Think Christian About New York’s Medical Aid in Dying Act

Medical Aid in Dying

For nearly a decade, New York State has sought to legalize medical aid in dying—and it seems like they are finally nearing the end zone. On April 29, 2025, by a vote of 81 to 67, the New York State Assembly passed the Medical Aid in Dying Act. The Senate is expected to vote on its version in the coming weeks, and Governor Hochul is likely to sign it into law thereafter. New York will become the twelfth state to legalize assisted suicide, and momentum is picking up across the nation for others.

Futile Care

Christians lament assisted suicide for many reasons. However, before I address our concerns regarding this specific bill, I want to acknowledge the suffering of those with terminal illnesses. Christians lament suffering. As a pastor, I have been at the bedside as people suffer in their final days. I have offered counsel to the terminally ill. I have had to make decisions regarding futile care in my own family. I have stroked the hair of my loved ones as they have passed from this world to the next. Christians do not want people to suffer, nor do we want to extend agony or ignore the trauma that can occur at the end of life. Christians realize that suffering is a condition of the fall—a condition that Jesus fully embraced as our suffering savior. Our opposition to assisted suicide is not one of cruelty but one of biblical compassion.

Compassion and Autonomy ?

New York's "Medical Aid in Dying" bill rests on two premises: First, it is compassionate to end suffering, and second, people have the right to make their own choices regarding their lives. Compassion and autonomy are the foundation principles that are said to motivate this legislation.

However, the Bible gives Christians a different understanding of compassion and autonomy. In scripture, compassion is the quality of showing kindness or favor, of being gracious or having pity. The Old Testament word for compassion is derived from the root word "womb," which compares God's love with maternal love. In the New Testament, the Greek word for compassion literally "means to be moved in one's bowels" or in one's innermost heart. Biblical compassion is an intense feeling that leads to actions consistent with love. Biblical compassion is always about God's covenantal love and His gracious acts toward His people. Biblical compassion has three components: it is relational, it is consistent with God's covenantal love, and it is active and present even amidst suffering. Thus, for an act to be truly compassionate, it must consider all three factors.

The Bible also provides Christians with a proper understanding of autonomy. God created humans with a will and, thus, the ability to make choices (The mystery of sovereignty and human choice is a debate for another time.) However, as creatures under a creator's authority, human autonomy is inconsistent with biblical anthropology. In New York's assisted suicide bill, autonomy infers "self-law" (auto-nomos). Secular conceptions of autonomy are concerned with self-determination. However, New York's definition of autonomy is reductionary because they do not fully consider one's relationship to God and others. Thus, I will propose several reasons the New York legislation's foundations present major concerns for Christians.

Who Determines Coercion?

First, §2899-d (7) states that patients who suffer from a terminal illness or condition may request a prescription to end their life "based on an understanding and acknowledgment of the relevant facts and that is made voluntarily, of the patient's own volition and without coercion, after being fully informed."

Based on this statute, a physician and psychologist must determine the patient's motives in making requests for life-ending drugs. But is it fair to ask physicians and psychologists to determine coercion? Coercion can take many different forms and be quite subjective. Can an innocent question about medical expenses be seen as coercive? Can a loved one's comment in a moment of grief be interpreted as coercive? What about a dying person's real or perceived guilt? Who determines what constitutes coercion, and is it fair to place this expectation on our physicians and healthcare workers?

Undue Burden

Furthermore, the conscience of those who are asked to make these determinations must be considered. Physicians already deal with tremendous pressures and expectations. Now imagine the psychological effects on physicians who are asked to determine the subjective nature of coercion while the patient and family members are dealing with grief.

Physicians already deal with high burnout rates from stress and anxiety. New York is adding more emotional stress as physicians are asked to determine patients' inner motives and decipher complex family relationships. Christianity's doctrine of loving thy neighbor must also include care for physicians. Consequently, New York's legislation claims to be compassionate while it undermines compassion for all those committed to the Hippocratic Oath.

Conscience Rights

Second, consider the moral dilemma facing physicians with sincere religious objections to assisted dying. While the legislation purports to protect conscience rights through §2899-m (1.a, 1.b), it requires these physicians to transfer or arrange the transfer of patients to providers willing to prescribe lethal medications. Unlike typical medical transfers designed to match patients with appropriate specialists or treatments that align with standard care, these transfers create a unique ethical tension: the referring physician must actively connect their patient with someone who will facilitate an action they believe violates the core medical principle of "do no harm."

This is fundamentally different from other conscience protections in healthcare, which typically don't require direct facilitation of the objectionable procedure. For example, the Church Amendments and other federal protections for conscience generally protect healthcare workers from being compelled to participate in procedures they find morally objectionable without obligating them to make referrals. Physicians who hold sincere objections to medical aid in dying may experience moral distress when required to initiate a chain of events leading to what they view as patient suicide, even when they are not the ones prescribing the medication.

This puts conscientious physicians in an untenable position: they must either violate their deeply held convictions by facilitating access to lethal drugs or potentially face disciplinary action for non-compliance with the law. Some may feel compelled to avoid diagnosing terminal illness in borderline cases or be less transparent about prognosis to avoid triggering the law's provisions. While not technically "abandonment" in the legal sense, this mandatory referral requirement fails to fully respect the moral agency of healthcare providers. True compassion in policy must consider the wellbeing of all parties involved in these difficult situations, including physicians and other healthcare workers. Thus, for a bill to be sold as "compassionate," one must ask where the compassion is for physicians and healthcare workers.

Soothsayer or Surgeon

Additionally, §2899-d (17) of the bill states that a person must be within six months of death. While physicians may provide a "best guess," no one can be sure when death will occur. I have witnessed patients who expected to die within months live for another year or more. It is an undue burden to ask our physicians to determine when God will end a life.

Third, §2899-d (8) states, "Medical aid in dying means the medical practice of a physician prescribing medication to a qualified individual that the individual may choose to self-administer to bring about death." The principle here is that of autonomy; the patient will self-administer the drugs to take their own life. But how autonomous is this act? Humans are relational creatures; we do not live on an island. A doctor must write a script, a pharmacist must fill the order, an insurance company must pay for the drug, an attendant must remove the body, etc.

Moreover, in my experience, at the end of life, many people do not have the faculties to administer their own medications; thus, many patients will need someone to actively participate in their death. While §2899-f (3) explicitly forbids anyone but the patient to administer the drugs, how can this be policed? While some terminally ill patients maintain their physical capabilities until very near death, studies from Oregon and Washington show that a significant portion of patients who receive prescriptions never use them, suggesting that physical capacity may indeed become a barrier for some. This raises legitimate questions about oversight and implementation in cases where patients' abilities may be compromised. The act of a third party administering fatal drugs would fundamentally change the nature of the act itself. While New York's bill seeks to promote patient autonomy and choice, it is overly optimistic about the capacities of those nearing death.

Who Pays the Bill?

Fourth, Assembly Bill A136 indicates that third-party providers must provide the services associated with medical aid in dying. Religious institutions and religious non-profits of a certain size must offer healthcare to their employees. While §2899-n addresses insurance issues broadly, further clarification may be needed regarding whether religious institutions would be required to include coverage for these medications in their health plans. The bill prohibits insurers from denying other services based on a patient's choice about medical aid in dying but doesn't explicitly address whether institutions with religious objections must include such coverage in their plans. Similar to the Little Sisters of the Poor case regarding contraception, what are the provisions to ensure religious institutions are not contributing to acts we find immoral? While New York legislators want to celebrate this bill as honoring patient autonomy, they do not consider that healthcare is not only about the patient. Healthcare includes all of us who pay premiums.

A Better Vision

Biblical compassion calls us to a richer vision of end-of-life care than simply eliminating suffering. True palliative care embodies all three elements of biblical compassion: it is deeply relational, maintaining covenant connection with the dying rather than isolating them; it reflects God's enduring love by remaining present even in the darkest hours; and it actively responds to suffering with skilled medical intervention and heartfelt personal presence. Just as God's compassion—rooted in the intimacy of the "womb"—never abandons us in our suffering, Christian palliative care walks alongside the terminally ill with tender mercy, sophisticated pain management, and spiritual support. This approach honors both the sanctity of life and the reality of suffering, allowing for meaningful closure, reconciliation, and even spiritual growth during life's final chapter. When we embrace this model of compassionate presence, we create sacred space where the dying are neither abandoned nor rushed toward death, but instead, they are tenderly carried through their journey with dignity and love.

So why should Christians care about New York's medical aid in dying legislation? We need to think Christian about end-of-life care because it is only a matter of time before medical aid in dying for the most vulnerable will come to your state. Christians everywhere should be concerned when death is considered the best option to express compassion and autonomy.