Allow terminally ill patients from out of state to access aid-in-dying

Last week, Oregon became the first state to stop enforcing its residency requirement for medical assistance in dying. Following a lawsuit brought by an Oregon physician and Compassion and Choices, an advocacy group campaigning for better end-of-life options, the state settled in favor of ending the restriction. The case was prompted by a southwest Washington resident who felt the care he was looking for was not easily available and sought help in nearby Oregon. For the first time since 1997, terminally ill patients from out of state can now avail themselves of Oregon’s Death with Dignity Act.

This move was long overdue. No other medical procedure discriminates against patients who cannot show proof of residency. The intent of assisted dying laws has always been to reduce unnecessary suffering at the end of life. Broadening access to Oregon’s law by removing the burden of residency is squarely in line with that sentiment. Terminal illness does not stop at state borders. And neither should our laws.

Oregon and Washington have long served a pioneering role when it comes to improving access to end-of-life care. For more than 10 years, Oregon remained the only state to permit terminally ill patients with a life expectancy of six months or less to ingest a lethal dose of medication to end their suffering. In 2008, Washington became the second. Today, eight other states and the District of Columbia allow medical assistance in dying (or, in the case of Montana, have no laws against it). Washington must now follow Oregon’s lead again and eliminate its residency requirement for its Death with Dignity Act. Because why should a person suffering from ALS who lives in Washington be allowed to die but not someone from neighboring Idaho?

As a cultural anthropologist, I spent five years shadowing patients, families and physicians at the front lines of assisted dying, mostly in the Pacific Northwest. And I have seen firsthand the tremendous relief an assisted death can bring. I also met very sick patients who lived in states without access to aid-in-dying, from Massachusetts to Texas, who had neither the time nor the resources to upend their lives and establish residency in a different state. At a time of great need and despair, they were shut out of accessing what they saw as a compassionate death.

Opponents of the move argue that getting rid of the residency requirement will lead to medical tourism. Such a scenario seems improbable. Most patients in the throes of a terminal illness won’t readily uproot their lives to die in a state far away from home and loved ones, even if they had the financial means to travel and were able to establish care with a local provider quickly. Besides, the number of patients who use assisted dying laws has remained consistently small over the past two decades — in Oregon, it’s 0.5% of all deaths in the state.

Accessing an assisted death will remain beyond the reach of most patients who must contend with a terminal illness, even if residency requirements were lifted in all states that currently allow aid-in-dying. But it is absolutely a step in the right direction.