Exclusive—Admiral Brian Christine, MD: America Needs a Culture of Care, Not a Culture of Death

In December, Governor JB Pritzker (D) signed a bill legalizing assisted suicide in Illinois. At the signing, Pritzker emphasized that the act would give terminally ill patients the autonomy to avoid unnecessary pain and suffering. Five days later, New York Governor Kathy Hochul (D) vowed to make assisted suicide legal in her state, saying such a move would allow New Yorkers “to suffer less–to shorten not their lives, but their deaths.”

Once Hochul signs New York’s “Medical Aid in Dying Act” into law this year, New York will become the thirteenth state, following Illinois, to legalize assisted death.

Proponents of assisted suicide present it as a compassionate response to suffering, arguing that it offers the terminally ill one final exercise in autonomy and a so-called “death with dignity.”

While avoiding pain is the primary justification activists invoke, most patients give different reasons for choosing a premature death. Loss of autonomy and fear of burdening family members consistently rank higher than unmanaged physical pain.

In Canada, where Medical Assistance in Dying (MAiD) has become the fifth leading cause of death since its legalization in 2016, government reports show that the most commonly cited reasons for seeking assisted death are not uncontrolled pain. More than 80 percent of recipients report loss of independence or inability to engage in meaningful activities, while roughly 45 percent report not wanting to be a burden. Oregon’s data shows the same pattern. In 2024, 89 percent of recipients cited loss of autonomy, and 42 percent—almost half—reported concern about burdening family.

These data points tell their own story about the strong cultural messaging patients have absorbed: that a life without autonomy is not worth living, and needing others is a failure.

As a physician, I recognize the deeply human impulse behind these assumptions. No one wants to feel powerless in the face of suffering or ask others to share in it. Yet, the difficulty of suffering does not absolve us of the responsibility to recognize the dignity inherent to every human person. We, at the Department of Health and Human Services, do not support assisted suicide, not because we deny the reality or severity of suffering, but because intentionally ending the life of a person violates human dignity. That dignity is not conditional; it does not depend on physical strength, independence, cognitive capacity, or health.

Pope John Paul II expressed this with particular clarity in Evangelium Vitae: “Even in the midst of difficulties and uncertainties, every person sincerely open to truth and goodness can, by the light of reason and the hidden action of grace, come to recognize in the natural law written in the heart … the sacred value of human life from its very beginning until its end, and can affirm the right of every human being to have this primary good respected to the highest degree.”

If dignity depended on autonomy alone, then the very young, the cognitively impaired, the severely disabled, and the dying would possess less dignity precisely when they are most in need of protection. Dignity must guide care practices, not by authorizing death when autonomy falters, but by obligating the community to surround vulnerable persons with protection, care, and love until natural death.

Supporters often reassure the public that assisted suicide laws are narrowly limited to the “terminally ill,” commonly defined as those expected to die within six months. In practice, this safeguard is weak. Physicians cannot reliably predict when a patient has six months to live, particularly in cases involving chronic or degenerative illness. What is presented as a narrow category quickly becomes expansive.

When the state accepts the premise that some lives are no longer worth supporting, safeguards erode. Assisted suicide regimes expand beyond their original targets, as seen in Belgium and the Netherlands, where eligibility now includes chronic and psychological illnesses and extends to children.

As Assistant Secretary for Health at the U.S. Department of Health and Human Services, I believe there is a better path. It is more demanding, but it is more humane. It requires investment in comprehensive palliative and hospice care that relieves pain without eliminating the patient. It requires mental health care that will treat despair rather than ratify it. It requires meaningful support for the sick, their families, and their caregivers so that no one feels abandoned. Above all, it requires a cultural renewal, one that understands dependence not as failure, but as a shared human condition.

A society is ultimately judged not by how efficiently it eliminates suffering, but by how faithfully it stands by those who suffer. We must choose a culture of care, not a culture of death. We reaffirm without exception the sacred value of every human life, from its beginning until natural end.

Admiral Brian Christine, MD, is Assistant Secretary for Health at the Department of Health and Human Services and head of the United States Public Health Service Commissioned Corps.