By Chuck Donovan

A cold winter is well underway in the American Midwest, and the ice is taking many forms. The weather has been dark and forbidding, but the other frozen form is in the shape of assisted suicide. On December 12, Illinois Governor J.B. Pritzker (D) signed into law a bill that makes his state the 13th jurisdiction in the nation (assisted suicide is already lawful in 11 other states and the District of Columbia) to permit physician-assisted suicide, euphemistically referred to as medical aid in dying, or MAID. As a nation with a concentration of liberal public policies on its West and East coasts, the United States now has its first heartland state to embrace a practice that is spreading around the world.

Coincidence or not, the assisted suicide debate is taking place against a background of soaring health care costs and governments operating at historically high deficits. Illinois is not an exception to the general trend, with a projected budget deficit of $267 million in 2026 that could rise as high as $2 billion in fiscal year 2027. Much of the deficit is attributed to spiking pension costs for retirees. Illinois is in the second-lowest tier for total fertility among the states, hovering in the range of 1.50 to 1.59 children per woman. Its law imposes no limits of substance on abortion. The pressure under the new MAID law to choose death near the end of life is likely to be as intense there as it has proved to be everywhere else assisted suicide has been legalized.

Meanwhile, across the pond, the grueling, year-long debate in the British Parliament grinds on. There, resistance from disability groups and medical institutions has remained consistent with the rare result that, to date, the House of Lords has proved itself capable of mounting serious opposition to an aid-in-dying bill that has lost altitude at each stage of what was expected to be a smooth path to passage. The leading figure in advocacy for the revolutionary bill is Lord Charles Leslie Falconer, a 74-year-old member of the Labour Party who has served in a variety of high positions in the British government, most notably as lord chancellor and secretary of State for Justice under Prime Minister Tony Blair from 2003 to 2007.

The legislation formally known as the Terminally Ill Adults (End of Life) bill is pending in what is called the Committee Stage of the extended process. During this stage, bills are scrutinized line by line, and lords may offer amendments as they see fit. As of December 19, the fourth day of reviews and votes on the amendments, peers had introduced more than 1,000 amendments to the bill, leading to the prospect that the traditionally required debates and votes on the amendments would forestall any vote on final passage. If that occurs, the clock would run out on the bill in this session of Parliament, and it would be defeated. The situation has been likened to a filibuster, and it has prompted some members of the lords who oppose the bill to urge that a final vote be allowed to occur out of concern that a tactical defeat of the bill by the unelected House of Lords would put that body at risk of severe reform or even abolition.

However, the amendments being offered concern serious topics that were left unaddressed when the House of Commons passed the bill last June by the relatively narrow margin of 314 to 291. One persistent theme is the long record of assisted suicide bills threatening the lives of the poor, the disabled, and other vulnerable members of society. On December 19, Baroness Sue Gray, former chief of staff to the current and very liberal Labour Prime Minister Keir Starmer, criticized the bill sharply as a menace to the vulnerable, saying there was “nothing in the Bill that would stop a person accessing an assisted death for reasons that were nothing to do with their illness but simply because they had been too worn down for too long by problems that could have been solved with the right care, attention and funding.” She cited the homeless as at particular risk, with their numbers rising across the United Kingdom.

Supporters of the assisted suicide measure broadly contend that 90% or more of the amendments being discussed are not substantive and many are designed merely to deter movement through the Committee Stage. At this point, the amendments’ substance is debated but no individual votes are held on them. Supporting groups like Humanists UK and My Death, My Decision are striving to convert the arguments from the content of the bill to the procedures involved in reaching a final vote. The House of Lords has already scheduled up to 10 Friday debates on the bill in 2026, which will carry the fight to the threshold of the March deadline for passage or expiration.

Opponents of assisted suicide seem as determined as ever to defeat the bill, and they have garnered support from an array of forces that is difficult to stereotype — even as assisted suicide proponents deplore the participation of many in the debate, including U.K. religious leaders. Care, Not Killing is an alliance of individuals and groups that champion the disabled and human rights, including health care providers and faith-based organizations. They have focused on research- and policy-based arguments against the assisted suicide bill, pointing to the evolution of practices in other countries where assisted suicide and euthanasia have advanced. They state, “The pressure people will feel to end their lives if assisted suicide or euthanasia is legalised will be greatly accentuated at this time of economic recession with families and health budgets under pressure. Elder abuse and neglect by families, carers and institutions are real and dangerous and this is why strong laws are necessary.”

Lord David Alton, a lifelong advocate for the right to life of the unborn (an issue where further liberalization of the law is also being pursued), cites a particularly stark example of the pressure and coercion that can be imposed on certain patients. He quotes the late Baroness Warnock’s statement that “if you’re demented, you’re wasting people’s lives — your family’s lives — and you’re wasting the resources of the National Health Service. … Maybe it has to come down to saying: ‘Okay, they can stay alive, but the family will have to pay for it.’ Otherwise, it will be an awful drain on public resources.” Baroness Warnock, who passed away in 2019, gained worldwide fame over her involvement in establishing the British policy on embryo research that created the 14-day rule, a construct under which new human life could be subjected to experimentation and destruction up to two weeks after fertilization.

Other key amendments to be debated and voted on in the House of Lords deal with vital matters like the scope of eligibility for assisted suicide, how and when the subject may be broached with patients who have not raised it, the value of the six-month-left-to-live rule, the conscience rights of objecting health care personnel and institutions, and other matters. For example, the bill as introduced defines, in line with similar measures around the globe, a terminal illness as a patient that “(a) has been diagnosed by a registered medical practitioner as having an inevitably progressive condition which cannot be reversed by treatment (‘a terminal illness’); and (b) as a consequence of that terminal illness, is reasonably expected to die within six months.” Clauses like this are widely cited but deserve far deeper scrutiny. Examples of patients outliving their diagnosis are numerous, and there is the related question of how a given diagnosis may inhibit treatments that may be expensive or that come into being during this “reasonable” six-month interval.

A cursory look at new drugs approved by the U.S. Food and Drug Administration in 2025 lists eight with application for cancer treatment out of 41 total approvals year to date. What was reasonable as the year began regarding any particular condition may be obsolete as the year ends. Medical science is providing increased hope and increased options at an unprecedented rate. Assisted suicide ends options and ignores the fact that (and here the contribution of artificial intelligence analysis of mass amounts of data may prove invaluable) we live in an age of exploding medical possibilities (in tandem with challenges regarding cost and other factors that will challenge us to reach consensus).

The long and short of it is that assisted suicide represents science and ethics gone off the rails. The tendency of these laws to grow in scope, to expand the idea of terminal conditions, or abandon them altogether, continues. Canada is a mere 16 months away from potentially adding mental illness as a criterion for eligibility for assisted suicide. Data on suicide and mental illnesses in Western nations shows a negative trend that is worrisome even in the absence of a debate over assisted suicide as a solution. The events in Illinois, and another domino about to fall in New York State, show how quickly protections for life can crumble. Today there truly is heartbreak in the heartland.

Chuck Donovan served in the Reagan White House as a senior writer and as Deputy Director of Presidential Correspondence until early 1989. He was executive vice president of Family Research Council, a senior fellow at The Heritage Foundation, and founder/president of Charlotte Lozier Institute from 2011 to 2024. He has written and spoken extensively on issues in life and family policy.