New Jersey’s Assisted-Suicide Residency Rule: A Quiet but Pivotal Moment in America’s Right-to-Die Debate

The Third Circuit’s decision to uphold New Jersey’s residency requirement for medical aid in dying looks narrow and technical: non-residents can’t use the state’s law. But beneath that seemingly modest holding lies a much larger story about how the United States is choosing to regulate death itself—state by state, lawsuit by lawsuit, rather than as a unified right.

What the ruling really does is cement a model of end-of-life autonomy as a conditional state privilege, not a national entitlement. That choice has far-reaching consequences for terminally ill patients, health-care providers, and the future geography of medical aid in dying across the country.

The Bigger Picture: How We Got Here

To understand why New Jersey can limit medical aid in dying to its own residents, it helps to see this ruling in the arc of U.S. right-to-die law over the last 30 years.

• 1990s: The Supreme Court sets the outer limits. In 1997, the Supreme Court decided Washington v. Glucksberg and Vacco v. Quill, holding that there is no federal constitutional right to physician-assisted suicide. States may legalize or ban it, but they are not constitutionally required to allow it. That’s the legal backbone the Third Circuit is leaning on.
• Oregon’s experiment. Oregon’s Death with Dignity Act, approved in 1994 and implemented in 1997, became the template: adult, terminally ill, mentally competent, multiple physician confirmations, waiting periods, and self-administration of the medication. Almost every U.S. law since has been a variation on this structure.
• Patchwork expansion. Over the next two decades, a small but growing cluster of states—Washington, Vermont, California, Colorado, New Jersey, Maine, New Mexico, and others—joined Oregon, while most states retained outright bans.
• The residency clause as a political compromise. Most states added residency requirements as a political safety valve. It let lawmakers reassure opponents that they weren’t turning their state into a destination for “death tourism” while still offering the option to their own constituents.

New Jersey’s 2019 law fits squarely within that lineage. Its safeguards—including two physicians, six-month prognosis, multiple requests, witnessed documentation, and mandatory self-administration—mirror Oregon’s design. The only truly contested feature here is who may access that framework.

Why the Residency Requirement Matters More Than It Sounds

Residency might seem like a bureaucratic detail, but for terminally ill patients, it draws a bright line between those who can plan their deaths and those who cannot—often based on nothing more than their ZIP code.

The Delaware woman at the center of this case, who sought to use New Jersey’s law before she died of stage four lymphoma, illustrates that gap. She lived within driving distance of a state that had already decided medical aid in dying is safe and acceptable under strict conditions. Yet a line on a map made that option legally inaccessible to her until Delaware passed its own law, too late to matter in her case.

That’s not a minor technicality; it’s the embodiment of American federalism in perhaps its starkest form: the power to decide not just how people live, but how they may die.

The Court’s Logic: Federalism, Not Moral Endorsement

Judge Stephanos Bibas’s opinion is notable for its tone: empathetic toward suffering patients, yet unequivocal about the legal boundaries. The decision rests on three key premises:

• No fundamental right. Following Supreme Court precedent, the court reiterated that medical aid in dying is not a “fundamental right” protected by the Constitution. That means states can restrict it without triggering heightened constitutional scrutiny.
• States as laboratories. The opinion emphasizes that “in our federal system, states are free to experiment” with laws as consequential as assisted dying. This language deliberately echoes the classic idea of states as policy laboratories, even when the experiment involves life and death.
• Privileges and immunities are limited. Plaintiffs argued that New Jersey’s law improperly discriminated against non-residents, invoking the Constitution’s Privileges and Immunities Clause. The court’s response was blunt: this is not the kind of core economic or civil right that states must provide equally to visitors.

The takeaway is not that the court believes residency limits are morally right, but that the Constitution doesn’t stop states from drawing that line. Moral debate is pushed back into legislatures, not courtrooms.

What’s Being Overlooked: The Emerging “Geography of Dying”

Most coverage of this ruling frames it as a binary: residents versus non-residents. What’s underexplored is how decisions like this are creating a geography of dying in America—where the circumstances of your death are shaped by a combination of state boundaries, wealth, mobility, and political culture.

Consider three dynamics:

1. Mobility and inequality. Even where residency requirements exist, wealthier patients can sometimes work around them by temporarily relocating, establishing addresses, or leveraging legal help. Low-income or disabled patients, or those with fragile social support, can’t. That effectively stratifies access by class and capacity to navigate bureaucracy.
2. Border communities. In the dense Northeast corridor, city and state lines cut across tight geographic and social networks. A terminally ill patient in Philadelphia or Wilmington may live closer to New Jersey’s doctors than to those in their own state. Yet legal access hinges on where they pay taxes, not where they receive actual care.
3. Pressure on neighboring states. As more patients in non-aid-in-dying states learn that just across the border lies a legal pathway, pressure builds on local lawmakers. Delaware’s new law—taking effect Jan. 1—can be seen, in part, as a response to this regional dynamic.

This geography is not accidental; it’s the predictable outcome of treating end-of-life autonomy as a localized regulatory experiment rather than a nationwide standard.

International Contrast: Why U.S. Policy Is So Fragmented

Looking abroad, the U.S. stands out for how deeply fragmented its approach is. Countries like Canada, Belgium, the Netherlands, and Switzerland also allow some form of medical assistance in dying, but they typically regulate it at the national or at least more unified level.

• Canada legalized medical assistance in dying (MAID) nationwide in 2016 after its Supreme Court found a constitutional right to such assistance in certain circumstances. While implementation varies by province, the underlying right is uniform.
• Switzerland has allowed assisted suicide under certain conditions for decades, and organizations like Dignitas serve foreign nationals, openly creating what critics call “suicide tourism.”
• The Netherlands and Belgium have some of the broadest frameworks, including for certain non-terminal conditions, though their systems remain tightly regulated and highly scrutinized.

By contrast, the U.S. is functionally running 50 different experiments at once, with little consistency in eligibility, safeguards, and—crucially—geographic access. That’s not just a policy choice; it’s a reflection of deep cultural ambivalence about autonomy, religion, and the role of medicine in death.

Religious and Ethical Crosscurrents

New Jersey’s law itself is a study in compromise. When Governor Phil Murphy, a Catholic, signed it in 2019, he acknowledged that his faith might prevent him personally from choosing assisted suicide, yet he supported giving others that option. That framing—“I wouldn’t choose it, but I won’t prevent you from doing so”—has become the dominant political language for Democrats in purple states.

Opponents, including many religious and disability-rights groups, worry about subtle coercion: patients feeling economic or emotional pressure to choose death to avoid being a “burden.” They also warn about mission creep, pointing to Canada’s expanding MAID program as a cautionary tale.

Supporters argue that without legal, regulated options, patients turn to more traumatic methods or travel long distances in pain and uncertainty. They emphasize that laws like New Jersey’s require self-administration, multiple requests, and physician confirmation of both diagnosis and mental capacity—guardrails meant to prevent abuse.

Data and Trends: What the Numbers Actually Show

While New Jersey’s own data set is still young, longer-running programs offer clues:

• In Oregon, annual reports show that the majority of those who use medical aid in dying are older, white, insured, and college-educated. The most commonly cited reasons are loss of autonomy, inability to engage in enjoyable activities, and loss of dignity, rather than uncontrolled pain.
• Usage rates remain low: in Oregon and Washington, deaths under aid-in-dying laws typically account for under 1% of all deaths each year.
• There is limited evidence of the kind of large-scale abuse often warned about, though critics argue data collection is incomplete and oversight may be too trusting of physician reporting.

These patterns complicate both sides’ narratives. The data doesn’t support a wave of coercion, but it does suggest that aid in dying is used primarily by relatively privileged patients who can navigate the system—a reminder that offering a legal right on paper doesn’t guarantee equal access in practice.

What This Ruling Signals for the Future

The Third Circuit’s decision sends several quiet but important signals for the next phase of the right-to-die debate:

• Courts will not lead; legislatures must. The federal judiciary is clearly signaling that it will not constitutionalize medical aid in dying, nor will it force states to open their doors to non-residents. Any expansion—substantive or geographic—will come from statehouses, not courtrooms.
• Residency fights will move to politics. Oregon and Vermont have already dropped their residency requirements, partly in response to legal challenges under the Constitution’s interstate commerce and equal protection principles. New Jersey’s victory may embolden other states to keep or even tighten their own residency rules—but it also gives advocates a clear political target.
• Regional ecosystems will matter more. As more Northeastern states (like Delaware) adopt their own laws, regional “ecosystems” of access will form. In the West, a corridor of states with aid-in-dying laws already effectively exists. States that remain holdouts may find themselves increasingly isolated as their residents quietly cross borders.

Looking Ahead: Questions That Haven’t Been Answered

This case closes one door but leaves several others ajar:

• Will more states follow Oregon and Vermont? If cross-border demand grows, some states may decide that the administrative and ethical costs of enforcing residency rules outweigh the political benefits.
• How will insurers and health systems respond? If patients start relocating or establishing “paper residency” to access aid in dying, payers and providers will be forced to navigate complex questions about continuity of care and liability across state lines.
• Could Congress ever intervene? While unlikely in the near term, federal lawmakers could regulate aspects of interstate travel or prescribe minimum standards, especially if a patchwork of conflicting policies creates legal chaos.

For now, the most realistic prediction is incremental change: more states experimenting, modest liberalization in some, and entrenched bans in others. The result will be a steadily sharpening divide between places where death is something the law allows you to plan—and places where it is something the law insists you endure.

The Bottom Line

The Third Circuit’s ruling on New Jersey’s residency requirement doesn’t just decide who can access one state’s medical aid-in-dying law. It affirms a broader American settlement: that control over the timing and manner of one’s death is not a national right but a localized option, contingent on where you live, how much you can travel, and how your state’s politics line up.

For patients like the Delaware woman at the heart of this case, that settlement is not abstract. It determines whether they spend their final weeks with a measure of control—or with the full weight of geography, law, and politics pressing down on their last choices.