Witnesses of the patient's consent could be an "interested party" – someone who could benefit financially or personally from the patient's death – Silecchia noted, raising even more ethical challenges to the proposal.
Also, the measure may apply disproportionately to the "most vulnerable," like low-income or elderly persons who feel they may be a "burden" to friends and family as they become sicker, and those suffering from mental illness like depression or anxiety, she explained.
Herbert Hendin, M.D. has written on the psychological issues surrounding patients with terminal diagnoses. In his book Seduced by Death, he explained how many of these patients, when they fear a terminal diagnosis, desire to end their lives – but many of them are suffering from a curable mental illness that can be treated.
It's not the fear of death that exacerbates their psychological condition, but rather the fear of dying, he explained, when "patients displace anxieties about death onto the circumstances of dying: dependence, loss of dignity, and the unpleasant side effects of medical treatments."
The advocacy group "Not Dead Yet" has also claimed that such fears drive a patient's desire to die, noting that "among the top five reasons given" for a fatal prescription request "are feelings of being a 'burden on others' (41%) or feeling a 'loss of autonomy' (92%) or 'loss of dignity' (78%)."
"These are not about pain from a terminal disease, but are psychological and social issues that cry out for meaningful supports and genuine care," the group continued.
"Yet the assisted suicide law does not even require disclosures about consumer controlled home care options to address feelings of loss of autonomy or feelings of being a burden on family, much less require that those services be provided."
"When these fears are dealt with by a caring and knowledgeable physician, the request for death usually disappears," he added.
In his experience treating these patients, Hendin found that when a patient chose treatment over a fatal prescription and resolved his fears – as well as unresolved conflicts he may have had with friends or family – he greatly appreciated his final months to do so, even if he experienced physical suffering in that time.
And, some warn, the legalization of assisted suicide actually opens the door for the normalization of other dark practices like euthanasia.
When a patient expresses a desire to die but chooses to wait until they are further along in their sickness to take the prescription, the ethical lines can become blurry as to whether that action was their own decision made with a clear mind, or was the decision of their friends and family who pressured them, while under extreme duress, into taking the medication.
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The state of New York Governor Mario Cuomo's own task force pointed to the possibility of this scenario in their 1994 guidelines "When Death Is Sought," updated in 2011.
"Even if the law is never changed to sanction involuntary euthanasia, the potential for abuse would be profound," they wrote. This is because "once euthanasia is established as a 'therapeutic' alternative, the line between patients competent to consent and those who are not will seem arbitrary to some doctors," including in some cases of patients who are "incapacitated" where their doctors will deem it therapeutic to give them a fatal dose of medication.
Leon Kass, who chaired President Bush's Council on Bioethics from 2001-05, explained this from a doctor's perspective in his work "Why Doctors Must Not Kill" – cited in the task force report.
"How easily will they be able to care for patients when it is always possible to think of killing them as a 'therapeutic' option?" he asked. "Physicians get tired of treating patients who are on their way down - 'gorks,' 'gomers,' and 'vegetables' - are only some of the less than affectionate names they receive from house officers."
And an assisted suicide law could also disproportionately target minorities and the poor, the New York task force report argued, because everyday prejudices – from which physicians, however well-intentioned, "are not exempt" – will affect how doctors choose to treat patients – with their very lives at stake.
"Finally, it must be recognized that assisted suicide and euthanasia will be practiced through the prism of social inequality and prejudice that characterizes the delivery of services in all segments of society, including health care," the report stated. "Those who will be most vulnerable to abuse, error, or indifference are the poor, minorities, and those who are least educated and least empowered."