February 22, 2026

by Mary Frances McGowan, mmcgowan@cleveland.com

In a growing number of states, terminally ill patients now have a legal option that would have been unthinkable to many Americans a generation ago: a doctor’s prescription that allows them to end their own life.

The question is one of the most personal in modern health policy: Should a mentally competent, terminally ill person be allowed — with state approval and medical oversight — to choose the timing of their death?

Supporters call it “medical aid in dying,” a last-resort option for those facing unbearable suffering. Opponents call it physician-assisted suicide and warn it could put vulnerable people at risk.

The debate is accelerating — and it’s reaching closer to Ohio.

Cleveland.com and The Plain Dealer will publish a continuing series involving the multitude of issues involving end-of-life decisions, including hospice care, the costs of care for the terminally ill, ethics, legal issues and more.

If you’ve experienced these issues in your family and are willing to discuss your experiences and thoughts, please email Mary Frances McGowan at mmcgowan@cleveland.com.

More than a dozen states have adopted “death with dignity” laws, all with strict regulations. Last year, Illinois became the first Midwestern state to legalize the practice. Most recently was New York, where a law was signed this month.

The laws are an effort toward allowing a patient to choose when they die instead of prolonging a time of anguish and agony for themselves and their families.

A leading advocate in Ohio says she hears that story every day.

“You hear the same thing over and over. ‘I just wanted them not to suffer, and I wanted them to feel like they had a sense of control if that’s what they wanted,’” said Lisa Vigil Schattinger, the founder of Ohio End of Life Options.

When some Ohio lawmakers proposed legislation in 2018, a Public Policy Polling survey found 87% of Ohio voters either strongly support (71%) or somewhat support (16%) giving terminally ill patients the right to control the end of their lives and should be allowed to die in as humane and dignified a manner as they see fit. This was true across political party lines.

But opponents fear that despite safeguards, the process clashes with the medical principle of “do no harm” and that vulnerable people could still slip through the cracks.

“The guardrails (for medical aid in dying) are absolutely well intentioned. … But I just think there are so many vulnerabilities,” says Dr. Jason Kolb, an assistant professor of clinical emergency medicine at Northeast Ohio Medical University and member of the organization No Suicide Ohio.

“The guardrails are absolutely well intentioned. … But I just think there are so many vulnerabilities,” said Dr. Jason Kolb, an assistant professor of clinical emergency medicine at Northeast Ohio Medical University, and member of the organization No Suicide Ohio.

ORIGINS AND PARTICIPANTS

Medical aid in dying is the legal pathway to allow a terminally ill, mentally competent adult to hasten their death by taking a lethal dose of medication prescribed by a physician.

Medical aid in dying is often confused with euthanasia, but the two are fundamentally different. Active euthanasia is illegal in all 50 states and involves a physician taking a direct role in ending a patient’s life through lethal injection. Medical aid in dying, by contrast, is a patient-led process in which an individual must ingest the medication themselves.

“Physician assisted suicide,” is the preferred terminology of the American Medical Association, which has long opposed the practice. However, jurisdictions where the option exists do not legally consider it suicide.

Oregon became the first state to offer medical aid in dying nearly three decades ago with its Death with Dignity Act in 1997. Now there are similar laws in 13 states and the District of Columbia.

Legislation is also pending in several other states. But Ohio doesn’t have a similar law, and there is no legislation pending in the General Assembly.

In states where the option is available, individuals who use medical aid in dying skew older. A 2022 Rutgers University study found that of 5,329 patients from across the country who died with the help of medical aid, 60% were ages 65 to 84. Another 16% were older than 85. Just 8% were 54 years old or younger.

Men outnumbered women 53% to 47%. More than 72% of the patients had at least some college education. More than 95% were non-Hispanic whites, and nearly 75% had cancer.

“I definitely see it expanding, and I would love to see Ohio push back in a really productive, healthy way to say, end of life suffering is a real problem. Physician assisted suicide is the wrong solution.”

Dr. Jason Kolb, who became paralyzed from the waist down in a skiing accident years ago

STATE RULES AND LIMITATIONS

State laws have some variations — including differing waiting periods and residency requirements —the parameters that qualify patients for medical aid in dying are consistent. Patients must be adults who are terminally ill with a prognosis of six months or less to live. Those conditions mirror those needed to qualify for hospice care. In fact, a large majority of patients who use medical aid in dying are simultaneously enrolled in hospice care.

Patients must be deemed mentally capable of making their own health care decisions. They must be capable of taking the medication, usually pills, themselves. In most jurisdictions, except for Oregon and Vermont, patients also must be state residents.

State laws also include additional safeguards to prevent abuse and coercion.

Only the patient can request the medication and only after consulting multiple licensed healthcare providers to determine their eligibility, including the attending physician primarily responsible for the patient’s health care.

A second independent review of the patient’s medical records by another provider is required to confirm the patient’s terminal diagnosis, prognosis, and mental capacity. A mental health evaluation may also be required.

The process requires patients to make formal written and multiple oral requests with their physicians, separated by varying waiting periods. Witness signatures are needed on written requests to ensure no coercion. At least one witness must have no relationship with the patient and cannot benefit from their estate.

Patients can change their minds, too. They can decide to rescind their request for medical aid in dying or simply opt to never take the medication. About two-thirds of people with prescriptions ingest the medication and die, according to a report.

OPPONENTS FEAR A ‘SLIPPERY SLOPE’

There have not been any substantiated cases of abuse or coercion since the implementation of Oregon’s law in 1997, but opponents fear these laws are a “slippery slope,” that could be further expanded.

Some make religious arguments against the practice. Others fear laws in the United States could eventually be more expansive and less restrictive, as is the case in some other countries like neighboring Canada.

The American Medical Association acknowledges that physicians overall hold diverse opinions, and said in 2019 physicians could provide medical aid in dying “according to the dictates of their conscience without violating their professional obligations.” But it did not endorse the practice.

Since 1998, Oregon’s Death with Dignity Act has allowed Oregonians who meet certain conditions to receive prescription medications to help them end their life.

Kolb, the member of No Suicide Ohio, argues that determining that a patient’s prognosis is terminal can be imprecise, and that individuals who experience more subtle expressions of mental illnesses like depression or early cognitive impairment symptoms could slip through the cracks.

Kolb, who became paralyzed from the waist down after a skiing accident years ago, says his experience makes him personally understand acute suffering. However, he believes assisted death is the wrong solution to very real problems.

His hope is that Ohio becomes a leader in opposing medical-aid-in-dying laws.

“(Nationally) I definitely see it expanding, and I would love to see Ohio push back in a really productive, healthy way to say, end of life suffering is a real problem. Physician assisted suicide is the wrong solution,” he said.

ADVOCATES SEEK A SENSE OF CONTROL

Vigil Schattinger, the founder of Ohio End of Life Options, says she hears from families every day who wanted their loved ones with terminal illnesses to suffer less and find comfort in their final days.

Advocates say that’s the point. Giving patients the autonomy to make their own decisions about their lives, including how it ends, is at the center of what drives them.

New York Gov. Kathy Hochul focused on that point when she signed her state’s law this month. Hochul said she grappled with competing influences — her Catholic faith, which opposes these laws, and her belief that government should protect individual rights. She found clarity at a funeral where the priest discussed death as being called home to eternal life.

“I think that as people understand how these laws work effectively in other states, that they will just continue to ask for this option, as they are in Ohio.” Vigil Schattinger, who watched her father-in-law die after using Oregon’s law in 2014

“I realized we’re not talking about ending life early, we’re talking about dying early. So that people can transition surrounded by family, loved ones, not in a hospital bed with strangers … after grueling pain, sometimes just unbearable for loved ones to witness,” Hochul said.

That was Vigil Schattinger’s experience, and the beginning of her advocacy. She watched her stepfather, Dr. Jack Rowe, die after using Oregon’s Death with Dignity Act in 2014.

“Now there’s 14 jurisdictions that allow this. At the time that Jack died, there were three,” Schattinger said. “I think that as people understand how these laws work effectively in other states, that they will just continue to ask for this option, as they are in Ohio.”

Retired Assistant U.S. Attorney Ann Rowland, who leads Ohio End of Life Options’ policy advisory group, experienced caring for her brother-in-law at the end of his life after he was diagnosed with glioblastoma multiforme, a form of brain cancer.

“The hospice team was outstanding, but they could do nothing about many of the predictable indignities John suffered at the end of his life,” Rowland wrote in an opinion piece for cleveland.com/The Plain Dealer in 2019. “I don’t know if he would have chosen medical aid in dying if it had been available to him, but I know I would if I were suffering the way he did.”

Rowland said her eventual hope for Ohioans is that they have all the end-of-life options possible available to them.

“We want, for Ohioans, the ability to choose from a whole array of options as they’re facing their terminal illnesses, whether it be palliative care, hospice care, medical aid in dying or at various times, all three,” Rowland said. “This is not an either-or situation.”