06 May 2026
The Dominoes Begin to Fall — The U.S. and Europe, 1990s-2010
Part 8 in the 11-Part Series “Is Any Life Unworthy of Living?“
Mark P. Mostert, Ph.D.
With assisted suicide and euthanasia now in the cultural mainstream, the pro-death lobby began to seize the moment. But which was the easier issue to move forward: assisted suicide or euthanasia?
Assisted suicide means that someone wants to end their life and someone else provides the means for the person to themselves end their life. For example, a terminally ill patient askes another person to provide a deadly substance. The person provides the deadly substance to the terminally ill person. The terminally ill person themselves then takes the deadly substance. Thus, the person commits suicide with a deadly substance provided by another.
Euthanasia occurs when someone administers a deadly substance directly to someone who requests it. Thus, someone actually kills the person requesting euthanasia.
To sway public opinion, assisted suicide was chosen as the better option, as it involved a person killing themselves (with assistance) rather than euthanasia, by which another person directly kills the patient.
Given that the U.S. Supreme Court had left open the possibility of states legalizing assisted suicide, the pro-death lobby decided to bring a test case in at least one state.
Mobilizing growing public sentiment favoring legalization, Oregon was the first domino to fall.
In 1994, a ballot initiative asked Oregonians to pass the Death with Dignity Act. The ballot passed very narrowly. Essentially, this made Oregon the first U.S. state to legalize assisted suicide. A number of lawsuits quickly challenged the new law as unconstitutional, but in 1997 state courts eventually upheld the law. In 2006, the law was upheld by the U.S. Supreme Court, which ruled that the federal government could not override the state’s law.
Oregon’s Death with Dignity Act stipulated policies supposedly “protecting” patients requesting suicide. These guardrails are important because, as we shall see later in this series, they proved to be ineffective in keeping assisted suicide a rare occurrence.
• Patient must make two separate oral requests for assisted suicide.
• Patient must also make a request in writing.
• Patient had to be terminally ill, corroborated by 2 doctors.
• Doctors must establish that the patient is of sound mind.
• Patient must administer the death medication themselves.
• Medication could not be administered by a doctor (which is euthanasia).
Other states were watching. Washington followed in 2008 and Montana in 2009. As we shall see later in this series, other states jumped onto the bandwagon.
By 2026, 13 U.S. states and Washington, D.C. had legalized assisted suicide.
Meanwhile, pro-death ideology was taking off elsewhere in the world.
The Netherlands was one of the first countries to legalize assisted suicide and euthanasia. Throughout the 1970s and 1980s, court challenges had sought to overturn the Dutch bans.
A turning point occurred in 1973, when a doctor euthanized her mother and was let off with a very light sentence. Thereafter, legal tolerance for euthanasia increased. This was a watershed moment, as it galvanized the Dutch public debate as to whether euthanasia should become legal.
As in the U.S., the pro-death ideologues seized the opportunity to sway public opinion to support legalization. By the mid 1990s, Dutch prosecutors began to develop an informal set of guidelines allowing for euthanasia. Doctors following these guidelines were rarely prosecuted, and if they were, punishments were negligible. Thus, a parallel set of legal guidelines was established and acted upon, even though the law prohibiting euthanasia remained.
In April 2002, legislation was passed in the Netherlands legalizing both assisted suicide and euthanasia. The criteria for people dying were initially similar to what had been devised in the U.S. However, by 2010 the original criteria had been expanded to include a wide array of people who were suffering — not merely terminally ill, not only for physical ailments, but to include for instance those who had psychological problems or dementia, those who were simply tired of life and those under the age of 18.
The true horror of this madness was slowly being revealed.
Mark P. Mostert, Ph.D., is senior researcher for Able Americans, a project of the National Center for Public Policy Research. This is part 8 of the 11-part series “Is Any Life Unworthy of Living?” Those wanting to be notified of future installments in the series should subscribe to the Able Americans email list.