To Die by Medical Aid or Not: That Is Our Question

PSYCHIATRIC VIEWS ON THE DAILY NEWS

Recently, an argument was made in the Psychiatric Times article, “Psychiatric Euthanasia in the Netherlands: Young People, Procedural Medicine, and the Limits of Psychiatry,” about the underlying problems of the euthanasia policy for youth in the Netherlands.¹ The authors pointed out the risks of finality so early in one’s projected life when the brain is still maturing rather rapidly, along with the common social contagion of copycat behavior in the young, among other risks. It is reported that most Dutch psychiatrists have personal moral and professional ethical reservations, although a small core group is pushing it for what is stated as reasons of compassion and autonomy.

Euthanasia means the direct involvement of the physician in the death of the patient. In what is often called physician-assisted suicide, the patient takes the prescribed lethal medication. Generally, euthanasia makes the physician feel more directly responsible for the death.

One of the authors of the Netherlands article has also been quite involved in our own debates on aid in dying in a series of Psychiatric Times articles.² My one conclusion at the time was also to emphasize the ethics of patient autonomy and suffering, and hence my suggested new descriptive moniker of “personal aid in dying.” I noted that the Preamble of our psychiatric ethical principles states that we need to “recognize responsibilities to patients first and foremost.”³

However, I was not thinking of the youth at that time. I also pointed out that the use of the word “suicide” in assisted dying is quite emotionally provocative in its own right and quite different than our usual concern with suicide in our clinical patients.

Shakespeare, hundreds of years ago, had Hamlet poetically address the anguish of being suicidal in his soliloquy of “To be or not to be? That is the question.” Now, our society, so far much less poetically, adds a different kind of suicidal question, that of physician aid in dying.

An overlap of both traditional suicide and aid in what is also called suicide may be increasing, especially for geriatric psychiatrists, as elderly patients increasingly want to process their own considerations about death and dying. Interestingly enough, although there is usually more loss of neurons in old age, “super agers” are actually producing more new neurons and plasticity.⁴

As a recent article in the Washington Post points out, the large number of aging boomers in the United States is likely to influence the legal decisions about aid in dying.⁵ More states are now enacting assisted-suicide laws. There still is the legally available, but slow process of dying by not eating or drinking.

Polling in recent years indicates that most Americans favor the legality of assisted death, though are more ambivalent about the morality. It is notable that the Southern and Midwest states have not made it legal, and that religiosity makes a big difference. Two-thirds of those without significant religious behavior and practice feel it is morality acceptable, while less than one-third in the more strongly religious believe that.⁶

Another challenge is the concern that current formal medical help in dying with hospice and other palliative care is often found wanting. Severely ill, older adult patients often do not have the wherewithal, even if they want to end their own lives. Hence, we have the rise of what are called death doulas to provide practical, emotional, and spiritual support at the end-of-life process.⁷

In recent columns, I have been focusing about what seems more psychologically important to me and others who are entering our 80s. Dying is where “the rubber meets the road” in a slow or quick life stop. As medical problems typically escalate, imagining a more difficult and painful dying process can become normalized. The number 1 topic when elders get together is usually our health and illnesses. For myself and others, I would venture that for many boomers, just knowing we have some availability and control of how to reduce our own anticipated unrelenting suffering, seems psychologically sound and reassuring in itself.

The extremes of age do seem to influence and matter in terms of deciding when and how to die. In general, there is the challenge to successfully resolve the moral preferences of the public, the ethical principles of physicians, and the laws. Due to the potential finality and irreversibility of such death and dying decisions, we need to continue to process and discuss all the numerous variables involved in deciding how to die. As physicians and psychiatrists, perhaps we should consider developing a subspecialty—or at least expert panels beyond personal physician preference—that is more likely to provide objective perspectives when needs be.

Dr Moffic is an award-winning psychiatrist who specializes in the social, cultural, ethical, spiritual, and religious aspects of psychiatry, and since 2012 is in retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekdays column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He has been an advocate and activist for mental health issues related to climate instability, physical burnout, and xenophobia, among other social justice causes, serving on many related local and national community and professional Boards. He serves on the Editorial Board of Psychiatric Times.

References

1. Os J van, Rooij W van, Konrad M. Psychiatric euthanasia in the Netherlands: young people, procedural medicine, and the limits of psychiatry. Psychiatric Times. March 5, 2026. https://www.psychiatrictimes.com/view/psychiatric-euthanasia-in-the-netherlands-young-people-procedural-medicine-and-the-limits-of-psychiatry

2. Moffic HS. Death and personal aid in dying (PAID). Psychiatric Times. June 26, 2025. https://www.psychiatrictimes.com/view/death-and-personal-aid-in-dying-paid

3. The Principles of Medical Ethics, with Annotations Especially Applicable to Psychiatry. American Psychiatric Association; 2013.

4. Lenharo M. Brains of ‘super agers’ are strong producers of new neurons. Nature. 2026;651(8104):20.

5. Neimabadi S. Here’s why some baby boomers are talking about assisted suicide. Washington Post. February 24, 2026. Accessed March 17, 2026. https://www.washingtonpost.com/health/2026/02/22/assisted-suicide-boomers/

6. Yi R. Most Americans favor legal euthanasia. Gallup. August 8, 2024. Accessed March 17, 2026. https://news.gallup.com/poll/648215/americans-favor-legal-euthanasia.aspx

7. Ross W. Find your calling: midwifing the soul. Spirituality and Health. 2026;39-41.