The Third Circuit Court of Appeals has ruled that New Jersey’s medical aid-in-dying law is limited to state residents, turning away a challenge from out-of-state patients and a doctor who wanted to treat them. The decision reinforces states’ authority to set the terms for sensitive medical practices while leaving room for debate about access and compassion.
The appeals court upheld New Jersey’s residency requirement, rejecting arguments that the state must extend assisted suicide to visitors. Judge Stephanos Bibas wrote the opinion and acknowledged the heartbreaking choices facing terminally ill people while making clear the law’s limited reach.
“Death brings good things to an end, but rarely neatly,” U.S. Circuit Court Judge Stephanos Bibas wrote in the opinion issued last week. “Many terminally ill patients face a grim reality: imminent, painful death. Some may want to avert that suffering by enlisting a doctor’s help to end their own lives. New Jersey lets its residents make that choice—but only its residents.”
The case began when a woman from Delaware with stage four lymphoma sought access under New Jersey’s statute but was denied because she did not live in the state; she later died after the legal fight moved through the courts. A New Jersey physician who wanted to provide care to nearby out-of-state patients joined the suit, along with other plaintiffs who have since passed away or stepped back.
One physician involved, Dr. Paul Bryman, expressed his disappointment with the ruling. “Terminal patients outside New Jersey should have the option of medical aid in dying without having to travel long distances,” he said. That plea highlights the human side of the story and why advocates pushed the courts.
The appeals court leaned on federalism to deny relief to the challengers, noting that states can experiment with grave policies like physician-assisted death and that other states can choose to criminalize it. “In our federal system, states are free to experiment with policies as grave as letting doctors assist suicide. Other states are free to keep it a crime,” the appeals court ruling said. “This novel option does not appear to be a fundamental privilege, let alone a fundamental right, that states must accord visitors.”
New Jersey joined a group of states that allow physician-assisted death when its governor signed the law in 2019, setting eligibility rules and safeguards for qualified residents. Under the statute, only adult New Jersey residents diagnosed with a terminal illness and given six months or fewer to live qualify, and two physicians must verify the diagnosis and the patient’s decision-making capacity.
The law requires multiple safeguards designed to prevent abuse and ensure choice is informed: two separate requests with at least one written request witnessed by two people, the right to rescind, and a requirement that one witness not be a family member, heir, attending physician, or facility employee. Patients must self-administer any prescribed medication, and physicians are required to discuss alternatives such as palliative care.
The ruling leaves states to set their own lines on how and to whom aid-in-dying is available, and it underscores a core Republican principle: let states make weighty decisions for their citizens instead of federal courts imposing a national standard. The debate over access and compassion will continue at statehouses and in the court of public opinion, with Delaware moving forward as its own law goes into effect on Jan. 1.
Graduate Student, wife, engaged political and legal writer.