Colorado 2025 assisted suicide report. Missing data.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alex Schadenberg

Colorado citizens legalized assisted suicide by approving Proposition 106 in 2016 which came into effect in 2017. In 2024, Colorado passed assisted suicide Bill SB 068 expanding their assisted suicide law by: permitting non-physicians to prescribe the assisted suicide poison, reducing the waiting period from 15 days to 48 hours and allowing the 48 hour waiting period to be waived if the presciber believes that the person is imminently dying.

The 2025 Colorado assisted suicide report states that:

In 2025, 580 patients received prescriptions for aid-in-dying medications under the provisions of the Colorado End-of-Life Options Act. This represents a 12.4% increase in the number of prescriptions compared to 2024. Among those prescribed aid-in-dying medication in 2025, CDPHE has received reports for 261 patients to whom aid-in-dying medication was dispensed. Also among those prescribed aid-in-dying medication, CDPHE has received death certificates for 512 patients through routine vital records registration. Note that not all of these deceased patients were dispensed aid-in- dying medication, and deaths may have been due to ingestion of aid-in-dying medication, the underlying terminal illness or condition, or other causes.

The Colorado report indicates that they do not know how many people died by ingesting the lethal poison concoction. 

The reporting is suspicious!

In 2025 there were 580 lethal poison prescriptions which was up from 516 in 2024 and 261 poison prescriptions dispensed which was down from 315 in 2024.

So the data makes it appear that more people are receiving a poison prescription for assisted suicide but fewer people are dying by assisted suicide. Based on the data, 45% of the people in 2025 who were prescribed a poison prescription obtained the prescription. The data must be wrong. 

In 2022, 317 people were prescribed poison prescriptions and 249 (79%) were dispensed. In 2023, 398 people were prescribed poison prescriptions and 316 (77%) were dispensed. 

A new trend started in 2024 with 516 poison prescriptions written and (315) (61%) prescriptions dispensed and as has already been explained, in 2025 only (45%) of the poison prescriptions were dispensed.

Unless there has been a change in the culture, it is suspicious that 45% of the 580 people who received a poison prescription received the prescription. 

• Is there a pharmacy that is dispensing assisted suicide poison and not reporting?
• Is there an underground or out-of-state source of assisted suicide poison that people obtaining with the prescription?
• Or are fewer people who have received a poison prescription having that prescription dispensed?

An investigation needs to be done to identify what is actually happening.

Let's look deeper into the data about who is being approved for assisted suicide in Colorado.

When examing the data the conditions that people have that are receiving approvals for assisted suicide remain consistent accept for two areas of concern.

The first concern is the increase in people with "other conditions" who are being approved for assisted suicide. Since legalization, 4.2% of the approvals were people with "other conditions" but in 2025 40 people 6.9% had "other conditions." The report does not indicate what is included within "other conditions."

The second concern is the increase in people with eating disorders or severe protein calorie malnutrition being approved for assisted suicide. In 2021 Colorado approved one person for assisted suicide based on a eating disorder. Eating disorders accounted for 19 assisted suicide approvals in 2024 and 17 in 2025.

Based on the likelihood that there is missing data in the report,  the Euthanasia Prevention Coalition urges the Colorado Department of Public Health and Environment to conduct an independent investigation into the assisted suicide data.

The $650,000 Killing — Predators in the Living Room When “Mercy” Becomes Manslaughter

This article was published by Kelsi Sheren on her substack on April 2, 2026.

When “Mercy” Becomes Manslaughter

By Kelsi Sheren

The “Death with Dignity” crowd is lying to you, shocker. They want you to think this is about a peaceful goodbye. It’s not. It’s about vultures circling the vulnerable, and a Colorado courtroom is finally exposing the bone-chilling truth.

A family is facing manslaughter charges for the death of a 91-year-old woman. But they didn’t act alone. They had a playbook provided by the Final Exit Network (FEN)—a predatory group of “exit guides” who specialize in teaching people how to die in the shadows.

Article: Family members charged with manslaughter in Colorado "assisted suicide" (Read)

Let’s call FEN what they are, a domestic threat to our elders. They don’t provide hospice. They don’t provide comfort. They provide a technical manual for suicide. They fly across the country to whisper in the ears of the fearful, telling them that their “civil right” is to quit. They operate on the fringes of the law, hiding behind the excuse that they only provide “education.”

Education? No. They provide the blueprints for a killing.

“Police say Kim attended a Final Exit Network workshop weeks before Milsy's death at The Lodge at Balfour, the same facility where Milsy lived. Texts show Kim brought in gear to make sure they had the right equipment, stating, "We've got the right equipment. I brought it in a (sic) showed it to one of the guides."

This wasn’t a doctor in a lab coat. This was a mechanical, cold-blooded execution. Following the FEN method, this 91-year-old woman was killed using a “suicide hood”—a plastic bag fitted with a tube and connected to a tank of nitrogen. They literally murdered this women with a plastic bag and called it compassion.

The goal of this method isn’t just death; it’s concealment. Nitrogen displaces oxygen, suffocating the victim while leaving almost no trace for a coroner to find. It’s designed to look like a “natural death” so the predators can walk away clean. It is a cowardly way to die and an even more cowardly way to “help” someone.

Here is the jagged pill the “mercy” activists don’t want you to swallow: $650,000.

That was the inheritance waiting on the other side of that nitrogen tank. When you normalize the idea that life is disposable, you create a market for death. If a grandmother is worth more dead than alive to the people in her own home, and an organization like Final Exit Network is there to provide the “how-to,” she is as good as gone.

This wasn’t compassion. It was a transaction. It was the ultimate abandonment of a woman who had seen 91 years of life, only to be ushered into the dark because she became an obstacle to a payout.

As a veteran, I’ve seen what happens when we decide some lives aren’t worth protecting. We are losing our collective soul to convenience and greed. We are trading our grandmothers for bank balances and calling it “progress.”

I’m done being polite about this and have been for a while. If we don’t stand up against groups like the Final Exit Network, Compassion and Choices, Dying with Dignity and the culture that empowers them, we are next and so are your kids.

Family members charged with manslaughter in Colorado "assisted suicide" death.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Boulder District Attorney Michael Dougherty

Jennifer Kovaleski reported for Denver 7 (ABC) News that Mildred “Milsy” Roller (91) died on February 18, 2024 by asphyxiation and not by assisted suicide. Assisted suicide is legal in the state of Colorado.

If you have suicidal thoughts, do not read this article, but seek help through a suicide help-line.

Kovaleski reported that:

Officers with the Louisville Police Department said they found Milsy inside her room at The Lodge at Balfour, a Boulder County assisted living facility, with a bag over her head connected by a tube to a nitrogen gas bottle. Beside her was a suicide note with the date changed from Feb. 5 to Feb. 18, 2024.

Family members have been charged with manslaughter. Kovaleski states:

An indictment details text messages, purchases, and planning that prosecutors said crossed the line from the right to die into felony manslaughter. According to the indictment, texts included statements like, "We need to talk about whether mom needs a will," and "She needs to write a suicide note and she really couldn’t today."

Court records say Milsy's daughter, Kim Roller, bought a nitrogen tank three days before Milsy died. Kim's brother-in-law David Norton ordered a pressure flow regulator from Amazon and helped Milsy install it, according to the indictment. Prosecutors say there had been a failed suicide attempt earlier that month.

According to the indictment Milsy had no terminal diagnosis and her family stood to inherit more than $650,000.

Boulder District Attorney Michael Dougher said:

"This is definitely about fighting for justice. And she doesn't have a voice in this process,"

Final Exit Network (FEN) involvement.

Kovaleski reported that Milsy's daughter Kim attended a FEN meeting where she learned how to kill her mother.

Police say Kim attended a Final Exit Network (FEN) workshop weeks before Milsy's death at The Lodge at Balfour, the same facility where Milsy lived. Texts show Kim brought in gear to make sure they had the right equipment, stating, "We've got the right equipment. I brought it in a (sic) showed it to one of the guides."

FEN is a group that provides instructions to enable people to die by suicide, but these instructions also enable people to kill, which is what happened to Milsy.

Kovaleski reported that the police have instructed the FEN to change its Colorado workshops, making sure participants understand the law and cutting out step-by-step instructions.

FEN is a type of "criminal" killing organization, as it provides information and advice to people to enable them to kill.

FEN has been associated with multiple concerning deaths. 

• In February 2026 a Texas woman was arrested for assisting her husband's suicide (Read).

• In July 2024, a retired doctor and assisted suicide activist, who worked with FEN, was charged with manslaughter in New York State (Read).

• In June 2021, FEN launched a court case to try to overturn the Minnesota assisted suicide law. The court case was an attempt to overturn the 2015 conviction in the death of Doreen in 2007. The Final Exit Network or FEN was found guilty, by a jury, of assisted suicide in the suicide of Doreen Dunn (57) in 2007, who was depressed but not terminally ill. (Read).

FEN continues their work under the guise of free speech and they avoid being prosecuted based on the fact that dead people don't talk.

Milsy Roller was not terminally ill. Milsy was allegedly killed by her daughter and son-in-law with instructions and coaching from the FEN.  

Since assisted suicide is legal in Colorado, If Milsy was terminally ill she may have been pressured to death by "legal" assisted suicide. So what's the difference.

Being killed by assisted suicide is legal. They cannot prove coercion in assisted suicide deaths. Being killed by manslaughter, a type of murder, is not legal with the same outcome.

It's time that we simply stop allowing people to kill people.

Assisted suicide was offered to Jane Allen. She had an eating disorder.

This guest commentary was published by The Denver Post on October 2, 2025.

By Matt Vallière

The big selling point of assisted suicide laws is that they are supposedly compassionate and a progressive step toward enlightened autonomy. But assisted suicide is anything but compassionate for vulnerable people, like the tragic story of my friend with anorexia, Jane Allen, which shows how assisted suicide laws threaten the lives of the young and curable.

There is a controversial diagnosis circulating called “terminal anorexia,” which is an arrow to the heart of young people with eating disorders who are already experiencing distorted ideas of their worthiness to live. Now, where assisted suicide is legal, they have the state and part of the medical profession telling them they were better off dead.

After struggling with anorexia for most of her life, in 2018, Jane was living in Colorado Springs and getting help for her mental health disabilities, including her eating disorder. She ended up in the care of an exclusive boutique eating disorder practice. She was in and out of hospitals and residential treatment. Jane’s condition resisted treatment, and she ended up receiving a “terminal anorexia” diagnosis.

Jane wrote that her eating disorder doctor, “would ‘make an exception’ for me and ‘allow’ me to die, if that was my choice. It didn’t feel like my choice – I felt coerced and spent an incredibly agonizing months in an assisted living facility.” Jane did not get the lethal prescription directly from her eating disorder doctor; instead, she was referred to another doctor who promptly checked the boxes required under Colorado’s “safeguards,” and saw to it that Jane got the lethal drugs.

Jane’s life was saved at the last minute when her father received a guardianship order from a Colorado judge and was able to have the lethal drugs destroyed. After that, Jane said, 

“I ate just enough to not die right away. And then I ate more. I weaned off the morphine and all the other hospice drugs that kept me in such a fog. I was getting better, and then I was told that I was too much of a liability and dropped from the [boutique] clinic.”

“I moved from Colorado to Oregon. I have a job that I love, a new puppy, and a great group of friends. I’m able to fuel my body to hike and do the things I love. I’m repairing my relationship with my family, and I have a great therapist who is helping me process all of this. Things obviously aren’t perfect, and I still have hard days. But I also have balance, and flexibility, and a life that is so much more than I was told would ever be possible for me.”

A week before she planned to go public with her story, however, she died suddenly of complications to her health caused by over two decades of starving herself. To this day, I wonder whether the months of treatment lost during Jane’s detour into “terminal anorexia” care worsened her condition, whether she could still be with us today, doing all the good. We’ll never know…

What we do know is that these laws are not so rosy as the propaganda would have you believe. They are as messy as life itself and there has been and will be more collateral damage in people like Jane or Coloradan, Mary Gossman, who was told by a nationally renowned Denver eating disorder treatment facility, “there’s nothing we can do for you,” which qualified her for lethal drugs under the law. She’s in a better place now and has joined as a plaintiff in a lawsuit to overturn the law. So, I ask: how many collateral deaths are acceptable to you? For whatever purported good they do, these laws just aren’t safe.

Matt Vallière is the executive director of the Patient Rights Action Fund and the Institute for Patient Rights both of which advocate against physician assisted suicide policies.

Previous articles on this topic:

• Netherlands woman dies by euthanasia based on anorexia (Link).
• Landmark study: Assisted death for eating disorders (Link).
• At least 60 people with eating disorders euthanized or assisted in suicide since 2012 (Link).
• ANAD clarifies that Anorexia Nervosa is not a terminal condition (Link)
• When I was Anorexic I would have chosen assisted suicide (Link).
• Psychiatrist: Anorexia does not justify Aid in Dying (Link).
• Anorexia is not a terminal condition (Link).

Colorado assisted suicide expansion court case lacks standing.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On May 22, 2025 the assisted suicide lobby filed a federal lawsuit on behalf of Jeff McComas and two Colorado physicians challenging the state assisted suicide law residency requirement.

The complaint argued that the Colorado assisted suicide law residency requirement violates the U.S. Constitution’s Privileges and Immunities Clause which “prohibits State officials from restricting non-resident visitors’ access to medical care within its borders absent a substantial State interest and restrictions narrowly tailored to those interests.”

Michael Karlik reported for Coloradopolitics on September 22 that:

A federal judge on Friday asked those challenging a provision of Colorado’s aid-in-dying law to reconsider whether they want to continue litigating, after a key plaintiff died earlier this month.

Jeff McComas from Minnesota, died on September 8 and the other two plaintiffs are doctors who are willing to participate in assisted suicide but they lack standing in the case that is based on out-of-state residents seeking to die by assisted suicide in Colorado.

Karlik reported U.S. District Court Senior Judge R. Brooke Jackson as writing:

“the Court wonders if this is the best case to challenge the Colorado statute. Please give this more thought and conferral, as the Court does not wish for the parties to waste their time and resources, or the Court’s, if there is no standing.”

This is not a victory but rather a set-back for the assisted suicide lobby who want to expand assisted suicide nationally by eliminating state assisted suicide residency requirements.

The assisted suicide lobby made the same arguments in Oregon, Vermont and New Jersey. Oregon and Vermont subsequently removed their state assisted suicide law residency requirement whereas New Jersey successfully defended their state assisted suicide law residency requirement in court.

Assisted suicide is not medical treatment or care therefore the Privileges and Immunities Clause does not apply to assisted suicide.

Colorado legalized assisted suicide by passing Proposition 106 during the November 2016 election. In 2024, Colorado passed Senate Bill 24-068 expanding their assisted suicide law by:

• allowing advanced practice registered nurses to approve and prescribe lethal poison,
• reducing the waiting period from 15 days to 7 days, and
• allowing doctors or advanced practise registered nurse to waive the waiting period if the person is near to death.

The original version of SB 24-068 allowed non-residents to die by assisted suicide in Colorado but this amendment was rejected by legislators. 

The 2024 Colorado assisted suicide report indicated that there were 510 lethal poison prescriptions written in 2024 which was up by 28% from 398 in 2023. 18 of the lethal poison prescriptions were based on the person having an eating disorder.

It's time to audit the death bureaucracy

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Euthanasia Prevention Coalition has petitioned the US Food and Drug Administration (FDA) to investigate the assisted suicide drug cocktails. (Petition Link).

Last week the Washington Examiner published an editorial opinion calling on the US states that have legalized assisted suicide to audit their death bureaucracy. The article states:

A deeply disturbing investigative report in UnHerd last week uncovered rampant violations of physician-assisted suicide practices in states with the oldest and largest programs. The 11 states that have legalized assisted suicide require clinicians to submit compliance forms shortly after the “patient’s” death. But the chaotic assisted-suicide bureaucracy rarely follows regulations, and clinicians put people to death with little to no oversight.

Between 2009 and 2023, 515 compliance forms and 293 “written request” documents were missing in the state of Washington. In all, one-third of the state’s assisted suicides were improperly reported. In Colorado, which passed its End of Life Options Act in 2016, almost 1,800 compliance forms are missing. And in New Mexico, where annual compliance reporting is also required by law, there has not been a single report issued since assisted suicide was enacted in 2021. For years, the state’s website suggested that a report was “coming soon,” but state officials quietly removed that promise from its website this summer.

Disturbingly, there have been no suspensions or revocations of clinician licenses connected with these irregularities.

Failing to report an assisted suicide is no mere statutory violation. Washington law states medical providers and pharmacists who neglect to “make a good-faith effort to file required documentation in a complete and timely manner” risk losing immunity protection for criminal acts.

The missing compliance reports are only the tip of the iceberg. Officials in Colorado and California were unable to provide numbers for the total assisted suicides carried out by clinicians and held no record of the type of drugs prescribed to more than 1,000 “patients.” Authorities in Oregon don’t know the result of 178 cases from 2024 in which “aid in dying” medications were prescribed.

Did the “patients” take the drugs in those cases? Did those drugs cause death? Did the “patients” even die? Oregon has no records on any of this.

Record keeping in Washington is even worse. By law, the state is supposed to perform a review of reporting compliance each year. But, blaming funding cuts, officials announced that they will no longer issue these legally required reports.

As more and more states consider whether to adopt assisted-suicide laws, a true accounting is needed to provide voters with accurate information about the outcomes of these laws in states where they are already established.

Given the gravity of the new revelations, the Department of Health and Human Services Office of Inspector General, in coordination with the Justice Department, should launch an immediate investigation into states’ assisted-suicide programs. It should focus on three critical areas: the failure to file mandatory compliance forms, inadequate tracking of lethal prescriptions, and the absence of disciplinary action against clinicians who endanger “patients” through noncompliance.

As assisted suicide spreads, the risk grows that vulnerable people, those feeling like burdens or facing financial strain, will be nudged toward death rather than helped to live. This is not compassion — it’s the worst sort of cultural and moral failure.

It is time for accountability.

More articles on this topic:

• How America Abandoned its assisted suicide safeguards (Link).
• Assisted suicide lobby launches court case to force Colorado to permit suicide tourism (Link). 
• The push to legalize and extend assisted suicide in America (Link).
• Oregon 2024 assisted suicide report (Link). 
• Death by assisted suicide is not what you think it is (Link).  
• Assisted suicide laws, once passed will inevitably expand (Link). 
• New York assisted suicide bill is a "bait and switch" (Link). 
• Oregon bill would expand assisted suicide again (Link).

How America abandoned its assisted suicide "safeguards"

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alexander Raikin

Alexander Raikin wrote an excellent article: How America abandoned its suicide safeguards which explains how the US states that have legalized assisted suicide abandoned the "safeguards" in their assisted suicide laws. I have written several articles on this topic especially since nearly every assisted suicide law in America, once passed, was later expanded. Raikin explains:

In 2020, Jane, a 29-year-old Colorado woman with eating disorders, was “provided with lethal drugs … in the midst of a mental-health crisis”, according to a lawsuit filed this year by the Institute for Patients’ Rights, an advocacy group seeking to overturn Colorado’s assisted-suicide program. Jane qualified for assisted suicide, the lawsuit contends, yet she was discharged from a hospice because she no longer qualified for hospice care, and her hospice considered her no longer competent to consent to medical treatments. So how could she have consented to suicide-by-doctor?

Jane was fortunate: her parents successfully sued for guardianship, and a court ordered the medication to be destroyed. Jane “went on to recover from all of it, including her anorexia”, according to Matt Vallière, the executive director of the Institute for Patients’ Rights. Jane found work as an occupational therapist, went on vacation, and even purchased a home. Although she ultimately died two years later of complications from her history of eating disorders, she’d had an opportunity to “live her best life”, Vallière says. That any medical professional decided that Jane qualified for assisted suicide, he claims, was “absurd”.

Raikin states that Jane’s case isn’t unusual and violations of assisted-suicide laws are rampant with no known suspensions or revocations of clinician licenses, even when patients were endangered. Raikin explains how these laws are being violated:

Much of the issue is oversight. In each of the 11 states that have implemented suicide-by-doctor, regulations require clinicians to submit compliance forms, typically within days of a patient’s death. These forms document that the patient expressly consented to die through assisted suicide, and that the clinicians followed all necessary legal safeguards and eligibility criteria, including affirming that the patient is terminally ill and of sound mind.

Failure to submit this documentation isn’t just a statutory offense. Medical providers and pharmacists who fail to “make a good-faith effort to file required documentation in a complete and timely manner”, as Washington state law instructs, risk losing“immunity protection” for the criminal act of assisting someone’s suicide. Yet a Department of Health report found that physicians improperly reported compliance for a third of all assisted suicide deaths in the Evergreen State. Indeed, Washington is missing 515 compliance forms entirely for the period between 2009 to 2023, according to my calculations based on annual reports, and is also short of 293 “written request” documents that patients are required to sign attesting that they wish to die by suicide. In Colorado, my calculations find that almost 1,800 compliance forms have remained missing since 2017.

The actual number of assisted suicide deaths is unknown. Raikin writes:

States can’t answer the most basic question: how many physician-assisted suicides have been facilitated by clinicians in America? Across Colorado and California, state authorities have no record of the type of “aid-in-dying drugs” that were prescribed to more than 1,000 patients, according to my analysis of state reports, including the California End of Life Option Act 2024 Data Report. In Oregon, the health authority has records on 376 assisted suicides completed in 2024, but for another 178 cases in which medications were prescribed, authorities don’t know if the patient died by ingesting the drugs, or even died at all.

Washington State has decided to stop publishing the assisted suicide data.

In 2022, Washington state announced that its Department of Health is diverting “all available funding” for its assisted-suicide compliance-review program to “data entry of submitted forms”, due to lack of funding from the state. Data entry is commendable. But by law, the state is also required to “review” reporting compliance and issue an annual report. Instead, this summer, a pop-up appeared on the department’s website: “Important Note: Due to funding cuts, the Death with Dignity Program at the Department of Health is suspended. … A 2024 annual statistical report will not be released.”

Washington state’s decision surprised even assisted-suicide clinicians. Jessica Kaan, the medical director for End of Life Washington, an institution which facilitates assisted suicides in the state, warned on a forum for providers that “no one will even be monitoring or responding to emails or phone calls that come into the DOH [Department of Health] about the DWD [Dying With Dignity] program”. Kaan called it “a grim situation”. After this push back, the state announced that it will release the 2024 report after all — but it will be the last one ever to be released.

Raikin then explains that New Mexico does not publish an annual report, even though the assisted suicide law requires an annual report. States are also removing the "safeguards" in the law. Raikin explains:

This systematic disregard of safeguards is happening as the process is being fast-tracked: states are removing requirements that applicants reside in state; allowing less-credentialed providers, such as social workers, nurses, and physician associates,to perform assessments instead of psychiatrists and psychologists; and reducing minimum waiting periods. In Oregon, which waived waiting periods in 2020,clinicians have reported in Oregon’s annual Death with Dignity Act report that assisted suicides routinely occur on the same or next day the patient makes there quest. Since in some cases it takes up to five days for a patient to die from ingesting the death cocktail, it is possible that it will take a patient longer to die than to receive lethal prescriptions.

The proportion of vulnerable persons dying by assisted suicide has also increased. Raikin writes:

The proportion of deaths of vulnerable patients has also increased by magnitudes. In the first year of Washington state’s program, 16% of patients mentioned “the physical or emotional burden on family, friends, or caregivers” as a reason for their decision to die, and 2% were concerned about “the financial cost of treating or prolonging the patient’s terminal condition”. By 2023, according to the state’s reporting, the number concerned with “feeling like a burden” jumped to half of all assisted-suicide deaths, and a 10th were concerned about “financial implications of treatment”.

A similar trend is unfolding in Oregon. In 2009, the first year that the program was available, no patients told their assisted-suicide clinician that they were choosing to die because of financial concerns, and only 12% felt like a burden. By 2024, the state’s reporting revealed that it was 9% and 42% of all assisted suicide deaths, respectively. No other states even report this data. The “attending physician follow-up form” in California, which records patient concerns that contribute to the choice of “aid-in-dying”, doesn’t have “financial concerns” or “feeling like a burden” on its otherwise identical menu of options.

Compliance with the law from physicians and the government is lacking. Raikin interviewed Craig New who overseas the assisted suicide program in Oregon. Raikin reports:

Craig New, who told me on the telephone that he’s the sole employee of the Oregon Health Authority responsible for monitoring compliance reporting, says that “ultimately the things usually get resolved because we bug them until they finally send in the paperwork”,but even so, his office has reported around a dozen physicians to the Oregon Medical Board for violations of compliance reporting. Thanks to privacy laws regarding medical licensing, it is impossible to know whether the reported physicians faced repercussions, but my review of the Oregon Medical Board’s investigations reveals that few offenses are prosecuted.

Raikin reports that Dr Rose Jeanine Kenny, in Oregon, was reprimanded by the Oregon Medical Board for contravening the assisted suicide law:

One example is Rose Jeannine Kenny, a family doctor, who in 2016 was sentenced to five years probation by the Oregon Medical Board for dozens of alleged prescription violations. Later the board received “credible information” that Kenny may have again violated the same provisions she was previously reprimanded for, and may possibly have committed “violations of the Oregon Death with Dignity Act”, such as failure to ensure consent, follow the rules of written and oral assisted suicide requests, abide by the minimum waiting period, and file compliance records. Kenny once again kept her license, this time by agreeing to “participate in all physician steps” for 10 more assisted suicides, supervised by a mentoring physician from Compassion & Choices — the largest lobbying group for assisted suicide in the United States. (UnHerd was unable to reach Dr. Kenny at any of the medical practices with which she is associated online.)

Raikin states that no researchers or law enforcement are allowed to systematically review the assisted suicide records. He then tells the story of a person in Maryland with a eating distorder:

Recent court proceedings in Maryland eerily echo the lawsuit regarding Jane. Angela Guarda, the director of the Eating Disorders Program at Johns Hopkins Hospital, testified that she was contacted by an ex-patient of Jennifer Gaudiani, the physician who coined the term “terminal anorexia”, and who has prescribed assisted-suicide medication to at least one patient. The concept of terminal anorexia was meant to apply only to patients over age 30; for younger patients, Gaudiani stressed in a paper for the Journal of Eating Disorders that “every effort should be made to promote full recovery and continuation of life”.

The ex-patient reported that her assisted-suicide assessor told her “she would ‘make an exception’ for me and ‘allow’ me to die”. The patient reported feeling coerced. She eventually weaned herself off morphine and hospice drugs and, 18 months later, reports that she’s doing well, with a job, a group of friends and a new puppy.

Raikin ends the article by stating:

Patients like these, who need hope the most, are facing much more than their illnesses. They also confront an assisted-suicide regime that blatantly and routinely violates the legal safeguards that were meant to ensure their protection from a death they might not want.

Further articles on this topic:

• Assisted suicide lobby launches court case to force Colorado to permit suicide tourism (Link). 
• The push to legalize and extend assisted suicide in America (Link).
• Oregon 2024 assisted suicide report (Link). 
• Death by assisted suicide is not what you think it is (Link).  
• Assisted suicide laws, once passed will inevitably expand (Link). 
• New York assisted suicide bill is a "bait and switch" (Link). 
• Oregon bill would expand assisted suicide again (Link).
  

Assisted suicide lobby launches court case to force Colorado to permit suicide tourism.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On May 22, the assisted suicide lobby filed a federal lawsuit on behalf of Jeff McComas and two Colorado physicians challenging the state assisted suicide law residency requirement. 

The complaint argued that the Colorado assisted suicide law residency requirement violates the U.S. Constitution’s Privileges and Immunities Clause which “prohibits State officials from restricting non-resident visitors’ access to medical care within its borders absent a substantial State interest and restrictions narrowly tailored to those interests.”

The assisted suicide lobby made the same arguments in Oregon, Vermont and New Jersey. Oregon and Vermont subsequently removed their state assisted suicide law residency requirement whereas New Jersey has successfully defended their state assisted suicide law residency requirement in the court.

Jeff McComas's rights are not being infringed by Colorado's assisted suicide law that limits lethal poison prescriptions to state residents.

First: Oregon and Vermont will assist the suicide of out-of-state residents. McComas has access to assisted suicide in Oregon and Vermont, therefore his constitutional rights are not being violated.

Second: Assisted suicide is not a form of medical treatment or care therefore the Privileges and Immunities Clause does not apply to assisted suicide.

Colorado legalized assisted suicide by passing Proposition 106 during the November 2016 election. In 2024, Colorado passed Senate Bill 24-068 expanding their assisted suicide law by: 

• allowing advanced practice registered nurses to approve and prescribe lethal poison, 
• reducing the waiting period from 15 days to 7 days, and
• allowing doctors or advanced practise registered nurse to waive the waiting period if the person is near to death.

The original version of SB 24-068 allowed non-residents to die by assisted suicide in Colorado but this amendment was rejected by legislators.

The 2024 Colorado assisted suicide report indicated that there were 510 lethal poison prescriptions written in 2024 up by 28% from 398 in 2023. 18 of the lethal poison prescriptions were based on the person having an eating disorder.

Assisted suicide laws, once legal, inevitably expand

Alex Schadenberg

Alex Schadenberg
Executive Director,
Euthanasia Prevention Coalition

When a jurisdiction is debating an assisted suicide bill, many organizations and individuals present information about the necessary safeguards that the jurisdiction must implement to “safely” legalize assisted suicide.

The Euthanasia Prevention Coalition knows that it is not possible to “safely” legalize assisted suicide and once legal the law will inevitably expand.

Great Britain is currently debating an assisted suicide bill  sponsored by Kim Leadbeater. Many states have already introduced assisted suicide bills in 2025 and we anticipate many more legalization bills this year. We know that some states that have legalized assisted suicide will debate bills to expand their law.  

This article focuses on the experience with assisted suicide in jurisdictions where it is legal. 

Nearly every jurisdiction that has legalized assisted suicide, later expanded their law.

The assisted suicide lobby groups know that it is more difficult to legalize assisted suicide than it is to expand the law once it is legal.

On June 5, 2024 Colorado Governor Gary Polis signed Senate Bill 24-068 which expanded their state assisted suicide law by: allowing advanced practice registered nurses to approve and prescribe assisted suicide, reducing the waiting period from 15 days to 7 days, and allowing the doctor or advanced practise registered nurse to waive the waiting period if the person is deemed to be near to death (same day death).

In previous years other states expanded their assisted suicide laws.

In 2019 Oregon passed Bill SB 0579 which expanded their assisted suicide law by giving doctors the right to waive the 15 day waiting period when a person was deemed to be near to death.

In 2021 California passed Bill SB 380 which expanded their assisted suicide law by reducing the waiting period from 15 days to 48 hours. It forced doctors who oppose assisted suicide to be complicit in the act and it forced all medical institutions to post their policy on assisted suicide.

In 2022 Vermont expanded their assisted suicide law by removing the 48 hour waiting period, (allowing same day death), removing the requirement that an examination be done in person, (allowing approvals by telehealth), and it extended legal immunity to anyone who participates in the act.

In 2023 Washington State expanded their assisted suicide law by allowing advanced practice registered nurses to approve and prescribe lethal poison, by reducing the waiting period to 7 days and to force healthcare institutions and hospices to post their assisted suicide policies.

In 2023 Hawaii expanded their assisted suicide law by reducing the waiting period from 20 days to 5 days, by allowing the waiting period to be waived if the person is deemed to be near to death and by allowing advanced practice registered nurses to approve and prescribe lethal poison.  

In 2023 Oregon expanded their assisted suicide law by passing House Bill 2279 which removed their state assisted suicide residency requirement.

In 2023 Vermont also expanded their assisted suicide law by passing Senate Bill 26 which removed their state assisted suicide residency requirement.

Oregon and Vermont removed their assisted suicide residency requirements in response to legal challenges by Compassion & Choices, an assisted suicide lobby group. By removing the state residency requirement assisted suicide was expanded nationally because anyone in America can die by assisted suicide in Oregon and Vermont.

There is currently a lawsuit by Compassion & Choices challenging the New Jersey state assisted suicide residency requirement. On September 19, 2024, a US District Court Judge upheld New Jersey’s right to limit assisted suicide to state residents. This decision was appealed by Compassion & Choices on October 18, 2024.

It must be noted that Compassion & Choices support legislators' attempts to legalize assisted suicide, but once it is legal they soon go on the offensive to expand that law.  

This was also true in Canada, where euthanasia and assisted suicide were legalized in June 2016 (Bill C-14) and the law was expanded by Bill C-7 in March 2021 by (among other things) removing the terminal illness requirement, removing the 10-day reflection period, allowing euthanasia for incompetent people who were previously approved and allowing euthanasia for mental illness alone. The implantation of euthanasia for mental illness alone has been delayed until March 2027.

Groups that support euthanasia will state that Bill C-7 was related to the Truchon court decision in Quebec, but Bill C-7 expanded the law further than the Truchon required.

Push back to assisted suicide legal expansions in America.

In March 2022 a group of California doctors launched a court case designed to protect the conscience rights of medical professionals who oppose assisted suicide. In September 2022 US District Judge Fernando Aenlle-Rocha ruled that the California End of Life Options Act that had been amended by Bill SB 380, violated First Amendment rights of doctors by requiring them to participate in assisted suicide.

In April 2023, The United Spinal Association, Not Dead Yet, the Institute for Patients’ Rights, Communities Actively Living Independent and Free, Lonnie Van Hook and Ingrid Tischer launched a lawsuit to strike down the California assisted suicide law. The case asserts that the California assisted suicide law is a discriminatory scheme that contravenes the Americans with Disabilities Act. This case continues.

It is harder to legalize assisted suicide than to expand the law after it is legal. No new state assisted suicide law has become law in the past three years yet in that same time 5 states, that had legalized assisted suicide, expanded their law.

Expansion occurs for many reasons

When we examine the expansions of the American assisted suicide laws we recognize several key themes. There is the removal of waiting or reflection periods, allowing non-physicians to do the act, and allowing non-residents to die by assisted suicide.

Other expansions to assisted suicide laws include the redefinition of the language of the law.

In December 2017, Fabian Stahle, a Swedish researcher asked the Oregon Health Authority how they define terminal illness. Stahle learned that the Oregon Health Authority defined the six month terminal illness prognosis as including someone who would have a six month prognosis if they reject effective medical treatment. This was clearly an expansion of the law by redefining the language of the law.

A similar redefinition of the meaning of the law has occurred in the Netherlands. The Netherlands has never actually amended their law but they have changed the interpretation of the meaning of the law.

For instance, originally the Netherlands did not consider euthanasia for people with psychological conditions. In 2009, an interpretation of the law suggested that euthanasia for people with psychological conditions was possible. Since that time the number of deaths for psychological conditions has continuously expanded.

In Canada, most of the expansions to the MAiD law have been based on equality. The Truchon court case in Quebec was decided based on the concept that preventing MAiD for people who do not have an irremediable medical condition was discriminatory. Justice Baudouin decided that it was unconstitutional to deny some people MAiD based on the person not being terminally ill.

Once legal, expansion of the law is inevitable.

When a legislature debates an assisted suicide bill they will do so based on the language of the bill. They will argue that the bill before them is tightly worded with effective “safeguards” but even if this were true, most often a bill that is legalized is expanded a few years later.

Once assisted suicide is legal, restrictions on the law become discriminatory. For instance, it becomes unjust to force a person to wait to die, it becomes unjust to limit it to terminal illness, it becomes unjust to limit it to physical conditions, it becomes unjust to force people to have to self-administer.

Before legalization, everyone is equal under the law. Everyone is equally protected from being killed or equally protected from suicide. Once legal, people who “qualify” under the law are medically abandoned as they are told that they can have treatment or death. In other words, death becomes an alternative to treatment and care.

Legislators need to know that we oppose killing people. 

We don’t just oppose killing people who are terminally or chronically ill, but we oppose killing all people. 

Legislators need to know that we support caring for people and not abandoning them to death.

Colorado assisted suicide deaths increase in 2023.

Alex Schadenberg
Executive Director,
Euthanasia Prevention Coalition

The 2023 Colorado assisted suicide report indicates that assisted suicide poison prescriptions and deaths have continued to rise every year since legalization.

Even though the number of assisted suicide deaths is continually increasing Colorado Governor Gary Polis signed Senate Bill 24-068 on June 5 to expand their State assisted suicide law. Nearly every state that has legalized assisted suicide has expanded their law.

The Colorado assisted suicide report indicated that in 2023 there were 389 lethal poison prescriptions written, which was up by more than 22% from 318 in 2022, 218 in 2021 and 185 in 2020.

The Colorado report indicated that in 2023, 294 of the lethal poison prescriptions were dispensed which was up by more than 18% from 249 in 2022, 164 in 2021 and 149 in 2020.

The data seems confusing since Colorado collects information on the number of lethal poison prescriptions that are written and it collects information on the number of lethal poison prescriptions dispensed but it doesn't collect information on how many people actually died by assisted suicide.

We expect that the 2024 Colorado assisted suicide report will show more increases in deaths now that Colorado expanded their assisted suicide law in 2024.

The assisted suicide lobby knows that it is harder to legalize assisted suicide than to expand the law once it is legal. Nearly every state that has legalized assisted suicide has later expanded their law.

2024 was a great year for preventing assisted suicide in America. 2025 will begin with a challenge.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alex speaking in West Virginia

On September 20, Delaware Governor John Carney vetoed Assisted Suicide Bill HB 140 (Link to the Statement by Governor Carney).

When Governor Carney vetoed HB 140 he continued the success with no new state having legalized assisted suicide in the past three years.

On November 5, West Virginia votes passed Amendment 1, preventing the legalization of assisted suicide. Amendment 1 passed with a narrow victory with 50.5% voting YES. West Virginia is the first US State to create a constitutional protection from assisted suicide.

Even though 2024 represented one of the most successful years in defeating at least 20 state assisted suicide bills. We will not rest.

2025 is expected to be as busy a year as 2024.

The assisted suicide lobby has already announced the introduction of a 2025 Delaware assisted suicide bill. The new bill will need to be defeated in the House or Senate since Delaware Governor-elect Matt Meyer has expressed support for legalizing assisted suicide.

The New York assisted suicide lobby announced the introduction of their 2025 assisted suicide bill with a planned campaign kick off and lobby day with other scheduled events. New York has faced assisted suicide bills nearly every year since 2016.

The assisted suicide lobby has also prepared a bill for Missouri, which is not likely to pass. In fact we expect to see at least 20 states debate assisted suicide bills in 2025.

Nearly every state that has legalized assisted suicide has expanded the law.

Colorado, which legalized assisted suicide in 2016, in 2024 passed Senate Bill 24-068 expanding the Colorado assisted suicide law by: allowing advanced practice registered nurses to approve and prescribe lethal poison, reducing the waiting period from 15 days to 7 days, and allowing doctors or advanced practise registered nurse to waive the waiting period if the person is near to death.

The original version of SB 24-068 would have removed the residency requirement for assisted suicide in Colorado. 

We expect that other states will attempt to further expand their laws in 2025.

In 2023 Washington State expanded their assisted suicide law by allowing advanced practice registered nurses to approve and prescribe lethal poison, by reducing the waiting period to 7 days and to force healthcare institutions and hospices to post their assisted suicide policies. 

Washington State has already announced another expansion bill. This bill defines assisted suicide as a "protected healthcare service" and will force healthcare providers to be complicit in promoting assisted suicide. The Washington State bill is part of the assisted suicide lobby's strategy of defining assisted suicide as healthcare and forcing healthcare institutions to provide it as a "service."

The Euthanasia Prevention Coalition predicts that assisted suicide will be debated in at least 20 US states, but since Oregon and Vermont removed their residency requirement assisted suicide has also become a national issue.

There is currently a legal challenge by the assisted suicide lobby to force New Jersey to remove it's state assisted suicide residency requirement.

It is possible that the battle to protect people from assisted suicide might move into the federal realm in 2025 since the assisted suicide lobby has removed state barriers to killing.

The goal of the assisted suicide lobby is to legalize assisted suicide in more states and to expand the scope of the assisted suicide laws in the states that have legalized it.

The goal of the Euthanasia Prevention Coalition is to prevent the legalization of assisted suicide in states where it is currently illegal while rolling back the legalization of assisted suicide in states where it is legal.

The British Assisted Suicide bill can be defeated

If Britain's parliament passes the assisted suicide bill, in a few years a bill will be introduced to expand the bill, as has happened in nearly every US state and in Canada.

Alex Schadenberg

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

The British parliament voted on Friday, November 29, 2024 (330 to 275) at second reading to support Kim Leadbeater's private members assisted suicide bill.

As I wrote on Friday, the battle is not over. The bill will be further scrutinized and committee hearings will occur before the final vote.

Some British MP's voted Yes to the assisted suicide bill but remain concerned about the implementation of a law. In other words, there are many MP's who may change their vote as they learn more about the bill.

Michael Savage, the Policy editor for the Observer wrote an article entitled: Wavering supporters of assisted dying bill ' are not certain to vote it into law',  published on November 30, 2024. 

Savage, who appears to support assisted suicide, states:

A wavering group of MPs who backed parliament’s historic vote in favour of assisted dying may yet oppose its passage into law without further reassurances, the bill’s supporters are being warned, amid concerns that significant hurdles still remain.

There are concerns about how the bill will impact the National Health Service. Savage writes:

Health secretary Wes Streeting, who opposes the bill, has said it will have “resource implications” for the health service. Shabana Mahmood, the justice secretary, is also fiercely opposed.

Some MP's supported the bill because they felt that the "safeguards" in the current bill could protect people in vulnerable conditions from being coerced.

I have written several articles concerning the fact that nearly every US state that has legalized assisted suicide, has expanded their laws.

When commenting on the bill that expanded the Colorado assisted suicide law, I explained that Oregon, California, Vermont, Washington State and Hawaii have also expanded their assisted suicide laws. Further to that, Compassion and Choices, an assisted suicide lobby group in the US has launched a lawsuit in New Jersey demanding the removal of their state assisted suicide law residency requirement.

Many of these states debated and defeated bills to legalize assisted suicide for many years, before finally approving an assisted suicide bill. Supporters of assisted suicide focus on creating a bill that sells the legalization of assisted suicide with the intention of expanding the law later.

For instance, Connecticut assisted suicide supporters initiated an assisted suicide bill for eleven consecutive years, with it being defeated every time.

Josh Elliott, a three term member of the Connecticut House, and a sponsor of previous assisted suicide bills was interviewed by Paul Bass for the New Haven Independent on January 4, 2024. Bass reported:

The version he plans to resubmit this year has been narrowed to cover terminally ill people with prognoses of less than six months to live, with sign-offs from two doctors and a mental health professional, monthly check-ins, and at least a year of state residence.

“Almost no one” would qualify under that restricted version of the law, Elliott said. But passing it would open the door to evaluation and expansion.

Elliott explains that his goal is to pass a "restrictive" assisted suicide bill and then expand the law later.

J.M. Sorrell, Executive Director of Massachusetts Death with Dignity, was quoted on a similar bill as saying,

“Once you get something passed, you can always work on amendments later.”

The US assisted suicide lobby admit to their 'bait and switch' tactic, meaning, to get a tightly worded assisted suicide bill passed and then amend the law later.

Members of the British parliament need to recognize that the assisted suicide lobby knows that it is harder to legalize assisted suicide than to expand the bill later. 

If Britain's parliament passes the Leadbeater assisted suicide bill, within a few years a bill will be introduced to expand the bill, as has happened in nearly every US state and in Canada.

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.