Repealing the Final Rule Would Be A Tragedy For Opposition To Euthanasia.

Meghan Schrader

By Meghan Schrader

As I’ve mentioned, the Final Rule, a 2024 update to Section 504 of the Rehabilitation Act, is one of the best tools that the anti euthanasia movement has had in decades. The Final Rule strengthens Section 504 and the Americans With Disabilities Act in several ways, including new prohibitions against medical personnel pushing disabled people towards death. These provisions are new bulwarks against assisted suicide, coerced DNRs, futile care statutes and the infanticide of disabled babies; such as in the 1982 Baby Doe case. Everything groups opposing euthanasia need to avoid a Canada-like situation is in those regulations.

The Final Rule not only addresses futile care statutes, assisted suicide and infanticide, it also contains numerous other beneficial provisions. For instance, the Final Rule contains new protections for disabled parents, internet access, accessible medical equipment and better community services for disabled people at risk of being institutionalized. Hence, the Final Rule will help protect disabled Americans from the scarcity that is pushing disabled Canadians towards euthanasia.

But in 2025, 17 states filed the Texas vs. Becerra lawsuit, now called Texas vs. Kennedy. The original lawsuit sought to repeal the entire Final Rule, as well as Section 504 itself. (The challenge to Section 504 itself was dropped after backlash.)

In addition to multiple disability protections that I think EPC blog readers from across the political spectrum can agree on, one clause of the Final Rule defined gender dysphoria as a disability. This was one of the reasons that the 17 states filed suit against the Final Rule.

But the gender dysphoria issue is currently a moot point. Regardless of whether one believes that gender dysphoria ought to be defined as an impairment, the President’s executive order on gender issues means that this government will not enforce that part of the Rule. So, eight of the original 17 states dropped out of the lawsuit.

But 9 states still want to eliminate the rest of the Final Rule. Texas, Florida, Alaska, Indiana, Missouri, Louisiana, Kansas, Montana and South Dakota want the government to avoid “burdening” states with the Rule’s requirement that states institute new supports for disabled people at risk of being institutionalized. So, on January 23rd, 2026, those states filed an updated version of their lawsuit. This iteration of the lawsuit makes no mention of gender dysphoria or repealing Section 504 itself, but it still seeks to have the entire Final Rule set aside.

I am also very worried that even if the lawsuit is dropped, HHS and the Department of Justice will rescind the entire Final Rule anyway.

This would be a shame, because the Final Rule is a critical tool for achieving opposition to euthanasia.

Groups opposing euthanasia have always fought the infanticide of disabled babies, which we know happens periodically in hospitals across the US and abroad because doctors make prejudiced judgments about the value of the babies’ lives. (Such as the UK Alfie Evans case.) Section 84.56 specifically addresses this problem. To quote from the text of the Final Rule:

“Comments: Several commenters asked the Department to clarify the application of § 84.56 to newborn infants.

Response: As indicated within the NPRM, the Department considers section 504, including § 84.56, to apply to newborn infants. This includes the prohibitions against the denial of medical treatment under § 84.56(b)(1) and (2), and the prohibitions on the discriminatory provision of medical treatment under § 84.56(b)(3).

Comment: One commenter objected based on its understanding that the Department's proposed rule would not apply to decisions to withhold treatment from infants with disabilities in which the disabling condition is related to the condition to be treated, noting that § 84.56(b)(2) addresses treatment for a separately diagnosable condition or symptom and not for the underlying disability. The comment concerned infants with disability conditions such as meningomyelocele, hydrocephaly, microcephaly, or other anatomical anomalies. The comment noted that failure to treat these conditions represents discrimination against a child with a disability.

Response: The Department believes that this comment misconstrues the section 504 rule. The Department intends that this rule will generally apply to the provision of medical treatment for infants, including those seeking treatment for separately diagnosable symptoms or conditions related to their underlying disability, when medical treatment is provided to other similarly situated children. For example, an infant with microcephaly may experience seizures. This would constitute a separately diagnosable symptom or condition for which treatment would be subject to the protections of § 84.56(b)(2) despite the fact that the seizures are a symptom of the infant's microcephaly. As the Department's NPRM made clear, with respect to separately diagnosable conditions, the rule will not require that the condition be entirely unrelated to the underlying disability. “Nor does it matter for these purposes whether the condition for which the individual is seeking treatment is in some sense causally related to the underlying disability if the decision to refuse treatment would not be made as to similarly situated individuals without the disability.” 88 FR 63405. In addition, § 84.56(b)(1) prohibits denying or limiting medical treatment to a qualified individual with a disability based on bias or stereotypes about that patient's disability, judgments that the individual will be a burden on others due to their disability, or a belief that the life of a person with a disability has a lesser value than the life of a person without a disability or that life with a disability is not worth living. Under such circumstances, the discrimination described by the commenter would also be covered under § 84.56(b)(1) even if the condition for which the patient sought treatment was not a separately diagnosable symptom or condition from their underlying disability.”

So, if you are fighting infanticide, the Final Rule is your best friend. 

Opposition to euthanasia has also always fought futile care laws, like those that exist in Texas and California, which allow hospital ethics committees to override patients’ and families’ desires for life-saving care that ableist physicians consider “futile.” For instance, the anti-futility provisions in the Final Rule were inspired by the case of Michael Hickson, who was denied treatment for COVID-19 because he was a quadriplegic. The Final Rule forbids such authoritarianism. It is the anti euthanasia movement’s best shot at eliminating futile care laws once and for all.

An excerpt about the Final Rule’s prohibition on medical futility reads as follows:

“The Department proposed §  84.56(b)(1)(iii) to prohibit recipients from denying or limiting medical treatment based on the provider's belief that the life of a person with a disability has a lesser value than a person without a disability, or that life with a disability is not worth living.

Comments: The Department received a broad array of comments from disability organizations, civil rights organizations, and other stakeholders supporting this approach. We received stories from people with disabilities describing their own experiences or those of friends regarding the denial of life-sustaining treatment and the difficulties involved in accessing it after such denials. We also received similar stories from providers. For example, one provider association described a 25-year-old patient with a developmental disability who had been referred to an inpatient hospice unit after becoming poorly responsive with brain imaging demonstrating a shunt and severe abnormalities. After the provider learned from a family member of a recent sudden change in the patient's behavior, the patient received a second opinion, leading to the shunt being surgically revised, the patient's condition improving, and her enjoying her life for many more years. In the words of this commenter, the patient's “referral to hospice without sufficient exploration of other treatment options was inappropriate and may have been driven by a mistaken clinical assumption regarding her baseline quality of life.”

Response: The Department will retain the provision as proposed. We respond to specific questions regarding the application of this requirement throughout this section.”

Hence, this section of the Final Rule forbids the futile care impositions that groups opposing euthanasia have fought for decades.

Moreover, we know that disabled Canadians are agreeing to be killed by “MAiD” because they aren’t getting the supports they need: not having wheelchairs, pain control, food, housing, jobs, etc. These conditions also contribute to high rates of suicide among US citizens with disabilities. Hence, the Final Rule helps prevent disabled Americans from experiencing Canada-like tragedies.

And, given that the Final Rule prohibits federal funding recipients from “from denying or limiting medical treatment based on the provider's belief that the life of a person with a disability has a lesser value than a person without a disability, or that life with a disability is not worth living,” it precludes turning disabled people’s suicides into a “medical procedure.” Think of the efforts we will have to expend against assisted suicide in the future: wouldn’t you like to use the Final Rule to fight those bills?

I urge other euthanasia opponents to do what they can to defend the Final Rule. Time is of the essence, because many of the regulations in the Final Rule are supposed to take effect this month and federal officials have already eliminated or delayed some of them. For instance, officials have rescinded new provisions requiring adequate staffing in nursing homes. New rules about internet access and home and community based services have also been paused. Therefore, the aforementioned anti-death provisions could soon be paused or eliminated as well.

So, if you are someone in Washington DC who interacts with officials at HHS or the Department of Justice, make the importance of the Final Rule part of your conversations. If you live in one of the states that is bringing the Texas vs. Kennedy lawsuit, write to your attorney general and ask them to drop it.

The Final Rule furthers compassion and dignity for disabled persons. It is also one of the USA’s most urgent anti-euthanasia issues in decades.

Author Note:

For information about how to contact your attorney general to ask them to drop the lawsuit, see this link.

To write to the US Department of Justice, go to this link.

To write to the Department of Health and Hunan Services, use this link.
For a quick explanation of what Section 504 of the Rehabilitation Act is, see this Drunk History video about the history of the law. 

Meghan is a disability instructor and a member of the EPC-USA board.