When I wrote about physician-assisted suicide (medical aid in dying) legislation in 2023, Nevada stood at a crossroads. Since then, much has happened. The Legislature passed a medical aid in dying bill (SB239) that was thankfully subject to Gov. Joe Lombardo's veto. 

While the governor's veto has given Nevada a reprieve, we know this debate isn't over. Instead of waiting for the next legislative battle, we should be proactively strengthening the alternatives.

As a pastor who has spent decades at the bedsides of the dying, I've witnessed firsthand the transformation that can occur when we fully embrace holistic end-of-life care. Where medical aid in dying offers a quick exit, proper hospice and palliative care offers something far more valuable: the opportunity for healing even when a cure is impossible.

As medical aid in dying advocates prepare to revive this legislation in the 2025 session, the question that should be debated is: What kind of end-of-life care system truly preserves the dignity of Nevadans? 

The answer lies not in hastening death but in revolutionizing how we care for the dying. Dame Cicely Saunders, founder of the modern hospice movement, showed us the way. Saunders understood something important: Dying isn't just a medical event, but a deeply human and spiritual journey. She recognized that pain isn't merely physical — it has emotional, social and spiritual dimensions that demand our attention and care.

When she established St. Christopher's Hospice in 1967, she pioneered a vision that transformed our understanding of death and dying. Her approach wasn't born in legislative chambers but at patients' bedsides, where she witnessed the complexity of human suffering and the transformative power of comprehensive care. As Nevada continues to grapple with medical aid in dying legislation following Lombardo's veto, Saunders' legacy offers crucial insights for our policy debates.

Saunders developed the concept of "total pain" — recognizing that end-of-life suffering encompasses physical, emotional, social and spiritual dimensions. This holistic understanding stands in stark contrast to the reductive approach of medical aid in dying, which frames death primarily as a medical event to be managed. Rather than viewing pain merely as a symptom to be eliminated, she developed sophisticated methods of pain control that allowed patients to remain alert and engaged with their loved ones.

In her book, Watch with Me: Inspiration for a Life in Hospice Care, Saunders wrote about the importance of "watching with" patients — being present and attentive to their needs, including spiritual ones. She believed this watchful presence often created natural opportunities for meaningful conversations about faith, death and what lies beyond. Regarding life beyond death specifically, she approached it through what she called "ministry of presence" — being there, ready to share faith when asked, while respecting each person's spiritual journey. She believed that genuine Christian love shown through excellent care could itself be a powerful testimony that might lead patients to ask about faith matters.

This balanced approach — maintaining strong Christian convictions while respecting patient autonomy — characterized her philosophy of hospice spiritual care and lent great weight to her perspective about hospice care being about "adding life to days, not days to life." A philosophy suggesting that spiritual care should enhance, not burden, a patient's remaining time.

But perhaps most relevant to Nevada's current debate is Saunders' understanding of the economics of dying. She advocated that comprehensive end-of-life care, while requiring initial investment, actually reduced overall health care costs while improving patient outcomes. This stands in sharp contrast to SB 239 and other short-sighted proposals for adopting a medical aid in dying system, where, as I previously noted, insurance companies can save millions by offering suicide pills instead of medical treatment and palliative care.

Saunders' model proved that the choice between costly care and hastened death is a false dichotomy. She showed that properly resourced hospice care could provide economic efficiency and human dignity — without compromising ethical principles or putting vulnerable patients at risk.

Instead of reviving legislation that risks turning death into a cost-saving measure, we should be investing in comprehensive end-of-life care that addresses the whole person. This requires several key initiatives.

First, we must strengthen our hospice programs through a systematic approach that includes expanding Medicare and Medicaid coverage for hospice services, establishing more facilities in rural Nevada, and creating mobile hospice units that can serve patients in their homes. Each program should maintain high staff-to-patient ratios and offer 24/7 access to qualified medical professionals who can respond quickly to pain management needs.

Second, we need to transform medical education to include training in spiritual and emotional support. Health care providers should learn to recognize spiritual distress as readily as they identify physical pain, understanding that both require professional attention.

Critics might argue that discussing faith with the dying is imposing beliefs at a vulnerable time. But in my experience, avoiding spiritual discussions altogether denies dying people the opportunity to grapple with their deepest questions and fears. The key lies in offering spiritual care with gentleness and respect, always following the patient's lead. This isn't about imposing beliefs but about creating space for patients to grapple with their deepest questions and fears.

Saunders' approach also offers wisdom regarding the spiritual aspects of dying. While maintaining her own deep Christian faith, she created a model of spiritual care that respected all beliefs, acknowledging that every dying person faces fundamental questions about meaning and purpose. This nuanced approach stands in contrast to secular arguments that dismiss spiritual care entirely and religious arguments that might impose specific beliefs.

Today's proponents of medical aid in dying legislation often use the language of dignity and autonomy. Yet Saunders demonstrated that true dignity comes not from controlling the moment of death, but from being surrounded by comprehensive care that affirms our full humanity until natural death occurs. She showed that autonomy isn't just about final decisions but about having genuine choices for quality care throughout the dying process.

The Apostle Paul wrote about death being "swallowed up in victory" — not through hastening its arrival, but through facing it with faith and dignity. This victory isn't just for the overtly religious; it's about helping every dying person find meaning and peace in their final chapter.

Third, we must support families through the dying process. Many face financial strain, emotional exhaustion and complex grief while caring for dying loved ones. We need expanded respite care services, paid family leave for end-of-life caregiving and professional counseling services for family caregivers. Support groups should be readily available during the dying process and after loss, and be covered by insurance.

As Nevada legislators inevitably revisit this issue, they should consider that no jurisdiction with medical aid in dying has simultaneously achieved Saunders' vision of universal access to quality end-of-life care. Instead, legalizing medical aid in dying often becomes a substitute for investing in comprehensive palliative care.

The foregoing suggested improvements to Nevada law and policy concerning those facing death may require significant investment, but they're far more cost-effective than our current approach of cycling dying patients through expensive emergency room visits and intensive care units. Moreover, they address the root causes that lead some to consider medical aid in dying: fear of pain, concern about burdening family members and spiritual distress.

Saunders once said, "You matter because you are you, and you matter to the end of your life." That radical affirmation of human dignity offers a far better foundation for public policy than the utilitarian calculations behind medical aid in dying legislation.

The governor's veto in 2023 has given Nevada time to pursue the palliative care alternatives. The 2025 Legislature should not waste this opportunity by merely pushing another medical aid in dying bill. Instead, lawmakers should work to build a health care system where no one feels compelled to choose death because proper care seems out of reach.

The measure of a society isn't just how it preserves life, but how it cares for those approaching life's end. Rather than returning to debates about medical aid in dying, let's commit to walking alongside the dying, ensuring that their final days are filled with dignity, meaning and the possibility of healing.

When we provide proper health care and support, many who initially wish for death's hastening often find unexpected value in their remaining days. That's the real "death with dignity" we should be fighting for. Let's hope that as this debate inevitably returns to our Legislature, we'll have the wisdom to choose the path of comprehensive care over expedient endings.

Jason D. Guinasso is an attorney with Greenman Goldberg Raby & Martinez in Reno and Las Vegas. Licensed in Nevada and California, he is a litigator and trial attorney. He also teaches business law at UNR and is a graduate student in the MALTS program at Regent College in Vancouver, British Columbia. The opinions expressed in this op-ed are those of the author in his personal capacity and do not necessarily reflect the views of his law firm, its clients or any other organization with which the author may be affiliated.

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