More states are considering following the lead of California and four other states in crafting legislation that would allow physicians to assist in the deaths of terminally ill patients. But medical organizations remain hesitant to support so-called aid-in-dying bills.

Last week a Nebraska legislative committee began deliberations on one such bill, prompting protests from the Nebraska Medical Association and Nebraska Academy of Family Physicians. The bill, they argue, “would force doctors to make subjective value judgments about the quality of a patient’s life,” according to an Associated Press report.

A similar bill is under consideration in the New York state legislature. Following its introduction last year, the Medical Society of the State of New York updated its position statement, stating that while it “supports all appropriate efforts to promote patient autonomy, promote patient dignity, and to relieve suffering….physicians should not perform euthanasia or participate in assisted suicide.”

In California, where an aid-in-dying bill passed last year, the response among physicians has been more accommodating. The California Medical Association has released guidelines for physicians and the public on the End of Life Option Act, after announcing that it would remain neutral on the legislation. (The American Medical Association opposes physician-assisted suicide.)

The topic has gained little traction on the presidential campaign trail, though last month Vermont senator and Democratic candidate Bernie Sanders spoke out in support of physician-assisted suicide at a forum hosted by the Leadership Council of Aging Organizations. (Vermont, Oregon, Washington, and Montana, along with California, have passed such bills.)

The issue is also contentious north of the border. Last year Canada’s Supreme Court ruled that terminally ill patients could seek a doctor’s help in ending their lives. Charged with drafting legislation reflecting that decision before a June 6 deadline, Canada’s Parliament released a report last month from a special committee focused on the topic. Among its recommendations is that physicians who object to the practice refer patients to other doctors.

The Canadian Medical Association expressed disappointment in the move. “While there is much to praise in this report, it does fall short on the issue of respecting a physician’s right to conscientious objection,” said CMA president Dr. Cindy Forbes in a statement. “As the government moves forward in drafting legislation, we must focus on ensuring effective access while also respecting different views of conscientious objection. Both can be achieved.”

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