NEW YORK − When Susan Rahn dies, she wants a party.
The 55-year-old grandmother from Webster, New York, has Stage 4 metastatic breast cancer.
Rahn considers herself lucky for having lived far beyond her expected lifespan at the time of her diagnosis over a decade ago, thanks to advances in medicine. That allowed her to watch her son, now 27, graduate high school, then college, and start his own family. Rahn regularly babysits her two granddaughters. In May, they went to Disney World for Rahn's birthday.
Rahn's cancer has spread to her bones and lungs. Though she doesn't know when she'll die, she knows the cancer will be suffocating. When death is close, she'd like to leave everyone with happy memories.
"We have a lot of choices when it comes to life," Rahn said in an interview. "When it comes to navigating what our death looks like, there's really not very many choices. And a lot of time, the choice has been made for us."
That's why she hopes to use a forthcoming state law allowing terminally ill people tovoluntarily end their life. New York is set to become the latest state to pass itsMedical Aid in Dying Actwhen Gov. Kathy Hochul is expected to sign it into law in the coming days.
When it takes effect six months after Hochul signs the legislation, patients with less than six months to live will be able to legally obtain a lethal prescription and administer it themselves. Because of additional restrictions under New York's law, including the delay on its implementation, Rahn worries the legislation she fought years for by sharing her story in appeals to lawmakers might not be available to her if cancer spreads too far too quickly.
New York would be the 13th state to have an aid-in-dying law. The first such law was enacted by Oregon in 1994. Except for Montana, the states are all Democratic-leaning.
All state laws have protections meant to ensure patients aren't forced into dying. New York's legislation−which requires mandatory waiting periods, added mental health evaluations and limits to prevent family or others from receiving financial benefits from a person's death − is more strict than most.
Proponents said it's an option for terminally ill patients to have the right to die on their terms, when pain can no longer be managed at the end of life.
"They know they're dying, and they just want that security," said Amy Paulin, the New York Democratic state assemblywoman who fought for the legislation for more than a decade. "That's very important for our loved ones, and our families, to have that security blanket."
Not a choice, diverse range of critics say
Opponents hope to see the laws, which they call assisted suicide, ended. Opposition stems from a range of views around ending life, including medical ethical guidelines, firm religious doctrine and concerns around disability rights.
They say the laws create a slippery slope that can expand to vulnerable groups who might be pressured to obtain lethal prescriptions. Legal and medical experts said the United States has more restrictive state laws than other countries, confined only to those who are gravely ill and make their own decisions. In Belgium, for example, the European country's more expansive law for euthanasia, when the doctor administers the lethal drug, allows deaths forpsychiatric illnessesandterminally ill minors.
"It's discrimination against people with disabilities," said Daniese McMullin-Powell, 80, a disability rights activist in Delaware, where the state'sEnd-of-Life Options Act took effect Jan. 1. McMullin-Powell, who had polio as a child and uses a wheelchair, is involved with Not Dead Yet Delaware, which is challenging the state's law.
"The guardrails, they keep saying they're protective," McMullin-Powell said. "But mostly, they're protective of the people providing the drugs and making the determinations that you're terminal. Often, people with disabilities are considered terminal even when they're not."
McMullin-Powell said she has seen her husband, who experienced a severe stroke, always come home from hospital visits. Her parents died in hospice at home, and her father had prostate cancer but lived several years longer than expected. McMullin-Powell sees a need to make better health care and pain management available instead of aid-in-dying laws, which she fears can be used to pressure people with disabilities to end their lives.
As a self-described liberal, she doesn't view the issue as political or religious. But much of the opposition is from the Catholic Church and Trump-aligned conservatives.
Project 2025, the Heritage Foundation's plan for the second Trump administration, aims to curtail laws around the country through federal oversight and action, particularly by using legal protections for people with disabilities. The conservative think tank has proposed improvements to palliative care by the Department of Health and Human Services.
"HHS has the authority to take the actions against these states with their quality-of-life regulations protecting persons with disabilities," said Roger Severino, director of the agency's civil rights office in President Donald Trump's first term. Severino is now vice president for economic and domestic policy at the Heritage Foundation. "They should act, because everybody has inherent dignity, and a person's disability doesn't change that."
What are medical aid-in-dying laws?
Since Oregon voters narrowly passed their law in 1994, a growing number of states and the District of Columbia have followed suit with similar legislation. About adozen states, from Arizona to Massachusetts, have pending legislation to legalize medical aid in dying, according toDeath with Dignity, an advocacy organization that supports andtracks laws around the country.
Most states allow only residents to obtain aid in dying; others allow people to travel to their state to obtain a lethal prescription. But the laws follow three basic principles, said Dr. David Orentlicher, director of the University of Nevada, Las Vegas, Health Law Program. They depend on a patient being terminally ill with a life expectancy of no more than six months. Additionally, the person must be mentally competent to make his or her own decision. Lastly, the patient must administer the drug themselves. This means some people dying with debilitating physical diseases may have difficulty administering their own lethal medication under the law.
Every state allows a patient to refuse lifesaving treatment. Aid-in-dying laws extend that logic to terminally ill patients to end intolerable, grave suffering, said Orentlicher, who is also a Democratic state lawmaker in Nevada.
"You can choose quality of life over length of life," Orentlicher said.
Determinations of who qualifies are made by medical providers. There are also waiting periods to fill a prescription, and states require annual reports on death data.
The cocktail commonly used by most doctors is called DDMAPh, the cocktail of high doses of digoxin, a heart drug; diazepam, or valium; morphine; amitriptyline, which is an antidepressant that also affects heart rhythm; and phenobarbital, a barbiturate. Recent medications make it as easy as a powder to pour into a glass of water or apple juice.
People become unconscious within a few minutes, and the median time to death is typically under an hour, though it can be longer, according to anOregon Health Authority reportin 2024.
The choice is rarely made to use the drug.
In the dozen states where it's legal, fewer than 1% of deaths are attributed to aid in dying, Orentlicher said. Figures are higher in other countries that have aid-in-dying laws, such as Canada, where it's about 5%, according togovernment records.
There's also no guarantee that people who are prescribed lethal medication use it. On average, about 30% of prescriptions aren't used, according to Death with Dignity.
Opponents have cited concerns about the potential of abuse of vulnerable groups under such laws. Orentlicher said it's aslippery-slope argumentthat doesn't hold.
A2022 study, using data over 23 years from American jurisdictions that have aid-in-dying laws, showed those who died from a legal prescription were overwhelmingly college-educated, White and had cancer diagnoses. Oregon's 2024 report indicated more than half of patients had cancer, followed by neurological disease and heart disease.
A2007 reviewof patients in Oregon and the Netherlands, which has allowed euthanasia and aid in dying since 2002, found those who received life-ending treatment tended to also be wealthier. There wasn't evidence of abuse for people with disabilities and racial or ethnic minorities, but people with AIDS had a higher chance of participating.
Shifting opinions
American public opinion has gradually shifted to support aid-in-dying laws. More than two-thirds of people surveyed support such legislation,Gallup foundin 2024. Arecent poll in New York, commissioned by a pro-medical aid-in-dying group, found 68% of registered voters supported the bill. Most who are religious or conservative staunchly opposed the practice.
Paulin, the state lawmaker, introduced the bill in 2016, a year after her sister Jane died in hospice from ovarian cancer. Paulin said her death wasn't the motivating factor for the bill.
But Paulin said she saw views change on aid in dying, particularly among younger lawmakers, and support grew from some former opponents who had experienced the prolonged death of terminally ill loved ones.
Hochul, who is Catholic, wrestled with the question beforedeclaring in mid-Decemberthat she would sign the bill into law. In a statement, she pointed to her mother's death from ALS and the "pain of seeing someone you love suffer and being powerless to stop it."
Lawmakers agreed to more restrictions to appease the governor. Among those are a mandatory five-day waiting period from when a doctor writes a prescription and when it is filled; a required mental health evaluation by a psychologist or psychiatrist; and an oral request from the patient by video or audio. There are also limits on who can serve as a witness, measures to prevent any financial benefit from a patient's death, and an extension to six months before the law takes effect.
Regardless, the New York State Catholic Conference issued a stern rebuke of the legislation. In ajoint statement Dec. 16, New York bishops said they "pray that our state turn away from its promotion of a Culture of Death."
The Catholic Church has firmly opposed what it sees as a sin akin to homicide and suicide, said the Rev. Peter Clark, director of Saint Joseph University's Institute of Clinical Bioethics in Philadelphia.
"The church is against any direct killing because it would go against the whole position on sanctity of human life," Clark said. "God gives life. Only God takes away life."
Rahn, the New York grandmother, is also Catholic. She wants to live and is not suicidal. But she knows she will die from cancer. She doesn't want her death to be painful and prolonged.
"God doesn't want to see people suffer," she said. "He's a compassionate God."
TheAmerican Medical Association, which represents doctors nationwide, also opposes what it views as physician-assisted suicide. Its policy says the "practices are fundamentally inconsistent with the physician's role as healer."
Conversely, theMedical Society of the State of New York, a doctors' association, supported the state's legislation. The group applauded a provision ensuring physicians can opt out of helping a patient receive life-ending treatment.
Accepting death
Dr. Charles Blanke sees his role as helping people who are suffering and know they're dying.
Blanke, a professor of medicine at Oregon Health and Science University in Portland, writes 100 to 140 prescriptions for lethal medication a year. He issued his first prescription in 1998, the year after Oregon allowed its law to take effect after a Supreme Court ruling upheld the law.
Most of Blanke's patients come from out of state. About two-thirds of patients end up using the prescription, he said, and he doesn't suggest or push the prescription.
Blanke said his patients are suffering and have no control over the diseases afflicting them after all other treatments have failed.
"I am helping my patients who often don't have any other option," he said.
At her final party, Rahn said, she has a playlist ready, including an Elton John and Rina Sawayama song, "Chosen Family." The food she'd serve would be up to her husband, Jeff. She plans to have her 12-year-old dog by her side.
After saying her goodbyes, she'd take her medication and fall asleep.
Eduardo Cuevas is based in New York City. Reach him by email atemcuevas1@usatoday.comor on Signal at emcuevas.01.
This article originally appeared on USA TODAY:New York to become latest state to allow aid in dying. What is it?
