up from 15%. Good care, on this view, starts with a conversation, not a machine.

The honest limit. Most people who use assisted dying laws already have palliative care: 92% were in hospice in Oregon, and 74% received palliative care in Canada. So assisted death is not only a sign of missing care. But the picture differs for people who were not near death. In Canada, only 23% of them had received palliative care (Health Canada). Palliative care can relieve most pain, but not all, and not every kind of suffering. Critics reply that care is still unequal, and that a law should not arrive before good care reaches everyone. For more, see palliative care.

Disability rights groups are some of the strongest critics. They are often secular and progressive, so their arguments are not mainly religious.

Choice inside inequality. At the Princeton dinner, Harriet McBryde Johnson argued that "choice is illusory in a context of pervasive inequality." She said:

"We shouldn't offer assistance with suicide until we all have the assistance we need to get out of bed in the morning…" (Johnson, 2003)

Two kinds of suicide prevention. Johnson quoted the disability researcher Carol Gill. Gill argued that society works hard to prevent most suicides but helps ill and disabled people die, and that this is discrimination.

Outsiders underrate disabled lives. Research supports part of this worry. In a 1999 study of 153 people with disabilities, 54.3% of those with moderate to serious disabilities rated their quality of life as good or excellent. Researchers call this the "disability paradox": outsiders expect a poor life, but many disabled people report a good one (Albrecht & Devlieger, 1999).

UN human rights experts. On 25 January 2021, UN human rights experts, including the UN's special rapporteur on disability, warned about laws that allow assisted dying "based largely on having a disability." They wrote: "Disability should never be a ground or justification to end someone's life directly or indirectly" (Not Dead Yet, reproducing the UN statement). They said such laws rest on "ableism," meaning prejudice against disabled people, which the UN Convention on the Rights of Persons with Disabilities rejects.

The other view, from inside the movement. Disabled people do not all agree. At the same dinner, Johnson presented the view of Andrew Batavia, a disabled lawyer and scholar. He argued that the disability movement fights for control over our own lives, and that this should include the end of life (Johnson, 2003). Many disabled people today support assisted dying for that reason.

Most traditions share two positions. They oppose deliberately ending life. They accept stopping treatment that is futile or too heavy a burden. For a fuller guide, see religious views.

Catholic Church. The 2020 letter Samaritanus bonus calls euthanasia "an intrinsically evil act, in every situation or circumstance." It also says "the judgement that an illness is incurable cannot mean that care has come at an end." It praises palliative care as the "compassionate 'remaining'" at the side of the sick (Samaritanus bonus).

Islam. The Islamic Code of Medical Ethics (1981) forbids any "positive measure to terminate the patient's life." It also says that "the aim is to preserve life not to prolong the dying process" (Ghaly, 2022). In 1986, the International Islamic Fiqh Academy ruled that life support may be removed once doctors confirm death by brain or heart criteria (IIFA Resolution 17). The mainstream view allows withholding or withdrawing treatment that does more harm than good.

Judaism. Jewish teaching generally says doctors should not hasten death and should work to keep people alive. But in very serious cases it separates actively ending life from allowing death to come (Pew Research). Orthodox authorities forbid any active hastening of death. Views in other movements have shifted. In 1997, Conservative Judaism's law committee approved Rabbi Elliot Dorff's ruling against assisted suicide by 21 votes to 2. In 2020, it approved his new ruling allowing narrow exceptions, by 9 votes to 5 (Dorff, 2020). In 2023, Reform Judaism's responsa committee (its panel on Jewish law) accepted assisted dying in principle for terminal or severe chronic illness. Its conditions are strict: full access to medical care, no financial motive, and screening for untreated depression. It ruled out mental illness alone. It also said it was "not convinced" any place yet meets these conditions (CCAR 5783.1).

Buddhism. The Buddhist ethicist Damien Keown says Buddhists generally oppose euthanasia and assisted suicide, because destroying human life is wrong even to end suffering. But life need not be preserved at all costs. In his words: "so long as there is no intention to take life, no moral problem arises" (Pew Research).

Hinduism. There is no single formal teaching. Many Hindus worry that ending life early disturbs karma, the moral law of cause and effect across lives (Pew Research). But there is another strand. In 1928, Mahatma Gandhi had a doctor painlessly end the life of a calf at his ashram that was suffering and beyond help. Asked whether he would apply the same principle to humans, he answered: "My reply is 'yes'." India's Supreme Court recalled this debate in 2018, when it allowed passive euthanasia (Indian Express, 2018).

Canada. In Carter v Canada (2015), the Supreme Court ruled unanimously that the ban on assisted dying broke the Charter of Rights and Freedoms. The court accepted that the law had a fair aim, protecting vulnerable people, but found the total ban went further than that aim needed. It allowed physician-assisted death for "a competent adult person who clearly consents" and has "a grievous and irremediable medical condition" causing intolerable suffering (Carter v Canada).

United States. In 1997 (Vacco v Quill and a companion case), the Supreme Court found no constitutional right to assisted suicide, but left states free to allow it (SEP). In Gonzales v Oregon (2006), it ruled 6 to 3 that the US Attorney General could not declare Oregon's state-approved practice "illegitimate" (Oyez). The question underneath: who decides what counts as real medicine?

Europe. In Pretty v United Kingdom (2002), Diane Pretty, who had motor neurone disease, asked that her husband not be prosecuted for helping her die. The European Court of Human Rights ruled unanimously against her. It said "no right to die" can be derived from the right to life (Article 2). It accepted that a ban on assisting could be justified to protect others (Pretty v UK).

Colombia. In ruling C-239 of 1997, the Constitutional Court held that the state's duty to protect life gives way to the informed consent of a terminally ill patient in intense suffering. It required a doctor to act and asked Congress for strict rules (C-239/97). In ruling C-233 of 2021, it removed the need for a terminal illness. A serious and incurable injury or illness causing intense suffering can now be enough (C-233/21).

India. In 2018, the Supreme Court allowed passive euthanasia (withdrawing life support) and recognised living wills, recalling Gandhi's 1928 debate. Active euthanasia remains illegal (Indian Express, 2018).

Where the law stands in late 2026

• France adopted an "aid in dying" law in August 2026 for incurably ill adults, after its Constitutional Council upheld it (The Guardian).
• New York began allowing medical aid in dying on 5 August 2026 (NY Department of Health).
• Illinois began allowing medical aid in dying on 12 September 2026, after a federal judge refused a request from disability rights groups to block it (Capitol News Illinois).
• Uruguay passed a Dignified Death law in October 2025, the first country in Latin America to legalise assisted dying through its parliament (BBC).
• Jersey, a British island, received royal approval for its law in 2026. The service will take time to set up (Government of Jersey).
• Scotland: in March 2026, the Scottish Parliament rejected an assisted dying bill by 69 votes to 57. Many opponents feared people could be pressured into an assisted death (BBC).
• England and Wales: on 11 September 2026, MPs rejected a new assisted dying bill by 286 votes to 270. Its sponsor, Labour MP Lauren Edwards, called the current law "too cruel and too unjust." Opponents included MP Ashley Dalton, who is being treated for terminal breast cancer. She argued the bill did not protect people with treatable depression who also had a terminal illness (The Guardian).
• Canada: on 7 October 2026, the justice minister said the government will bring in a law to keep people whose only condition is a mental illness excluded from MAID, with no end date. The same law would "open the door" to advance requests, for people whose illness will later take away their ability to decide (CBC News).

For every country, see the legal landscape.

Many people quoted above shaped this debate: Singer, Rachels, Kass, Velleman, Saunders, Dworkin and Johnson. Four more names come up again and again.

Philippa Foot. British philosopher whose 1977 paper "Euthanasia" asked when a person can be better off dead. She stressed that euthanasia must be for the good of the person who dies (SEP).

Daniel Callahan. In 1969 he co-founded the Hastings Center, a leading bioethics institute. He opposed euthanasia but supported hospice and accepting a natural death (Wikipedia: Daniel Callahan).

Margaret Battin. American philosopher who generally supports assisted dying and led the 2007 study of vulnerable groups described above. Author of Ending Life: Ethics and the Way We Die.

John Keown. British legal scholar who opposes euthanasia and argues the Netherlands shows a slippery slope. Author of Euthanasia, Ethics and Public Policy. (He is not Damien Keown, the Buddhist ethicist quoted above.)

To compare the main arguments side by side, see arguments for and against.

There is no formula, but good questions help:

• If you were very ill, what would you fear most: pain, losing control, or being a burden? Which of those could care, money or company change?
• Should the law be written for the most independent patient, or the most vulnerable one? Can it protect both?
• Who should decide that suffering is "unbearable": the person, their doctor, or the law?
• If a country allows assisted dying, what should it guarantee first?

How strong is the evidence?

Back to the dinner at Princeton

Neither Harriet McBryde Johnson nor Peter Singer changed their minds. But something human passed between them. After Princeton, he sent her a kind email. He had also given her a signed book of his writings.

A friend in the disability movement was appalled that Johnson had let Singer help her at dinner. Johnson wrote back to say she had changed her will: the friend would inherit Singer's book. The friend replied that she was changing her will too. The two women joked that each had given the other "a reason to live."

At the end of her essay, Johnson did not claim to have won. She would not call Singer a monster, she wrote, because that "would make monsters" of many people she lived and worked with every day. Her defence against his ideas was not anger. It was "the muck and mess and undeniable reality of disabled lives well lived" (Johnson, 2003).

In 2024, the playwright Christian O'Reilly turned their exchange into a play, Unspeakable Conversations, at the Galway International Arts Festival. Two disabled actors and activists, Mat Fraser and Liz Carr, took the roles, with Carr playing Johnson. Carr also fronted the 2024 BBC documentary Better Off Dead?, which set out her case against assisted dying (Wikipedia: Harriet McBryde Johnson; Wikipedia: Liz Carr). More than twenty years on, the argument is still unfinished.

Both sides care about suffering, dignity and freedom. They disagree about how to protect all three at once. If you hold your view with care, and listen to the best version of the other side, you are doing what Johnson and Singer did over dinner.

If any of this feels personal, because you are ill, caring for someone, or struggling yourself, you do not have to think it through alone. Free, confidential support is here.