Death with dignity laws, also known as medical aid-in-dying laws or physician-assisted dying laws, allow terminally ill patients to request and receive medication to end their lives peacefully and with dignity. Currently, ten states and the District of Columbia have death with dignity laws on the books.
Supporters of death with dignity laws argue that they give terminally ill patients control over their end-of-life decisions and the option to avoid prolonged suffering. Opponents argue that these laws violate the sanctity of life and are vulnerable to abuse.
Notably, disability rights advocates have expressed concerns that death with dignity laws might coerce patients to end their lives prematurely. According to testimony posted to Not Dead Yet, a grassroots disability rights group opposing medical aid in dying laws, disability and “terminal disease” can be subjective distinctions rather than objective diagnoses. Conditions like muscular dystrophy or multiple sclerosis may be perceived as either progressive disabilities or terminal diseases depending on the individual’s perspective. If death with dignity laws fail to address underlying issues of ableism and lack of support for people with disabilities, these laws might harm disabled people.
However, the reality is not always straightforward. For instance, Bob Joondeph—who has served as the Executive Director of Disability Rights Oregon since 1991, longer than Oregon’s Death with Dignity Act has been in existence—publicly acknowledged that while he has received letters of concern about the potential correction of disabled people under the Act, he has no knowledge of a particularized instance where a disabled person was coerced to end their life under the Act.
Under death with dignity laws, a patient must meet certain eligibility criteria, such as being a resident of the state, having a terminal illness with a prognosis of six months or less to live, and making an informed and voluntary request for aid-in-dying medication. The patient must also self-administer the medication, as medical professionals are not allowed to assist with the administration.
But recently, it is the first criteria—being a resident of the state—that has raised concerns. In October 2021, Doctor Nicholas Gideonse challenged the constitutionality of the residency requirement in Oregon’s Death with Dignity Act.
First, Dr. Gideonse argued that the Privileges and Immunities Clause of the Constitution “prevents a state from restricting non-resident visitors access to medical care within its borders absent a substantial state interest and restrictions narrowly tailored to those interests.” He also argued the Privileges and Immunities Clause “prohibits differential treatment of in-state and out-of-state residents that infringes on the fundamental right to travel.”
Second, Dr. Gideonse contended that the residency requirement violates the Constitution’s Commerce Clause because it prevents his out-of-state “patients from procuring services in Oregon solely on the basis of their residency.” Alternatively, he maintains that the burdens to interstate commerce “clearly exceeds the benefits, if any,” of the requirement.
In August of 2022, a terminal ill Connecticut resident, Lynda Bluestein, and her physician, Diana Barnard, brought a suit challenging the residency requirement of Vermont’s medical aid in dying law. Like Dr. Gideonse, the plaintiffs argued the requirement violated the Privileges and Immunities and Commerce Clauses of the Constitution. Ms. Bluestein and Dr. Barnard additionally raised an Equal Protection Clause argument under the Fourteenth Amendment. They contended that the Vermont statute “invidiously discriminate[s] against non-residents of Vermont without a legitimate state interest.”
But before reaching the merits, both cases settled, leaving no indication of how state courts view the constitutional challenges. Oregon agreed to suspend enforcement of its residency requirement as a condition of the settlement last March. And in March 2023, plaintiffs challenging Vermont’s residency requirement in the state’s Medical Aid-in-Dying Law won a settlement under which officials “agree not to enforce the residency requirement” for an out of state resident.
The movement to eliminate state residency requirements for death with dignity laws represents an opportunity to address constitutional concerns related to equal protection, privileges and immunities, and commerce. However, it is important to recognize that concerns raised by disability rights advocates regarding potential coercion and discrimination against disabled individuals still need to be addressed. It is crucial to remain engaged in discussions and debates around these issues to ensure that end-of-life care options are accessible and equitable for all individuals, regardless of their residency or disability status.