Judy Govatos has heard that magical phrase “you’re in remission” twice, in 2015 and again in 2019. She beat Stage 4 lymphoma with such aggressive chemotherapy and other treatments that at one point she became weak to stand, and rely on a wheelchair. He was hospitalized several times, developed an infection and lost about 20 pounds. But he prevailed.
Ms. Govatos, 79, a retired nonprofit executive who lives in Wilmington, Del., is grateful for the extra years. “I feel incredibly lucky,” she said. She was able to take and teach lifelong learning courses, work in her garden, visit London and Cape Cod with friends. He spends time with his two grandchildren, “an elixir.”
But he knew the cancer could return, and he didn’t want to endure the pain and disability of further attempts to beat it.
“I am not looking to cure death. I want quality of life,” she told her oncologist. “If that means less time living, that’s fine.” When her months dwindled, she wanted medical assistance in dying. After a series of request and consultation, a doctor will prescribe a lethal dose of a drug that he will take himself.
Assisted dying remains illegal in Delaware, despite repeated legislative attempts to pass a bill allowing it. Since 2019, however, it has been legal in nearby New Jerseyhalf an hour’s drive from Ms.’s home. Govatos.
But New Jersey restricts assisted dying to terminally ill residents of its own state. Ms. Govatos is more than willing, therefore, to be one of four plaintiffs — two patients, two doctors — taking the New Jersey officials to federal court.
The lawsuit, filed last month, argues that New Jersey’s residency requirement violates the Constitution’s privileges and immunities clause and its equal protection clause.
“The law prohibits New Jersey physicians from providing equal care to their patients who are not New Jersey residents,” said David Bassett, an attorney at the New York firm Wilmer Cutler Pickering Hale and Dorr, which brought the suit. at the advocacy group Compassion & Choices.
“There is no justification that anyone has said” for such discrimination, he added. The suit also contends that prohibiting New Jersey doctors from offering assisted-dying care to out-of-state patients restricts interstate commerce, the province of Congress.
The New Jersey Attorney General’s office declined to comment.
“I want not to die of terrible pain and terrible fear, and I have experienced both,” said Ms. Govatos. Even when she enrolled in hospice, many of the pain medications used caused her to pass out, hallucinate and vomit.
To legally end his life when he decides “is a question of mercy and kindness,” he said.
This is the third time Compassion & Choices has pursued this route in its efforts to expand access to assisted dying. It filed similar lawsuits in Oregon in 2021 and in Vermont last year. Both states agreed to settle, and their legislatures passed revised laws repealing residency requirements, Oregon in July and Vermont in May.
The plaintiffs hope that New Jersey, another blue state, will follow suit. “We hope we don’t have to go before a judge. Our preference is to negotiate a fair resolution,” Mr. Bassett said. “That’s what matters for our patient plaintiffs. They don’t have time for a full trial.”
“It’s not the traditional process of trying to convince a state legislature that this is a good idea,” said Thaddeus Pope, a law professor at the Mitchell-Hamline School of Law in St. Louis. Paul, Minn., which tracks end-of-life law and court cases.
Reducing residency requirements in New Jersey could have a bigger impact than in Oregon or Vermont. The sheer population density along New Jersey’s borders — there are nearly 20 million residents in the New York metropolitan area alone — means that medical aid in dying is suddenly available to more people, and more quickly than through law
With a major airport and direct flights, “it’s easier to get to Newark than Burlington, Vermont,” Mr. Pope pointed out.
Many states where assisted dying is legal have relaxed their laws because of findings like that of a 2017 studywhere about one-third of California patients who asked a doctor about assisted dying either died before they could complete the process or became too ill to continue with it.
But New Jersey still uses the stricter series of steps first codified by Oregon in 1994. That means two verbal requests to a doctor at least 15 days apart, one written request with two witness, and a consultation with a second physician; both must confirm that the patient is eligible. There is a 48 hour wait after a written request before a prescription can be written.
Even without having to establish residency, “it’s not going to be a walk in the park,” Mr. Pope said. “You can’t just go to New Jersey, get the drugs and come back.”
Finding a doctor willing to prescribe can take time, as can using one of the state’s few compounding pharmacies, which compound the necessary drugs and fill the prescription.
Although there is no official test to see if patients return home with the drug, both Mr. Bassett and Mr. Pope advise that the lethal dose should be taken in New Jersey, to avoid the possibility that members of the family face prosecution in their home states for assisting suicide.
However, preventing dying patients from signing leases and obtaining government IDs to become residents will speed up the process. “Not everyone has the will, the financial means, the physical means” to establish residency, said Dr. Paul Bryman, one of the plaintiffs is a doctor and medical director of a hospice in southern New Jersey. “These are often people with disabilities.”
Bills recently introduced in Minnesota and New York do not include all residency requirements, Mr. Pope said, because they are likely to be challenged in court.
“I think the writing is on the wall,” he said. “I think all residency requirements will go, in all states” where assisted dying is legal. There are 10, including the District of Columbia (although legality in Montana depends on court decision, not law).
Despite the often heated debate over aid-in-dying laws, very few patients actually turn to lethal drugs in the end, state records show. Last year, Oregon reported that 431 people received prescriptions and 278 died using them, just .6 percent of the state’s deaths in 2022.
Only in New Jersey 91 patients used assisted dying in the past year. About a third of those who receive prescriptions never use them, perhaps reassured enough by the prospect of a quick discharge.
Fears of “death tourism,” with an influx of out-of-state patients, have not materialized, said John Burzichelli, a former state assemblyman who helped steer the New Jersey law through the legislature and now favors allowing eligible non-residents to participate.
“I don’t see lines of people at the tollbooths coming to take advantage of this law,” he said.
If her cancer returns and New Jersey refuses to allow out-of-states to legally end their lives there, Ms. Govatos the trip to Vermont. He envisions a farewell party for a few friends and family members, with poetry readings, music and “very good wine and good food.”
But driving over the Delaware Memorial Bridge will be much simpler. “It would be an incredible gift if I could go to New Jersey,” he said.