Once we accept killing as an answer to suffering, suicide and homicide are transformed into a ‘good.’

ALS is a catastrophic terminal disease that, within a few years of diagnosis (the physicist Stephen Hawking was an exception), eventually causes total paralysis. It is also a tragic condition that euthanasia/assisted suicide activists zealously wield to justify killing as an acceptable answer to suffering.

Now, the understandable fear of ALS is being deployed by academic advocates as a means of breaking the (U.S.) requirement for a six-month terminal diagnosis and self-administration in assisted suicide.

In jurisdictions where MAiD [the euphemism for assisted suicide that seeks to turn life-ending it into a medical “treatment”]is legally available, such laws are intended to support patient autonomy and alleviate suffering. However, for patients with ALS, the clinical reality of progressive paralysis combined with legal requirements for self-administration of lethal medication creates a cruel dilemma. Approximately one-third of affected individuals express interest in MAiD if their suffering becomes intolerable [12], yet current laws require that it be initiated while patients retain the physical ability to self-administer the prescribed medication.

However, patients are not legally eligible to access MAiD until it is determined they have a life expectancy of six months or less. This creates a narrow and clinically unrealistic window where waiting until they meet legal eligibility may mean they are no longer physically capable of completing the required act, regardless of prognosis, suffering, or intent.

According to the authors, these protections are discriminatory “barriers” to death:

These laws permit terminally ill, mentally competent adults to request and self-administer physician-prescribed lethal medications. However, all include a non-negotiable requirement that the patient must perform the final act of administration independently. Self-administration is strictly interpreted as an “affirmative, conscious, and physical” action taken by the patient, without direct assistance from another individual, even if the patient is physically incapable of performing that act due to disease progression. For patients with ALS, especially those with advanced-stage disease, this requirement functions as a barrier to access.

The answer to this injustice? Loosen the existing limitations:

The requirement for self-administration in US MAiD statutes creates a predictable and preventable barrier for patients with ALS. While some jurisdictions have improved procedural access, most laws remain misaligned with the realities of progressive neuromuscular disease. International legislative reforms demonstrate that it is possible to uphold safeguards without excluding patients based on physical ability. Addressing this issue is not about expanding MAiD access broadly, but about eliminating a narrow structural exclusion that uniquely burdens patients who meet every other legal and ethical criterion. Individuals with ALS should not be denied a legal medical option simply because they cannot swallow a pill or press a syringe. Overall, aligning MAiD statutes with clinical realities and disability rights is not only feasible, but ethically imperative.

I would argue that providing proper care for all terminally ill patients is the ethical imperative, not enabling some patients to be lethally injected.

And don’t think that allowing active euthanasia would long be limited to people with ALS. Allowing medicalized homicide would eventually leak into other disabling conditions. It would also lead to advocacy for allowing suicidal people who don’t want to experience the difficulty of swallowing a massive overdose to become eligible for the lethal jab, which comes with a lesser likelihood of serious side effects such as convulsions and extended coma.

Alas, the logic is impeccable. Once we accept killing as an answer to suffering, suicide/homicide are transformed into a “good” and becoming dead into a “right.”

Ironically, the most effective opponents of assisted suicide are disability rights activists because they — correctly, in my view — see the movement as discriminating against them by creating the principle that dependency makes one worthy of induced death. Still, some might say, so what? ALS is so awful that anyone would want assisted suicide to be available as an escape.

Not so. My late friend Robert Salamanca had ALS (I met him as a hospice volunteer) and was furious that people like him were used by activists to further the death agenda. From his “I Don’t Want a Choice to Die,” first published in the San Francisco Chronicle.

Euthanasia advocates believe they are doing people like me a favor. They are not. The negative emotions toward the terminally ill and disabled generated by their advocacy is actually at the expense of the “dying” and their families and friends. We often feel disheartened and without self-assurance because of a false picture of what it is like to die created by these enthusiasts who prey on the misinformed.

What we, the terminally ill, need is exactly the opposite — to realize how important our lives are. And our loved ones, friends, and, indeed, society need to help us feel that we are loved and appreciated unconditionally.

Bob died peacefully — with dignity — of ALS in his sleep. I was honored to give his eulogy.