Readers weigh in on medical assistance in dying laws across Canada and the United States, alongside the state of federal science funding and researcher departures.
When a patient asks a physician for medical assistance in dying. the core question is rarely about counseling or social support. For nearly a decade, Kristen Creek has assessed and provided medical assistance in dying, known as MAID, in Winnipeg, Manitoba. Reflecting on a recent discussion by Gary Rodin and Madeline Li published on October 5. Creek argues that counseling should support patients’ choices rather than serve as an additional barrier to respect. Medicine often
follows the golden rule of treating patients as the provider would want to be treated. but the platinum rule serves better: treating patients as they would want to be treated. When asked what would make them no longer want MAID. patients overwhelmingly reply that they want a cure or a reversal of irreversible decline. things medicine cannot offer. In the end. intolerable suffering belongs to the person living it. making shared decision making a process
of listening and identifying vulnerability rather than determining whether a patient should want to die.
Across the border. the framework surrounding end-of-life choices differs sharply. prompting debate over how American laws compare to Canada’s federal model. Shannon J. Winakur. a retired cardiologist in Baltimore. notes that thirteen states and Washington. D.C. have legalized MAID. with legislation pending in at least 16 other states. Opponents frequently warn that the United States might mirror Canada’s approach. which establishes a federal right to MAID. does not strictly require a terminal illness diagnosis of less than six months to live. and allows physicians to administer the medication. often by intravenous means. In contrast. American access remains state-based. requires patients to be terminally ill with less than six months to live. and mandates that patients self-administer the medication. Winakur points out that this feared convergence has not materialized during nearly thirty years of American experience. which began with Oregon’s passage of MAID legislation in 1997.
Pushing the debate further. Beatrice Shushan of Carlsbad. California. contends that medical and legal professionals should not be involved in end-of-life decisions at all. Shushan argues that individuals should be able to purchase the necessary means to a serene death directly from a pharmacy at a time of their choosing. without having to navigate complicated institutional systems. Meanwhile. readers also addressed broader institutional pressures facing federal research institutions. following a report on October 4 regarding the National Science Foundation withholding $1.4 billion. which equals 19 percent of its primary research budget.
James Lawrence Powell of Buellton. California. the author of “The Rise and Fall of Federal Science: From Jefferson’s Republic of Knowledge to Trump’s War on Science. ” characterizes that budgetary withholding as part of a much larger assault on federal science. Powell writes that during the first 18 months of President Trump’s second term. more than 10. 000 scientists and health professionals with doctorates left federal service. while thousands of peer-reviewed research grants were terminated. suspended. or delayed. Scientific advisory committees were abolished or reconstituted. databases and observing programs were disrupted. foreign students and scholars faced new restrictions. and the United States withdrew from international scientific and public health efforts.
While some of these administrative and policy measures have faced successful challenges and blocks by Congress or the courts. Powell emphasizes that the cumulative effect reaches far beyond any single budget line. American scientific leadership was constructed over generations upon stable institutions, rigorous peer review, administrative continuity, and deep international cooperation. Once those foundational pillars are weakened or dismantled. they cannot simply be restored by reversing a policy decision or replenishing a budget.
These ongoing public debates highlight a broader societal tension regarding institutional control over deeply personal and national futures. Whether examining the individual autonomy demanded at the end of life or the systemic erosion of foundational scientific infrastructure. the underlying conflicts force a reckoning with how laws. medicine. and government institutions serve the public interest. As legal frameworks shift across state and international boundaries. the permanence of these structural changes continues to test the resilience of both personal liberty and public trust.
assisted dying MAID federal science funding National Science Foundation end-of-life care medical ethics
