Defining the Line between Coercion and Compulsion
Two more states in the US have recently fallen into the death trap. Delaware recently became the twelfth state, and New York may be the thirteenth states to legalize what used to be called physician-assisted suicide (PAS) but is increasingly called medical aid in dying (MAID). New York’s legislature has passed their legislation, so at this time, the bill only needs the governor’s signature. According to Compassion and Choices, a death-supporting advocacy organization, there are now sixteen other states that have active legislation to help people kill themselves. If those are successful, a majority of states in our country will have made it legal for a person to request drugs from their physician to end their life.
The Hippocratic Oath, once a rite of passage from medical student to medical practitioner, is long gone, having been replaced with other, more modern versions that don’t require such a strong commitment to protecting human life and “doing no harm.” I guess doctors don’t want to find themselves stuck with a commitment not to offer abortion and MAID.
The arguments developed to defend legal killing of children through abortion have now been adopted and modified to support the offer of death to the elderly, infirm, or disabled. Self-murder is defended as an inviolate and sacred right to be protected as one’s personal choice—absent interference from loved ones or doctors. Passive euthanasia, the kind of “mercy killing” they have in the Netherlands and Canada where an individual gives their consent for their doctor to kill them, isn’t legal in any US state. At least, not yet.
Another good thing is that no one is being compelled anywhere by law to kill themselves. So far, that is something that only happens in dystopian books and movies, but there is a fine line between compulsion and coercion. That line is often blurred by the compelling influence of shifting cultural mores and health care professionals who tend to patients in medical or existential crisis—some who advocate strongly for death.
Death is winning by shifting cultural mores and by a medical profession that largely favors it.
The situation of how the killing of babies with Down syndrome in the womb after prenatal diagnosis is regarded in Denmark provides a good example. The large-scale abortion of these babies caused some people a few years ago to speculate that Denmark would be Down syndrome free by the year 2030. That wasn’t a government-stated goal, and there was no legal mandate imposed to kill babies with Down syndrome, but what Denmark did in 2004 was revise its prenatal care guidelines to recommend all pregnant women undergo prenatal testing, not just those considered high risk. More than 90 percent of pregnant women have taken up the recommendation and undergo screening in Denmark. Possibly, it is just done routinely without pregnant women really understanding what is happening. If Down syndrome is discovered during screening, women may request an abortion, but requests for an abortion of a baby identified with a fetal anomaly after the first trimester must be approved by a committee. By the committee’s own admission, those requests are routinely rubber stamped and the babies are killed. The result of the easy access to prenatal screening and abortion is that 95 percent of Down syndrome pregnancies are aborted in Denmark. Again, there is no legal requirement to kill a baby with Down syndrome, but what has been created is a strong normative social pressure to abort. Only eighteen babies with Down syndrome were born in Denmark in 2019. There were over 61,000 babies born in Denmark that year. That’s only one baby with Down syndrome for every 3,389 births. By comparison, in the US, the number is about one in 640.
On February 22, 2025, I published an article called “Discouraging News for Disability Advocates” in which I shared new research that showed years of advancing legislation that would require doctors to provide parents who receive a prenatal diagnosis of Down syndrome with factual and current information on the disability, including positive outcomes experienced by many families who have welcomed children with the same condition into their homes. Twenty-three states have passed these laws, but they are not being observed, and parental encounters with physicians have not improved. In fact, it may even be worse now than before the legislation was passed in those various states. I wrote in that article that those who had responded to the researcher’s poll “revealed that ‘an increased proportion of parents felt that their physicians encouraged pregnancy termination’ following a prenatal diagnosis. Shockingly, 42 percent of parents reported that following a prenatal cell-free DNA screen—a non-conclusive screening test, not a diagnostic test—their physician encouraged them to abort the pregnancy.”
So, the problem is the doctors. In the case of prenatal diagnosis and abortion, a 1995 poll of OB/GYNs who belong to their professional association, the American College of Obstetricians and Gynecologists (ACOG), showed that 63 percent of member physicians believed that abortion was justifiable when the baby was shown to have a nonfatal condition, like Down syndrome. Ninety percent believed abortion was appropriate for those diagnosed with a fatal condition! It has been thirty years since that poll, but I daresay the situation with the medical profession is no better now than then. Perhaps even worse.
After the New York legislature passed its Medical Assistance in Dying (MAID) bill in June 2025, the Journal of Medical Ethics published a piece called “Physicians’ preferences for their own end of life: a comparison across North America, Europe, and Australia.” The report showed that “about half of the physicians who responded considered euthanasia a (very) good option.” The good news, I guess, is that physicians in Georgia (US) were polled and only 37.4 percent considered euthanasia a good option. Understand that the question asked was about euthanasia and not PAS—i.e., they asked about doctors killing patients rather than doctors giving drugs to patients so they could kill themselves. Those numbers change when the question of PAS is presented. 43.9 percent of doctors in Georgia approve of PAS, whereas 71.2 percent of physicians had a personal preference for PAS in Oregon, the first state to pass legislation allowing PAS. The question was asked in the situation of a terminal cancer diagnosis.
Acknowledging that drawing parallels between abortion and PAS may not be accurate, what I have presented about the medical profession’s influence on family decisions to abort after a prenatal diagnosis of Down syndrome may loosely correlate to decisions about PAS, so I ask again: Where can we draw the line between compulsion and coercion?
It is alarming that during the general election in 2024, West Virginia had a referendum on its ballot to prohibit PAS by amending its state constitution. The measure only passed by 0.88 percent: The state was almost equally divided between those who would allow PAS and those who wanted to retain a ban. The New York MAID bill passed its state assembly with a fourteen vote margin and its senate by eight votes.
PAS has become socially acceptable—even desirable—in the US. The Death Train is long out of the station in the US and making its grand tour into each of our states with its foul, black smoke belching out from its stack. How do we stop it?
Death is winning by shifting cultural mores and by a medical profession that largely favors it. I will make two broad suggestions that I admit need careful thought and refining.
I attended a conference recently where one of the organizers mentioned Antonio Gramsci’s ideas of cultural revolution—what later came to be called the “long march through the institutions.” It is undeniable that postmodern (and often Marxist) zealots have seized much of K–12 and higher education, media, entertainment, religion, and other institutions that form culture and have changed them from their once loosely Christian roots to something hostile to life and Christian belief. This person said we need to do the same thing in reverse to reclaim those institutions—one of which, in the context of this article, is medical schools. Happily, Benedictine College in Atchison, Kansas, has announced its intent to establish a faithfully Catholic medical school that would “enshrine Catholic moral teaching on the infinite dignity of the human person as created by God.” Pray for its success.
My second suggestion is one I have written on before. For far too long, the pro-life movement has been focused on defeating Roe v. Wade. That was accomplished by the Dobbs decision in 2022, but life continues to lose now at the state level. Many have identified the threat of PAS as the new target of pro-life initiatives. I don’t disagree that we need to work to defeat the march of death by PAS across our country, but currently we’re losing that battle too. The suggestion I discussed in that article is to broaden the pro-life lens to include the entire span of life by accepting our Catholic social teaching (CST) in stressing the importance of promoting integral human development: the protection and support of life throughout the life span. Focusing on the beginning and end isn’t sufficient for a culture that has lost its basic understanding of human dignity and the immeasurable value of all human life.
My ongoing hope for our wonderful Pope Leo XIV is that his name represents an ascendency of CST. Beginning with Leo XIII, we have a rich legacy waiting to be mined and put into action.
Of course, there is no substitute for prayer and fasting. Regardless of our position in life, each of us can take up that discipline as a strong weapon to defeat the enemies of life. The line between compulsion and coercion is the strength of a culture that values and promotes life. We have to change the culture of death closing in on us just like the first disciples of Jesus did—by the power of their prayers and the witness of their lives.