Just over thirty years ago, Oregon became the first state to allow physicians to intentionally seek death as part of healthcare. At the time, discussions of Jack Kevorkian were all the rage, along with his slogan, “dying is not a crime.” However, questions about expanding assisted suicide and euthanasia are not merely a thing of the past. Recently, The Economist and The New York Times have each run in-depth articles sympathetic to euthanasia, and the states of Illinois and New York have legalized assisted suicide.
After Oregon’s 1994 “Death with Dignity” law took effect, the Jesuit moral theologian James Keenan published an important article, “The Case for Physician-Assisted Suicide?” in which he asked what the representative case would be for physician-assisted suicide (PAS)—or as it goes by now, “medical aid in dying” (MAiD). In the article, Keenan asked whether the standard rhetorical example is actually a representative case that reflects the typical MAiD patient, and if not, what that means. He presented the familiar case of “Uncle Louis,” which I might summarize as: Uncle Louis is very old and has lived a full life. He is dying of a debilitating, incurable cancer that has no good pain management. Uncle Louis has had a conversation about MAiD with his long-time physician with whom he has a good relationship. They have tried everything else and as a last resort Uncle Louis (autonomously and freely) decides that he would like “medical aid in dying.” Why should we not affirm Uncle Louis’s choice to die early and on his own terms in order to avoid pain and preserve his “sense of self?” Why should he be left to suffer?
Keenan’s conclusion is clear: Uncle Louis is not the representative case. Rather, he argued thirty years ago, the more probable average case was that of Mary X—a woman who had a progressive chronic condition, who feared dependence on her family and others, and who was depressed. Mary probably did not have proper medical coverage or access to counseling and thought MAiD was her only option. Mary’s case, Keenan starkly observes, “demonstrates not the lack of autonomy (autonomy is, after all, only for those with power), but rather the inequities in our country … Proponents for the case of Uncle Louis … are only interested in the autonomous person … [Ultimately,] the law that Uncle Louis wants invalidated is the same law that keeps the more common Mary X from being marginalized to death.”
Throughout the last thirty years, however, those who have argued that euthanasia and assisted suicide are always wrong and a public danger have been met with charges of being uncaring and promises that the implementation of such programs would be responsible, regulated, data-driven, and equitable. Indeed, after thirty years, we can ask whether Keenan was right when he argued that the more likely case once euthanasia is implemented would be a vulnerable Mary X rather than an autonomous Uncle Louis. Did the regulations bring about the intended results?
A New Case for Medical-Aid-In-Dying? https://t.co/VIivnP9Qa0
— Public Discourse (@PublicDiscourse) May 26, 2026