California, like other American states, permits assisted suicide, but not euthanasia, and not assisted assisted suicide. Patients who want to die must administer the lethal drug themselves. So a woman who has purchased the drug but cannot swallow it or inject herself must continue to suffer.

In an article in the American Journal of Bioethics, several prominent bioethicists argue that this is tantamount to discrimination against persons with disabilities. “That creates an underclass of terminally ill patients who, due to their substantially impaired motor function, cannot access a medical procedure legally provided to more-able-bodied terminally ill patients.”

The deficiency of California’s End of Life Option Act, becomes obvious, they contend, in a case decided in a federal court in 2022. Three terminally ill patients with neuromotor disabilities and four aid-in-dying physicians sued to be able to receive aid-in-dying. The judge reluctantly dismissed the lawsuit. He wrote that there is a boundary between assisted suicide and euthanasia which cannot be legally traversed. “The accommodation that the plaintiffs seek—to permit physicians to administer aid-in-dying medication—would traverse this boundary… it would transform the benefit under the act into something else entirely.”

The authors of the AJOB article conclude: “today’s aid-in-dying laws unjustly disenfranchise terminally ill patients with advanced neurologic diseases that impair movement and strength. As they rapidly approach their deaths, these patients deserve equal rights to all end-of-life options.”

Scott Kim, of the National Institutes for Health, wrote a very interesting commentary on AJOB’s focus article. He pointed out that arguments for equal opportunity for assisted suicide are never-ending in principle. There is always someone whose situation lies on the other side of the boundary between being allowed to die and not being allowed to die.

If we truly want to promote equal respect for all human life, there is only one option: an absolute ban on assisted dying. He writes:

So there are three choices: assisted dying with contested boundaries stabilized by a democratic process, which is in turn susceptible to influence of inequalities of power, privilege, and economic resources; assisted dying with no boundaries, an egalitarian dystopia; and finally, assisted dying for none, based on a human rights achievement thousands of years in the making—a deep commitment to the equality of all human lives.