New Jersey court decision prevents suicide tourism and all of it's grisly reality

By Dr Jacqueline Abernathy

Article: Judge upholds New Jersey assisted suicide law residency requirement (Link). 

Jacqueline Abernathy

Vulnerable citizens, disability rights advocates and people who oppose assisted suicide were delivered good news last week when the latest attempt at judicial activism by the assisted suicide lobby failed to strike down the residency requirement in New Jersey’s assisted suicide law. Compassion & Choices has been trying to chip away at the supposed safeguards in the state legislation and has, for years, pinned its hopes on litigation that could persuade judges to circumvent the will of the people. This latest attempt failed otherwise New Jersey would have joined Oregon and Vermont as the third suicide tourist destination in the United States.

Once an assisted suicide law is passed and the practice is legalized, safeguards like residency requirements, eligibility, provider qualifications, and waiting periods become the next target for advocates. Colorado just passed Bill SB 128 expanding their assisted suicide law to lower the waiting period and allow non-physicians to prescribe lethal poison drugs. However, the first draft of that bill would have revoked the residency requirement and reduced the waiting period from 2 weeks to only 2 days. The legislators compromised on cutting the waiting period to one week, however, embracing suicide tourism was a harder sell. I testified that the reason for such an abbreviated waiting period and liberalized qualifications on who could legally assist suicides was to accommodate non-residents who would be eligible to end their lives in Colorado. Expanding the law was the goal but the ultimate desire for euthanasia advocates was that assisted suicide be accessible to sick and dying people in neighboring states where their lives are protected from legal violence. When someone takes a moment to consider the pragmatic and grizzly reality of what that means for society, not just ill people and their loved ones but others who have to clean up the aftermath, it should become evident why selling suicide is a faulty and grisly idea.

Just from a patient's rights perspective, allowing vulnerable people to access lethal poison from a total stranger who will only have them as a patient as long as it takes to dispense the lethal dose is bad medicine even if we weren't talking about an irrevocable destruction. Healthcare providers are supposed to take into consideration the confluence of a patient's situation including the validity of someone's terminal diagnosis, treatment options, the patient's mental capacity to consent, the possibility of treatable depression, and other circumstances that can be resolved, and potential coercion, real or just perceived. A patient could be under pressure not to spend some heirs' inheritance or believe that there would be no one to take care of them if their family isn't willing. Or, someone might just assume this and be gravely incorrect. The family might desperately want as much time with them as possible and the ability to support them in their difficult time.

Likewise, someone hiding their intent to be killed may choose to do so alone also risks dying in a less palatable way. Assisted suicide drugs often include an anti-emetic to deal with the nauseating nature of the barbiturate overdose and it is not uncommon for people to vomit after taking the poison. There's a risk of asphyxiation on one's own vomit or not ingesting sufficient doses of poison to fully overdose. What about those victims whose death is delayed? When the process takes longer, those who do not die as quickly as expected risk having the process interrupted. Someone choosing to take the dose in time to avoid rigor mortis or gruesome post-mortem decay before a visitor finds them the next morning might not yet be dead when their friend or housekeeper arrives. Even if there was a note, people may call an ambulance in a panic, and unlike do not resuscitate orders, paramedics and hospital staff intervene "full code." The hastiness and secrecy of travelling out of state to be killed enables these tragedies.

Making suicide into a business is really bad medicine (as if killing were healthcare, to begin with), but adding the ethical conflict of financial gain is a significant concern with suicide tourism. Suicide tourism fosters specialty death clinics by creating a market for suicide as a service, niche practices staffed by unethical, unscrupulous doctors or zealots who are ideologically pro-euthanasia who believe death on demand is a personal right for those who meet any legal criteria. There is no second opinion. Visiting a doctor once, specifically because they sell suicide suggests no doctor-patient relationship, and furthermore, with a doctor who has a conflict of interest: a profit motive against critically assessing each patient's situation to determine if they truly want to end their lives, if they are guided by wrong assumptions or ignorance of non-violent options, and if there are treatment alternatives they haven't considered. It's counterproductive for somebody who runs a business selling suicide to risk losing future customers by being the doctor who can't be counted on to just hand over the script on demand like a vending machine.

People do not pay huge sums to travel to a clinic that prescribes lethal poison without the assurance that they will get that prescription when they arrive. People are less likely to endure the expense and trouble of travelling to an assisted suicide-sympathetic practice if they may be turned away. Rather, it is just rational to go to a clinic that has a reputation for rubber-stamping requests and so other clinics are pressured to do the same merely to stay competitive. Suicide tourism fosters specialty death clinics by creating a market for suicide as a service, niche practices staffed by unethical, unscrupulous doctors or zealots who are ideologically pro-euthanasia who believe death on demand is a personal right for those who meet any legal criteria. There is no second opinion.

As for loved ones, the secrecy that this allows and the ability to end a life while alone is rife with the potential for lifelong guilt and regret from family members who might wish they had been there to hold their loved one’s hand, others would have given anything to assure them that they don't have to die this way. Imagine blaming yourself for not being supportive enough, acting greedy or selfish that someone you loved died because they thought you valued their money that they stand to inherit more than you valued their life. I can't fathom the shame I would feel if my grandparents, parents, siblings or spouse didn't think I would be there when they needed me, and worse, knowing they died with that misperception without me ever having the chance to redeem myself.

Imagine the added trauma of just stumbling across your loved one's dead body the day after having met them for brunch, when they were very alive and nowhere close to naturally succumbing to their underlying illness. It is possible that some people would rather just run off to kill themselves in isolation rather than return home with their dose, launching a panic and an anxiety-laced search for them, creating pointless emotional agony from the search effort, an agony which will not end in relief, just further anguish. A suicide how-to manual in Japan caters to anyone who just wants to disappear completely. It provides bus routes to the dense Aokigahara forest, so someone can kill themselves where their body is unlikely to ever be found (it even offers pointers for how to avoid suspicion from park staff, trained to spot people suicidal people in crisis). Some people may choose suicide tourist states as their final destination in order to hide from their family and friends. Maybe they do not want the shame of having anyone know they died by assisted suicide or think that it is easier for their family not to know they died in this manner. Whatever the motive for secretly seeking assisted suicide, it complicates the grief of those left behind. Losing a loved one is inherently painful. Suicide tourism serves to only add layer upon layer of additional torment and trauma.

For the average citizen of a suicide tourist destination, there is the added risk of the heavy emotional and financial toll from cleaning up after the deceased. While it is true that most suicides (77%) occur at home, those who travel from their homes out-of-state just to obtain deadly drugs might not return home. Those who seek suicide away from home are first and foremost trying to subvert the laws of their home jurisdiction but again, how many might be trying to subvert loved ones back home as well? As mentioned before: some people just do not want to die where they could be found. Furthermore, what about those suicide-seekers with no one to return home to anyway or those who can not afford return travel? Suicide is an inherently impulsive act and someone might be unwilling or afraid to wait. Perhaps some are unable to afford return travel or prefer to spend their money to die in an Airbnb with a scenic view of nature.

There are suicide hotspots for a reason Parks attract despondent people not just because some just want to "return to nature" when they die. National parks are prime suicide destinations in the United States suicide is the second leading cause of death among visitors and deaths can cost over a quarter-million dollars in recovery and identification efforts per victim. Park Rangers have suffered immense psychological damage from these macabre discoveries. We know that the mere proximity to suicide violence increases the likelihood of suicide among those who experienced it, primarily the survivors but even strangers like first responders. It could also be the hotel maid or the owner of an Airbnb who endures the terror of discovering a tourist cold and breathless in their bed. Because pills are easier to conceal than guns or ropes and are inconspicuous any public place can become the spot someone chooses to die if they are inclined, where anyone can become a victim of finding their corpse.

These are merely a few hypothetical pitfalls of turning death into a tourist attraction. Assisted suicide itself is already wrought with abuses and anguish but allowing clinics to sell it as a commodity to patients they know nothing about (and patients they have no intention of getting to know) is a compounding public health and safety risk.

The people of New Jersey as well as neighboring states who would have availed themselves of out-of-state suicide are fortunate that the court opted to protect them. Even though the reasons for denying the petition were more procedural, the logistical issues of liability from the decedents' home states, the effect is the same: vulnerable people from neighboring states are protected by the laws enacted to keep them safe, at least for now.