Opinion: Medical aid in dying and the burden of choosing to live

Earlier this month, New York made medical aid in dying (MAiD) available to terminally ill patients with less than six months to live. Unlike most states, it requires patients to record their oral request on audio or video, a safeguard meant to prove the choice is genuinely the patient's. Proponents argue that giving people the choice to end their lives on their own terms empowers them, but the author contends this view of autonomy is too simple.

Philosopher David Velleman challenged the premise that more choice always means more autonomy. He argued that simply having an option can be harmful, even if it is never exercised, and even if exercising it brings benefits. The author illustrates this with a teacher offering free tutoring to a student who is already doing well; the offer plants doubt, and even if the student accepts and benefits, he would have been better off never having received the offer.

Applied to MAiD, the availability of death as a medically sanctioned option changes what it means to stay alive. Without MAiD, living is the default; with it, remaining alive becomes a choice that may require justification. The author concludes that this shift robs patients of the ability to simply live without having to choose not to die, and that encountering death as an option presented by one's physician is fundamentally different from recognizing suicide as a abstract possibility.