Medical Aid in Dying: Residency Restrictions

Compassion & Choices believes that medical aid in dying should be available to all qualified patients, regardless of their ZIP code. With the exception of Vermont and Oregon, in every state where medical aid in dying has been authorized via the legislative process, there is statutory language that limits the use of the practice to in-state residents. However, firsthand experience from doctors and patients, and decades of data, make it clear that the residency restriction functions more as a barrier to access than as a safeguard.

The process of establishing residency in a new state while terminally ill is an extremely burdensome and expensive process that no one should have to endure. The residency restriction is a barrier to accessing medical aid in dying for nearly all dying people who live in a jurisdiction where aid in dying is not yet authorized. A significant number of terminally ill people residing in states where medical aid in dying is authorized have also been adversely impacted by these restrictions, as many receive their regular medical care across state lines.

Whether it be through the courts or the legislature, Compassion & Choices continues to advocate for greater access to all forms of end-of-life care.

 

Gideonse v. Brown

In 2021, Compassion & Choices filed a lawsuit in federal court on behalf of Dr. Nicholas Gideonse that challenged the constitutionality of the residency restriction contained in Oregon’s Death with Dignity Act. In this case, Gideonse v. Brown, et al., Dr. Gideonse explained that he regularly treats patients from neighboring Washington State and that medical aid in dying was the only type of care that he was unable to provide to these individuals. The residency restriction required these patients to either find a new doctor during the dying process or to not have the option of medical aid in dying. Dr. Gideonse argued that the residency restriction violated the United States Constitution because it unlawfully discriminated against his out-of-state patients.

On March 28, 2022, Dr. Gideonse and the State of Oregon defendants reached a settlement in the case. As a result of this settlement, the Oregon Health Authority (OHA), Oregon Medical Board, and the Multnomah County District Attorney have all agreed not to enforce the residency restriction. Further, the OHA agreed to initiate a legislative request to permanently remove the residency restriction from the law.

In July 2023, Governor Tina Kotek signed HB2279 into law, which removed all residency restrictions from the Oregon Death with Dignity Act.

Learn more at the Gideonse v. Brown case page.

 

Bluestein v. Scott

On August 25, 2022, Compassion & Choices filed a lawsuit on behalf of Lynda Bluestein, a terminally-ill Connecticut resident, and Diana Barnard, a Vermont physician specializing in hospice and palliative care and associate professor of family medicine at University of Vermont. Both Ms. Bluestein and Dr. Barnard’s non-Vermonter patients were unable to access medical aid in dying in Vermont, due solely to a provision of The Patient Choice and Control at End of Life Act (the Act) that restricted the option to Vermont residents.

The lawsuit alleged that the residency requirement contained in the Act is unconstitutional. Filed on the heels of the State of Oregon agreeing to suspend enforcement of its residency requirement as a result of the settlement reached in the Gideonse v. Brown suit, the lawsuit was the most recent challenge to a residency restriction contained in a medical aid-in-dying law.

On March 14, 2023, the plaintiffs announced that a settlement had been reached in the case. Lynda Bluestein is now able to access medical aid in dying in Vermont regardless of her residency status, and the Vermont Department of Health agreed to publicly support legislation to remove the residency requirement permanently. On May 2, 2023, Vermont Governor Phil Scott signed a bill permanently removing the residency restriction from the state’s medical aid-in-dying law.

Learn more at the Bluestein v. Scott case page.

 

Govatos v. Murphy

On August 29, 2023, Compassion & Choices filed a federal lawsuit on behalf of Judith Govatos, a Delaware resident with stage-4 lymphoma; Andrea Sealy, a Pennsylvania resident with metastatic breast cancer; Dr. Paul Bryman, a New Jersey physician, geritrician, and hospice medical director; and Dr. Deborah Pasik, a New Jersey physician. The lawsuit challenges a requirement that restricts access to the state’s medical aid-in-dying law to only New Jersey residents.

Both Govatos and Sealy would like the option of medical aid in dying, but are currently ineligble for a prescription because they are not New Jersey residents. Both Drs. Bryman and Pasik regularly treat patients at the end of life, but are unable to offer their out-of-state patients the same end-of-life options as their in-state patients. If not for New Jersey’s residency restriction, Drs. Bryman and Pasik would be able to offer qualifying terminally ill patients the option of medical aid in dying.

Compassion & Choices believes New Jersey’s residency restriction is unconstitutional and impermissibly limits a person’s ability to access health care and a doctor’s ability to offer health care to their patients. Compassion & Choices is hopeful that, like Oregon and Vermont, New Jersey will soon remove the residency restriction from their medical aid-in-dying law.

Learn more at the Govatos v. Murphy case page.

 

Resources

If you are a non-resident considering Oregon or Vermont for the purpose of medical aid in dying, please see this attached document for general guidance.

If you are the friend or family member of a non-resident considering Oregon or Vermont for the purpose of medical aid in dying, please see this attached document for general guidance.

If you are an Oregon or Vermont medical provider that is considering prescribing medical aid in dying to a non-resident,  please see this attached document for general guidance.

If you are requesting information regarding the use of telemedicine in light of the Gideonse v. Brown settlement agreement, please see this attached document for general guidance.

Do not hesitate to contact Compassion & Choices’ legal team if you have specific questions regarding this settlement and how it impacts you.

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VICTORY: Colorado Gov. Jared Polis signed the improved End-of-Life Options Act.

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