The Plain Dealer and cleveland.com explore the U.S. model of Medical Aid in Dying (MAID) throughout 2026 in its End of Life Ohio Series.
If you would like to share your experiences and thoughts, please email Mary Frances McGowan at mmcgowan@cleveland.com.
By Mary Frances McGowan, cleveland.com
Critics say that our northern neighbors represent a “slippery slope,” given that the populations qualifying for the option extend far beyond the terminally ill, putting vulnerable people at risk.
“We need look no further than the Canadian experiment, where in just 10 years, over 100,000 people have died at the hands of doctors,” Carrie Snyder, Executive Director of Ohio Right to Life, said recently in a statement following the introduction of MAID legislation in Ohio. “Ohio needs to protect vulnerable citizens, not encourage their suicide.”
But the reality is that comparing laws in the United States to Canada’s experience is like comparing apples to oranges.
The first “death with dignity” law in Oregon predated legalization in Canada by nearly two decades. Since then, several other states have followed suit by passing similar legislation with strict guardrails. Canada’s laws are governed on a broader federal basis. The concept of medical aid in dying is rooted in Canadian’s constitutional rights governing life, liberty and security of person.
“Their governing document differs from ours; their legal system differs from ours; their health system differs from ours — so we’re not comparing apples to apples,” said Lisa Vigil Schattinger, the founder of Ohio End of Life Options.
“No disrespect — they have gone through the path that makes sense in their society, and we are going through, hopefully, the path that makes sense in our society. They just differ.”
This story is part of a continuing series published by cleveland.com and The Plain Dealer 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.
Legal origins and differences
In 2015, the Supreme Court of Canada struck down portions of the country’s Criminal Code prohibiting medical aid in dying in the landmark Carter v. Canada decision, ruling that the provisions violated Canadians’ Charter rights to life, liberty and security of the person.
Following the Carter decision, Parliament amended the Criminal Code in 2016 to allow medical aid in dying for eligible adults with “grievous and irremediable” medical conditions, including a requirement that their natural death be “reasonably foreseeable.” After the “reasonably foreseeable death” requirement was deemed unconstitutional by a Quebec court, the law was revised in 2021. That restriction was removed and access was expanded to individuals experiencing “grievous and irremediable” suffering, even if their natural death was not approaching.
Criminal law in Canada is set at the federal level, while health care law is largely governed by provinces and territories. That means MAID is legal across the country under the Criminal Code, but how it’s delivered and overseen can vary depending on where someone lives — just as there are slight variations exist in laws from state to state in the United States.
But the overall, the legal landscape for MAID in the United States is fundamentally different.
The U.S. Supreme Court explicitly ruled in 1997 that no constitutional right to medical aid in dying exists, leaving it up to individual states to determine whether to allow the practice.
That year, Oregon became the first state to do so, and through the years, has been joined by 12 additional states and the District of Columbia. Since the first “death with dignity” law in Oregon, state laws all limit access to the option to adults who are mentally competent and terminally ill with a six month or less prognosis.
Differing eligibility and safeguards
In both the United States and Canada, patients must meet basic eligibility standards for medical aid in dying. They must be adults, capable of making their own medical decisions, and able to make a voluntary, informed request free from outside pressure.
After those minor similarities, the fundamental differences begin.
Canada allows non-terminal patients to qualify and relies primarily on clinician administered euthanasia, unlike the United States, which limits aid in dying to terminal cases and requires patients to self-administer.
In the United States, eligibility is limited to terminal patients with six months or less to live. Patients must be able to give themselves the medication. Both an attending physician and a second independent clinician must confirm a patient’s eligibility. In most states — except Oregon and Vermont — patients must also be residents.
In Canada, patients must meet what the law defines “grievous and irremediable medical condition,” meaning that they have an incurable illness, an advanced and irreversible decline in capability, and suffering that cannot be relieved under conditions acceptable to the patient.
Both countries require multiple layers of safeguards, but Canada’s system has different standards depending on whether a patient’s death is considered “reasonably foreseeable.”
That legal standard also doesn’t necessarily mean a patient is terminal, merely that death is the natural outcome of their current medical condition, even if there isn’t a specific timeline on when death can be determined.
All patients must submit a written request signed by an independent witness and be assessed by at least two independent clinicians. For patients whose death is not reasonably foreseeable, additional safeguards apply:
- A clinician with expertise in their condition may be required.
- Patients must be informed of alternative treatments.
- A 90‑day assessment period generally applies, though it can be shortened if the patient risks losing decision-making capacity.
MAID accounts for roughly 5% of all deaths in Canada, about one in every 20 deaths, the most recently available federal data shows. That’s far greater than in the United States, where it accounts for a fraction of 1% of deaths in states where it is legal.
Critics’ concerns
For critics of Canada’s approach, the root of their concern is that broadly defined eligibility could push vulnerable populations to choose death instead of accessing social services that could improve their conditions. This includes the mentally ill, those who are socially isolated, impoverished and disabled.
Disability rights advocates and the United Nations have raised concerns that some patients are seeking the option for suffering that is tied to their unmet needs such as housing, income, or access to support for their conditions, rather than it being strictly medical.
There are a number of cases critics say illustrate these concerns.
- A man from St. Catharines applied for MAID when facing chronic pain and homelessness. After his neighbors stepped in with a GoFundMe campaign, he found housing and withdrew his application.
- A mother of a young woman experiencing various medical conditions – including cerebral palsy, spina bifida and chronic seizure disorder — said she was told by a doctor that not considering MAID for her daughter was “selfish.”
- A paraplegic former member of the Canadian military testified before the House of Commons that a Veterans Affairs Canada employee offered her MAID as an option when she was fighting for the installation of a wheelchair lift or ramp at her house.
“Choice is not made in a vacuum,” said Dr. Ramona Coelho, a family physician based in London, Ontario, and an opponent of MAID. “It depends on what supports are available to you and what alternatives are being offered.”
Looking ahead
Critics say the law leaves room for interpretation. They argue physicians are given broad discretion in determining who qualifies, which can lead to different outcomes depending on the provider.
They also argue legal protections can be unevenly applied and may not fully address risks tied to depression or lack of access to alternative care.
The scope of the law is able to expand in Canada in the way it cannot in the United States. Canadians can challenge limitations as infringements upon their Charter rights. In the United States, MAID laws are state statues with no basis in fundamental freedoms.
That means the scope of the law in Canada could expand further.
Federal legislation allows for the future inclusion of mental illness as a sole qualifying condition, though that change has been delayed multiple times and is currently set to take effect in 2027. In the United States, those found to be suffering from mental illness are automatically disqualified.
Canadian policymakers have also debated the use of advance requests, which would allow competent adults with incurable illness to decide in advance to access MAID in the future. That might apply to patients with Alzheimer’s or dementia, for instance, where they might ultimately lose the mental capacity to consent.
Those decisions are still being weighed. The answers could shape how broadly the system is applied in the years ahead.
Opponents cite various primary reasons for their resistance – from personal philosophical differences to fears that legal guardrails present in these laws are insufficient. But the through-line connecting them is a fear that permitting what they consider to be suicide as a healthcare option opens a Pandora’s Box.
“Our major objection is that once suicide is considered a treatment option, that even people who never would have considered this are left to justify why they don’t want to have this aid in dying, rather than why they do this,” said Carrie Snyder, executive director of Ohio Right to Life, which holds significant influence on Capitol Square.
“It’s like a cancer, you know, a Pandora’s box, where you can’t stop that when you have a legal pathway, you just can’t stop that from expanding,” she said.
Logistical hurdles
Rep. Eric Synenberg, a Beachwood Democrat, last month introduced the Ohio Medical Aid in Dying Act, which would require patients to meet the same eligibility standards used in other states where the option is legal.
Eligible patients would be adults with a terminal illness and a prognosis of six months or less to live. They would need to be mentally capable of making medical decisions, physically able to self-administer the medication, and have their eligibility confirmed by both an attending physician and a second, independent consulting physician.
Patients would also be required to make two oral requests to a physician—separated by at least five days unless death is imminent—and submit a written request witnessed by two people, including one who is independent of the patient.
The bill is pending before the Ohio House Health Committee, where it is expected to face significant opposition. At least six of the committee’s 13 members, including its chairwoman, belong to the House Pro-Life Caucus, which is expected to oppose such legislation. Other influential lobby groups, including the Catholic Conference of Ohio and the Center for Christian Virtue, have also come out against the proposal.
The measure is guaranteed at least one hearing at which Synenberg can make his case in sponsor testimony, but it will be months before it advances, if at all. READ MORE
April 26, 2026
By Mary Frances McGowan, cleveland.com
COLUMBUS, Ohio – Eight years after similar legislation stalled at the Statehouse, Ohio lawmakers are again weighing whether terminally ill residents should be able to determine the timing of their death.
Rep. Eric Synenberg this week introduced legislation to legalize “medical aid in dying” in Ohio, allowing mentally competent adults with a terminal diagnosis and six months or less to live to hasten their deaths by taking a lethal dose of medication prescribed by a physician.
The proposal follows reporting by cleveland.com and The Plain Dealer, on Ohioans who sought the option out of state, including David Hollister of Chagrin Falls. Hollister urged lawmakers to act shortly before his death in September, and Synenberg introduced the bill one day before what would have been Hollister’s 65th birthday.
“He wanted a dignified end-of-life option that would not require him to leave his home to receive that care,” Synenberg said. “Sadly, David is no longer with us today, and one day before what would have been his birthday … I want to recognize David for his advocacy.”
Synenberg, a Beachwood Democrat, knows that it won’t be an easy fight. When similar legislation was introduced in 2018, it received one hearing and failed to advance out of committee.
Recent public polling has shown that most Americans are open to medical aid in dying, and advocates say that public education on the subject has improved since the last legislative battle.
Yet opposition to such legislation is also strong, particularly among the religious.
Opponents say that built-in safeguards are insufficient, even though state oversight reports in Oregon, where medical aid in dying has been legal since 1997, have not identified documented cases of prosecuted coercion.
Others fear that the law could be further expanded or argue that medical aid in dying clashes with the medical principle of “do no harm.”
Synenberg and other supporters hope that despite the challenges ahead, the new bill can move the conversation forward.
“I know we will get some pushback on this bill in the legislature, but my ask today is that my colleagues on both sides of the aisle consider having civil discourse on this bill,” Synenberg said during a press conference on Thursday.
“Let us allow people from all perspectives to come to committee and testify and be part of this conversation.”
The 2026 Ohio Medical Aid in Dying Act- READ MORE
March 22, 2026
By Mary Frances McGowan
CLEVELAND, Ohio — Terminally ill Ohioans who want to decide when life should end have few options, with just two states on opposite coasts offering a legal path for nonresidents to access medical aid in dying: Oregon and Vermont.
On paper, the opportunity for patients and caregivers to avoid prolonged suffering by taking a trip out of state seems straightforward. But Ohioans who have taken on the challenge often find that the actual process is filled with financial and logistical obstacles that can end in frustration.
That was Liz Madigan’s experience. She helped her terminally ill sister, Pat Knippen, research traveling to Oregon — but Pat died before they could make the trip.
“She wanted the choice,” Madigan, a former hospice nurse from Concord, said. “And you know, the fact that we had to think about taking her either to one coast or the other to have that option … it just hurt.”
Dana Hollister of Chagrin Falls expressed similar frustration. She and her husband, David, investigated traveling to Vermont after he was diagnosed with ALS. Ultimately, they were forced to give up as David’s health began to decline.
“It just got too complicated,” Hollister said.
Ohio doesn’t allow medical aid in dying — a process to allow a terminally ill, mentally competent adult to hasten their death by taking a lethal dose of medication prescribed by a physician.
Advocates say it is a process that allows terminally ill patients to die with dignity on their own terms. Twelve states and the District of Columbia have enacted laws allowing it. In Montana, medical aid in dying is permitted through a court ruling.
Opponents fear that despite safeguards, the process clashes with the medical principle of “do no harm.” Some argue against the idea based on religious convictions.
But even in states where it is available for nonresidents, navigating complex medical logistics in a new place and doing that before the body becomes too weak is often too big of a burden.
Universal guardrails – Read More on Cleveland.com
With more than a dozen states having such laws, The Plain Dealer/cleveland.com is seeking to broaden understanding and gauge public views of what such a law might mean if adopted in Ohio.
As reporter Mary Frances McGowan noted in a recent story, “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?”
But as McGowan also reported, opposition to the idea is fervent, with opponents calling it “physician-assisted suicide,” and many religious leaders strongly opposed to what amounts to an individual deciding to take their own life with the help of pills provided by a doctor.
A 2018 attempt in Ohio to legalize such a decision by a mentally competent, terminally ill patient never made it out of committee.
So how do members of our Editorial Board Roundtable view this possibility now?
Thomas Suddes, editorial writer:
No — absolutely not. True, the plan would require conscious, articulate consent by a dying person, and oversight by a physician, but the dangers of even implicit coercion by potential survivors could still factor into a patient’s decisions. And ascertaining a dying patient’s state of mind — as to intentions — may be nearly impossible. What Ohio must instead do is offer all Ohioans top-line end-of-life care, and full availability of palliative drugs.
Ted Diadiun, columnist:
My religious, spiritual and personal beliefs all scream against this, and I cannot imagine ever taking part on any level. But I have trouble arguing that it should be illegal for a person who draws different conclusions to make a different decision. This is a situation where “my body, my choice” applies. It’s different from abortion: The life you end is your own only. It should be up to you.
Eric Foster, columnist:
No one questions the availability of health care directives, documents in which people can choose to decline medical treatment that could keep them alive. I don’t see a law allowing someone to choose medical treatment that would end his or her life as an entirely different thing. People should have that choice. Frankly, I don’t see it as my business to deny them that. Live and let live. Or die.
Lisa Garvin, editorial board member:
Extending the life of terminally ill patients wreaks an enormous emotional and financial toll. Why wouldn’t people want to spare their loved ones that burden and pass with dignity on their own terms? And why do some doctors insist on continued treatment of terminal patients, knowing that it’s futile? Medical aid in dying is a compassionate extension of the do-not-resuscitate order that allows us to refuse life-saving treatment.
Victor Ruiz, editorial board member:
Some people feel the need to control every part of human life, from forcing births, to policing how people live, to insisting that a terminally ill person must suffer through their final days. To me, that is cruel. If someone is competent, they should be able to choose dignity over pain. We should be fighting for quality of life for everyone, including health care that supports a good life and a good end.
Mary Cay Doherty, editorial board member:
The American Medical Association rightly opposes physician-assisted suicide and refuses to use the misleading “medical aid in dying” euphemism. While these laws purport to compassionately hasten death and preserve dignity for the terminally ill, they undermine and imperil the right to life for everyone. It’s a slippery slope from terminally ill patients “choosing” death to a culture of death where the right to life hinges on age, ability, and health.
[Ohio End of Life Options response on Facebook:
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.”