Legalize Assisted Suicide

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Thursday, November 13, 2014

In 1994, Oregon voters passed the Death with Dignity Act, which legalized physician-assisted suicide for the terminally ill. Since then, it has become legal in 4 more states, including New Mexico, where the state court ruling that it is constitutional is under appeal. Is it, in the words of the American Medical Association’s code of ethics, “fundamentally incompatible with the physician’s role as healer”? Will these laws lead to a slippery slope, where the vulnerable are pressured to choose death and human life is devalued? Or do we need to recognize everyone’s basic right to autonomy, the right to end pain and suffering, and the right to choose to die with dignity?

  • PeterSinger90


    Peter Singer

    Philosopher & Professor of Bioethics, Princeton University

  • Andrew-Solomon90


    Andrew Solomon

    Author, Far From the Tree & Prof. of Clinical Psychology, Columbia University

  • 010Baroness-llora-Finlay Sian-Trenberth-Photography90


    Baroness Ilora Finlay

    President, British Medical Association & Member, House of Lords

  • sulmasy-headshot-2-90


    Dr. Daniel Sulmasy

    Prof. of Medicine and Ethics, University of Chicago & Member, Presidential Bioethics Commission

    • Moderator Image


      John Donvan

      Author & Correspondent for ABC News

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For The Motion

Peter Singer

Philosopher & Professor of Bioethics, Princeton University

Peter Singer is a philosopher and author, best known for his work in ethics, and often described as the world’s most influential living philosopher. He is the Ira W. DeCamp Professor of Bioethics in the University Center for Human Values at Princeton University, a position that he now combines with the part-time position of Laureate Professor at the University of Melbourne. His books include Animal Liberation, Practical Ethics, Rethinking Life and Death, One World, The Life You Can Save and The Point of View of the Universe. In 2014 the Gottlieb Duttweiler Institute ranked him third on its list of Global Thought Leaders, and Time has ranked him among the world’s 100 most influential people. An Australian, in 2012 he was made a Companion to the Order of Australia, his country’s highest civilian honor.

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For The Motion

Andrew Solomon

Author, Far From the Tree & Prof. of Clinical Psychology, Columbia University

Andrew Solomon is a writer, lecturer, and a professor of clinical psychology at Columbia University. Solomon's newest book, Far From the Tree: Parents, Children, and the Search for Identity (2012), won the National Book Critics Circle award for nonfiction and was chosen as one of the New York Times “Ten Best Books” of 2012. Solomon’s previous book, The Noonday Demon: An Atlas of Depression (2001) won the National Book Award for nonfiction and was a finalist for the Pulitzer Prize. He is a director of the University of Michigan Depression Center and Columbia Psychiatry; a member of the board of visitors of Columbia University Medical Center, of the national advisory board of the Depression Center at the University of Michigan, and on the advisory board of the Depression and Bipolar Support Alliance. In 2011, he was appointed special advisor on Lesbian, Gay, Bisexual, and Transgender Mental Health at the Yale School of Psychiatry.

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Against The Motion

Baroness Ilora Finlay

President, British Medical Association & Member, House of Lords

Baroness Ilora Finlay, a leading palliative care physician, is president of the British Medical Association (2014-15), president of the Chartered Society of Physiotherapy, and is a past president of the Royal Society of Medicine. She has led Palliative Care Strategy Implementation in Wales since 2008, and chaired the Welsh Medical and Dental Academic Advisory Board since 2012. Finlay was a general practitioner in inner city Glasgow before returning to Cardiff to work full-time in care of the terminally ill. She works at the Velindre Cancer Centre, covering SE Wales when clinically on call. Finlay started the Marie Curie Hospice in Wales and since 2008 has responsibility on behalf of Welsh Government for strategic oversight of all hospice and palliative care services in Wales. Since 2001, Finlay has been an Independent Crossbench Peer in the House of Lords.

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Against The Motion

Dr. Daniel Sulmasy

Prof. of Medicine and Ethics, University of Chicago & Member, Presidential Bioethics Commission

Dr. Daniel Sulmasy is the Kilbride-Clinton Professor of Medicine and Ethics in the Department of Medicine and Divinity School at the University of Chicago, where he serves as Associate Director of the MacLean Center for Clinical Medical Ethics and as Director of the Program on Medicine and Religion. He received his AB and MD degrees from Cornell University and holds a PhD in philosophy from Georgetown University. Sulmasy was appointed to the Presidential Commission for the Study of Bioethical Issues by President Obama in 2010. His research interests encompass both theoretical and empirical investigations of the ethics of end-of-life decision-making, ethics education, and spirituality in medicine. He is the author or editor of six books, including Safe Passage: A Global Spiritual Sourcebook for Care at the End of Life (2014). He also serves as editor-in-chief of the journal, Theoretical Medicine and Bioethics.

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Declared Winner: Against The Motion

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Voting Breakdown:

55% voted the same way in BOTH pre- and post-debate votes (47% voted FOR twice, 6% voted AGAINST twice, 2% voted UNDECIDED twice). 45% changed their minds (7% voted FOR then changed to AGAINST, 9% voted FOR then changed to UNDECIDED, 5% voted AGAINST then changed to FOR,0% voted AGAINST then changed to UNDECIDED, 15% voted UNDECIDED then changed to FOR, 9% voted UNDECIDED then changed to AGAINST) | Breakdown Graphic

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    • Comment Link Luke Skilbred Tuesday, 04 August 2015 11:07 posted by Luke Skilbred

      It's especially on such emotional and personal subjects such as this that we must adjust our focus to ensure we have a wide-frame view on the entire topic. I think it's best to start at the root of the question and move

      upward. In this case, the central topic, wrapped up into one word is "suicide", which is broadly defined as "the taking of one's own life", just as homicide is "the taking of another human's life". Our entire legal system relies

      on the premise that each individual has a right to self-ownership, for instance, the notion of property rights is just an extension of self-ownership to objects that you have mixed your labor with, since labor is only a

      description of your body carrying out work. Another example is the barring on both the government and of private individuals of imposing unlawful imprisonment upon an innocent man. This would be meaningless if a

      person has no presumption of self-ownership, otherwise, the state could, for instance, imprison any unemployed persons and put them into a forced-labor camp because the state decides that this would be better for the

      individual, as well as for "society" for her/him to be working rather than not. To be clear, I'm no more an absolutist than the common law already is, for instance, like Dr. Sulmasy says in his opening statements, drunk driving

      laws limit the reach of our individual rights, but only because they pose an substantial, existential risk to OTHER PEOPLE who never had a choice in their decision to drink & drive. The key is that they have violated another

      person's right to self. This brings me back to the definitions of Suicide and Homicide, while homicide is a legitimate crime since it is a prohibition on a person to the extent that they violate the rights of other persons, suicide is simply the "taking" of something that's already owned by the "thief".

      Many of us choose to occasionally drink alcohol, smoke tobacco, "cruise" around the city in our car for fun, engage in surfing/skateboarding/snowboarding/skiing, eat fast-food & "junk" food, go swimming in natural

      waterways, speed slightly on the highway, eat seafood, or go on vacations which increase our risks to travel-related fatalities and theft. All of these choices improve the quality of life of millions, if not billions, of people on this

      earth (who usually live by the motto "everything in moderation") and also pose increased risks of limiting the life of an individual, but we allow them to fulfill their interests UNLESS WE CAN MAKE THE CASE that the person is uninformed of the risks. or incapable of making decisions for themselves (children and the mentally-disabled, for instance). If we take the logic of the "Against" side in this debate, wouldn't we slam our fist on the scales in

      favor of quantity as opposed to quality just as they do in the case of suicide? Shouldn't we ban all recreational sports that kill people? ban all fast food (perhaps a government-scheduled meal plan would be helpful

      instead!)? The list goes on.

      An individual has the right to self-ownership unless a compelling case can be made against it. Perhaps the mentally-ill and mentally-handicapped, children, and those in severe short-term stress could be limited, regulated, or outright denied in their right to suicide based on the circumstances, but THE CASE MUST BE MADE. I am my own person, innocent until proven guilty, I am not the property of the government, "society", or even doctors. Doctors can join my friends and family, using their right to free speech, to persuade me one way or another on any choice I make with my life, but unless they can prove that I am not mentally-stable, the choice is up to me.

    • Comment Link kristen inDallas Friday, 27 March 2015 11:45 posted by kristen inDallas

      The con side hinted at it, but I'm surprised the question was never brought to the pro side.... what happens to society when doctors' objectives include a patient's death rather than the treatment of a patient's pain (potentially resulting in death). What happens tip the doctor patient relationship. What happens to the general public's (not just the doing public's) level of trust in the medical profession when a portion of its accredited membership are actively engaged in our death? Involving doctors, who we need to be able to count on to treat us, in suicide decisions has societal consequences beyond just personal choice. Just look at the growing number of anti vaccine, homeopathic, medical skeptics. I don't support this, but I talk tip these people with respect and time and again there is a root of general distrust. I in my opinion these topics are clearly related.

    • Comment Link Shelby H Wednesday, 04 March 2015 18:16 posted by Shelby H

      Some say Assisted Suicide is wrong, but others think it’s a blessing. Just about the half country has abortion legal, and thatch giving women rights to decide what happens to there body. So should men and women decide their fate by assisted suicide. Wouldn't it be more peaceful to go out painlessly.
      It would be much better to go out peacefully because you wouldn't have to go through all that pain and suffering. Would you wanna be forced to sit around or lay around a hospital all day? What if you were brain dead? What if you were a vegetable and couldn't even move or go to the bathroom properly. You would wanna end it fast. Why not go out with some peace and dignity. Why suffer with one that pain.
      Going through all that pain, and suffering is a lot worse than watching a loved one go through it. Imagine laying in a hospital bed having a few months left. Watching your family come and go to apologized, feel sorry, give you all that love, and attention they should have give you before.Why not end right then? Let your family move on, let you move on. It’d end suffering everyone so much more painlessly
      Brittany Maynard a 29 year old women who has been diagnosed with terminal brain cancer. She lived in a state that was illegal to use assisted suicide. So she moved to oregon where it was legal. She was prescribed pills by her doctor to off her herself. “ It Would not tell anyone else that he or she should choose death over dignity. My question is who has the right to tell me that I don’t deserve this choice”. This should be a choice for people some may be afraid to do it but to others a blessing.
      Assisted suicide should be legalized because it’s peaceful, painless, and allows one to determine his or her own faith. People would wanna go peacefully around belongings and loved ones. People would go painlessly before all the pain happens. They could skip all the pain. Some people would rather decide what happens to the,. Others then having a family member decide for them.

    • Comment Link Jeffrey Tuesday, 24 February 2015 15:41 posted by Jeffrey

      Isn't the only issue about choice? The question was legalize assisted suicide, yes or no. If we leave behind the cultural constructs and meanings of this and ask, only, if it should be legal, than we have a question of choice. Under that model, there will be doctors who will and doctors who won't. The same will be true of people, some will want it and some won't. How is this different than, say, abortion or gun rights. It's a matter of choice.

    • Comment Link Jeremy Monday, 02 February 2015 14:00 posted by Jeremy

      I was surprised to find the results online greatly opposed the availability of physician-assisted suicide as the live audience appeared to still favor it's legalization.

      Since this question deals with the unquantifiable--the quality of one's life and pain at end-of-life, it was difficult for either side to provide a scientific grounds for its availability--both sides used emotional case studies and the against-side interpreted statistics with a rather biased representation, but the science of pain is very much in the eye of the beholder.

      Growing up in a medical family, I've realized that the process of diagnosis is very much an interrogatory practice when it comes to pain--asking a person with a terminal illness to diagnose their pain as a "0 to 10" is a far cry from anything scientific. Without true advances in the science of pain and perception of it, there is no objective standard for which a doctor can properly treat it. At our current point, treatment of a patient's pain relies on the patient's direction (if your pain is a 10, you'll get a larger likelihood of aggressive treatment than a 3).

      Since the diagnosis of pain and quality of life can only be determined by a patient with our current body of knowledge, it is only ethical to allow the same person to choose if they would rather end their life.

      The current systems are an excellent start and have proper safeguards to prevent someone from using physician-assisted suicide to do themselves unnecessary harm. The alternative--having doctors guess or depend on a patient in a difficult state-of-mind request the doctor actively end their life through suspending feeding/life support or administering anesthesia is an unwise place to put the responsibility.

    • Comment Link Diana-Colorado 50+ yrs a RN Sunday, 25 January 2015 18:06 posted by Diana-Colorado 50+ yrs a RN

      I was 18 years old-in nursing school-when my first patient died of cancer. Her name-- Lurleen. Three years later, when I became an RN, I then worked @ Stanford in Cancer Research. At that early time (1960s) most patients died. The research project was the last ditch effort for treatment. The patients were referred from local physicians that knew about the specific NIH research project. Some patients had terrible physical decay and also experienced major negative symptoms such as vomiting, diarrhea, and pain.

      The patients and their families taught me so much. I was all of 21 years old when I started. Each death was different given the location of the cancer, the use of chemotherapy, and/or radiation therapy. How they lived life and their religious orientation also affected the dying process. The meaning of death was different for all of them. There were oh so many variables to consider.
      As nurses, our priority was to give patients and families due respect and to support their present status as research subjects. At that time (60s) their stay in the hospital was long. Once accepted under the research protocol, all healthcare was provided for them till death. Thus we got very close to the patients and their families. I've held many hands and talked to oh so many patients at their life's end.
      I have 'war stories' and I have 'endearing stories' such as my daughter being named after the wife of a newlywed patient-Larry. I met them in 1962. Tana was a nurse as well and their beginning marriage was similar to mine. We still are friends 55 years later. I still remember so many names and stories from my work in Cancer Research and patients in later years.
      In our healthcare society we have a legal term called "Informed Consent". We also have the legal process of Informed Denial/Withdrawal whereby the patient or surrogate decision maker has the legal right to refuse treatment and/or accept treatment.
      In reading some of the earlier notes, I felt saddened by comments of mistrust in the healthcare system and professional providers. Yes, there have been incidents that did not meet the Professional Standard of Practice. Yes, Safeguards do need to be in place in all healthcare settings as well as accountability for poor practice. Throughout my professional career-- clinically and administratively-- I've advocated for a patient's right for self-determination. The healthcare professions are filled with outstanding individuals committed to the best interest of others they provide services to.
      I believe that 'Death with Dignity' should be the mantra used today NOT Physician Assisted Suicide. A patient has the right for 'self-determination' that is balanced with the legal and moral standards in our country. I support the movement allowing personal choice on how one should spend their last chapter in life. I support Compassion & Caring's efforts for laws to allow a patient to end suffering at the end of their life. The bill to support death with dignity is being presented in CO this January 27, 2015. I will go to observe the process and support the bill. I will engage my representatives to tell them my story and experience with dying patients, family, and friends.

    • Comment Link M. Ross Adams Sunday, 07 December 2014 20:25 posted by M. Ross Adams

      If the moderator of the program had used the phrase "assisted dying" or "physician aided dying" instead of the negatively loaded word "suicide," the result would have been quite different. A Gallup poll in May 2013 found that 70% of Americans favor allowing doctors to hasten a terminally ill patient's death when it is described as allowing doctors to "end the patient's life by some painless means." However only 51% support it when the process is described as doctors helping a patient "commit suicide."

      The word "suicide" is loaded with horrible connotations - it has the same root as "genocide" and "homocide." It is associated with teenagers hanging themselves because they didn't get into the right college. This debate was about people who are already dying - that's what the laws require. It's time for the doctors to catch on ---- they are doing great harm when they allow dying people to suffer unnecessarily at end of life.

    • Comment Link Michelle Wednesday, 03 December 2014 14:02 posted by Michelle

      I'd like to hear how the undecideds were swayed against. The final statement was so frustrating -- I'm very grateful for the debater's mother that she was convinced that her life was worth living and that worked out for her. But it's not an argument against making assisted suicide available. The debater's argument seems to be that the mere possibility of assisted suicide will drive people to choose it against their better judgment. In this case, it's very difficult to imagine that a woman who was convinced in the course of a debate over the idea that she had a reason to live would have simply chosen to die had the possibility not been denied her. Instead, this woman may have been one of those such as were mentioned in Oregon, who kept the option at the ready but ultimately never used it. We need to give people the credit for thinking critically about a literally life or death choice, not presume that they will be too dumb to decide whether life has value, and thus we must keep the decision out of their hands.

    • Comment Link John Hurd Saturday, 22 November 2014 21:51 posted by John Hurd

      Dr. Shulmasy's arguments sound insincere to me. He claims the most common reasons given by people wanting to take their own lives is being a burden and not being in control. I have seem many people stuck in such a degrading vegetative state that few of us would want to go on like that. I think there are financial politics at play here. Dr. Shulmasy makes his living by caring for the (slowly) dying. If too many people were able to end their lives with the help of a physician, Dr. Shulmasy's income might decrease considerably. I don't care for his reasoning.

    • Comment Link VA Friday, 21 November 2014 13:29 posted by VA

      Isn't the question more whether there is open communication with your doctor? Doctor's need to trust their patient's opinions more.

    • Comment Link Susan Rose Friday, 21 November 2014 10:51 posted by Susan Rose

      In all honesty, I cannot fathom how this is even a debate. It should be a deeply personal choice, and it's so offense when I hear others claim that Brittany Maynard made the wrong choice. For whom? You? Why do you get to give your opinion, and really, who asked for it? If you've ever watched someone with terminal cancer slowly die like I have (I led a cancer support group for those with terminal cancer for many years), then you would understand just how ridiculous this "debate" is. I've watched lovely end-of-life transitions at the hands of those terminally ill--absolutely beautiful celebrations of their life. I've also watched terrible end-of-life transitions where the family is left in horrendous medical debt, exhausted from sleeping in a hospital chair, and broken. In this day and age where our health care insurers practically decide whether we're comfortable with the best drugs or hurting because they won't cover those specific medications, it's offensive that armchair quarterbacks are judging whether this should be legal or not. Like the argument with gay marriage: If it bothers you that someone is planning a death with dignity, don't do it.

    • Comment Link Mary Faber Thursday, 20 November 2014 21:28 posted by Mary Faber

      I am somewhat bemused that fence sitters swayed against. From where I sat Singer & Solomon offered a stronger argument - while I was already for the motion I found myself decidedly more in favour following the debate. Still young at 27, I am lucky to have avoided terminal illness or chronic pain thus far, but have such empathy for those that are suffering. I would like them to have the option to choose (and for me to potentially have in future).

      Why is it that with matters pertaining to suffering the human species treats other species more 'humanely'??

    • Comment Link gabriella lonardo Monday, 17 November 2014 13:43 posted by gabriella lonardo

      Brittany asked the poignant question of WHO had the right to deny HER the right to die in her own terms. Denying her such choice means imposing others' convictions (religious or other) on her. She was even clear that she did not advocate her choice as the right one for everybody. Everybody should have the right to choose when the time comes, and that choice should be personal and based on one's convictions. Religious or other kind of beliefs CANNOT inform legislation; in so doing, government would be endorsing the views of one particular religion or set of religions on the whole of the population. Those who are AGAINST assisted dying should simply not take it, but leave the rest of us decide without interference

    • Comment Link Thomas F.. Ferrara Monday, 17 November 2014 12:13 posted by Thomas F.. Ferrara

      I suspect that one's decision on how to end life is tied in closely with how one lived life. If life has been one of constant struggle, ugly childhood and you have received very little help of any sort along the way to make things easier, OR if life has been one of success after success, absent of any financial worries, plenty of friends, travel -- all in all a very happy one -- and you know you did it all by yourself, then you will probably choose what to you appears the easy way out. In the first case the person figures they have put up with enough suffering, and in the latter, they figure what's the point in suffering, I haven't done it or avoided it as much as possible so why put up with it now. In both cases, the lives they have led have tended to be self-centered and that's what will determine how they choose to go.

      On the other hand, taking the lives of both of the above cases and changing one significant component, the outcome would be very different. But that component is the hangup for so many because it means surrendering to another how one chooses to lead one's life including how to end it. The other choice is to consider oneself as a signficant (NOT isignificant) component of the human race whose actions, moment to moment, have an impact on other human beings for better or worse. This awareness plays a sifnificant influence on the choices you make.

      Some of these choices -- indeed many -- will cause you incovenience perhaps significant inconvenience, yes maybe even suffering. But what drives you is the feeling that that is the correct thing to do because it is benefitting other human beings.

      To reach this state of mind is almost impossible to do without a good reason for doing so. Many of us have found this through a growing awareness of an infinite being who has communicated this lesson of how and why one should lead their lives for the benefit of the whole human race. This infinite being has been the source of our life, has communicated to us how we should lead that life, and yes, has communicated to us how we should let Him end our lives -- the life He gave each of us in the beginning.

      In today's modern world there are available pain relievers so that those who are suffering agony from their illness or condition can be made pain free. Think Hospice.

    • Comment Link Pete Larson Sunday, 16 November 2014 16:40 posted by Pete Larson

      "When the Son of Man returns will be find faith?" The decision has been I the hands of our creator since I he beginning of time. What makes it right for us to assume that responsibility now?

    • Comment Link Courtney Thursday, 13 November 2014 19:04 posted by Courtney

      I support this legislation but I wonder if it should be called "Death with Dignity". I understand that the dignity lies in having the choice, but I think it implies, if unintentionally, that those who do not choose assisted death have lost their dignity.

    • Comment Link Anonymous Thursday, 13 November 2014 07:16 posted by Anonymous

      Given that abortion on demand has taken hold of our state and our nation, it is no surprise that suicide on demand is following suit. However, these phenomena are both at odds with who we are as a nation.

      A belief that every human life has an objective and inherent value forms the basis for our entire society and system of government in the United States (see Declaration of Independence). That belief is what makes us different from other cultures and systems with whom we are often at odds. Those who desire that America dispense with this foundational belief about human life bear the heavy burden of proving, first, that human life really has no objective value, and second, that treating human life as a dispensable commodity is a superior cultural approach.

    • Comment Link Christine Hughes Monday, 10 November 2014 19:01 posted by Christine Hughes

      Thank you Josh McNattin, for bringing out that pain alone is not the only great compromiser of quality of life. Surely severe incontinence and/or the loss of ability to think for oneself can compromise a person's dignity as well. Whether it be someones religious and/or spiritual beliefs, I do not want their shame, judgement, or fears of the afterlife transferred onto my individual right to die. I am not an intellectual. I am a human being with chronic illness for 28 years, and my dog, bless him, is offered a more dignified exit than me.

    • Comment Link jaynarayan Saturday, 01 November 2014 01:20 posted by jaynarayan

      Human society today is in danger zone of its existence. We do not know the value of life, the so called intellectuals of the society are unaware of the goal of human life. Our current thinking is that the human life starts at birth and ends at death. We do not information about the existence of life after death. So the death is not the end of suffering. The suffering continue to exists even after death. We must first of all understand the meaning and purpose of human life and life in general. Once that understanding is clear we will be having no difficulty in making the decision. It is foolish to loose the precious life than to take the advantage of it. Rather than so called suicide is to live the life with tolerance and endeavour towards perfecting the life. Remember my dear friends the life is very precious so better to live the life to its fullest possible extend for the higher cause than to terminate it for the sake of value less reason. Learn to live the life you will forget the pain of any physical or mental illness.

    • Comment Link Josh McNattin Friday, 31 October 2014 09:01 posted by Josh McNattin

      Anyone opposed has never watched a loved one die slowly, painfully, from something like cancer as I did my mother and no, the current state of the art in pain management is not enough to stop the highest levels of pain and even where they are, oftentimes the caregiving facility fails to administer them on a timely and regular enough schedule to stay on top of the pain. Oftentimes nurses are overworked and spread too thin to make their rounds quickly enough to get around to patients for their next dose. Once you get behind, the pain becomes much harder to control.

      The word that came to mind about forcing people to go through the experiences they dot: barbaric. For my mother got to the point that pain medication didn't help. The cancer began to compromise her nerves so that she couldn't hold a cup of water to drink without suddenly losing control and dropping it. She became delirious and wanted to walk though she would fall and we'd have to fight to keep her in bed. She was given a colostomy bag but still wanted to get up to go to the bathroom, I was afraid of her falling and breaking brittle bones, further complicating an already unbearable situation. I couldn't hug her anymore because of painful tumors. I don't blame people for not understanding, I didn't used to either, but please understand. PS - She turned 60 the month she died.

      As for those who speak of the state paying for assisted suicide, I'm pretty opposed to the welfare state, but do you seriously want to relegate people to the options of hanging themselves, shooting themselves, stepping in front of trails, jumping, taking whatever pulls they can get their hands on, etc. Going through the horror and/or leaving the horror for their families? Not to mention the failure rate for amateur suicides and the resulting injuries. I recently knew a woman who lept from a 14 story building onto the sidewalk below and was torn apart by a tree that she hit, suddenly a private decision becomes a traumatic event for many more people who knew her or saw her. Physicians would have to be involved somehow, even if solutions were offered through Walgreen's it would have to be prescribed. I don't think insurance has to be involved and prices can be kept low enough that no outside funding would be necessary, someone needing to die to end suffering will usually have assets they won't need any more to bring funding to the table.

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