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.

Delaware: Another Defeated, Dangerous Assisted Suicide Bill Reaches Governor’s Desk

Contact Delaware Gov. Carney and Demand He Veto HB 140 Assisted Suicide

Jacqueline Abernathy

By Dr Jacqueline Abernathy

On Friday, September 13, Delaware assisted suicide bill HB 140 finally landed on Governor John Carney's desk. It has been nearly 3 months since HB 140 died in the state senate only to rise again immediately after and pass by a single vote, just shy of meeting a second, irreversible demise when the clock ran out and the 2024 Delaware legislative session adjourned sine die. The eleventh-hour passage and session end caused immense confusion on whether or not HB 140 would become law within 10 days of arrival in the governor's office, that is with or without the governor's signature. Governor Carney had expressed his misgivings indicating a reluctance to sign the bill, so we have held out hope. Without a veto, assisted suicide will become legal (by default) early next week.

This may sound familiar to my anti-euthanasia allies because this is not the first time a presumed dead assisted suicide bill was shockingly revived and sent to the governor's desk for a signature months after it initially failed. In 2015 California Assembly where a similar assisted suicide bill SB 128 was soundly defeated that summer only to reemerge two months later as ABX2-15. The session had ended, along with it the prospect of SB 128 passing, but when Governor Jerry Brown called a special session dedicated to transportation, the same assisted suicide proposal was inappropriately reintroduced under its new name and new rules where it could bypass the full legislative process (committee action and floor votes of both chambers), scrutiny that had destroyed the first attempt. ABX2-15 was a last-ditch effort in the suicide lobby's relentless crusade to impose assisted suicide on Californians who fought off their advances for 23 years. Even attempts to completely bypass voters failed when they lost not one, but two court cases within a few weeks after the first session ended. Unable to exploit the judiciary to legislate from the bench (a failed strategy in other court cases in California since 1992 as well), they resorted to circumventing the legitimate legislative process hoping that the ninth, not the third time would be the charm with the new bill. Sadly, it worked, and nine years ago today I was writing an open letter to then-Governor Jerry Brown and rallying allies to demand a veto, just as I am doing now.

That effort failed, but we still have hope that Delaware will escape this same fate. When we lost in California, we had just defeated HB 150, an assisted suicide bill sponsored by the same representative as HB 140, who needed nearly a decade to advance to the same juncture. We kept this scourge at bay session after session. In fact, it took two sessions to finally, narrowly pass HB 140 just like it took two sessions to pass the California assembly. The parallels between California and Delaware are striking. Because our utmost activism did not prevail in California in strikingly similar circumstances, there is a temptation to despair that this same outcome may happen now. That is until we consider this a second chance to redouble our resolve and protect vulnerable lives in Delaware. Since 2015, we now have the benefit of nearly a decade more of experience, expertise, and mobilization. 

Governor John Carney

Whereas I was sharing the Governor's email address to cut and paste and drafting sample language for individuals to use, we now have a pre-populated email that can be auto-filled with each advocate's name and address and then sent instantly. There are embedded buttons that allow for easy sharing across a host of social media platforms. It could not be more efficient or easy to speak up for those in danger and spread the word to other advocates on a variety of platforms where this call to action will be seen by audiences that were previously harder to reach. This is a numbers game, as in my experience there are legislative aides who are simply tallying the sum of those who contact the governor in support of assisted suicide and those opposed. We must not let calls and support go unanswered where the governor could believe he has a mandate to allow HB 140 to become law.

This is a rematch of sorts, an opportunity to show how much stronger we are now than we were 9 years ago. The euthanasia lobby is stronger also, so we must give this our greatest effort. I am seizing this moment and it only takes a mere moment to contribute. I implore you to join the fight. Visit the link, speak for the weak, and share everywhere you can. The sum of these small efforts is what can save countless lives at risk in Delaware.

Delaware Governor Carney needs to veto assisted suicide Bill HB 140 to protect your citizens most in need of real care and compassion, not killing.

Governor John Carney

The following open letter was sent by Dr Jacqueline Harvey Abernathy, Ph.D., M.S.S.W. to Delaware Governor John Carney on July 4, 2024.

Everyone needs to contact Delaware Governor John Carney and urge him to veto assisted suicide Bill HB 140. Email him at: john.carney@delaware.gov

Dear Governor Carney,

Dr Jacqueline Abernathy

I write today urging you to veto HB 140 to protect your citizens most in need of real care and compassion, not killing. I implore you out of deepest concern, not just for the people of Delaware but you personally as well, since you will bear responsibility for the deadly consequences HB 140 will undoubtedly inflict as written, but also the greater toll when the law is almost certainly expanded. I don't claim to know the future, but I do know the past and the history of state assisted suicide laws and I have no reason to believe that Delaware law would not be exploited as-is and reformed to remove safeguards and otherwise increase eligibility and access to death on demand. I speak as an expert on this very topic, a bioethicist with a Ph.D. in Public Administration and Policy and a bibliography of scholarly peer-reviewed publications on assisted suicide and end-of-life medical decision-making. Therefore, I am not offering a mere guess when I warn you that HB 140 presents immediate harm to your constituents and only stands to grow more dangerous with time.

The proverbial slippery slope is not a logical fallacy but rather, it is documented history. The supposed safeguards used to pass bills like HB 140 falsely suggest that state-sanctioned suicide can be safe. These are a smokescreen used to placate concerned legislators into voting to legalize assisted suicide for some in certain conditions, but afterwards, those qualifications and regulations are amended to include more disposable lives and easier, faster access to lethal poison. What protections in HB 140 you have been told will protect your constituents: not only do these flimsy regulations fail to prevent abuses but sooner rather than later, those provisions will be stripped from the law if you make the mistake of not vetoing HB 140. 

Insistence by pro-euthanasia lobbyists that there has been no documented abuses is widely debunked in scientific literature, even by staunch allies. A recent example just published in the Journal of the American Geriatrics Society, “Medical aid in dying to avoid late-stage dementia,” gives examples, one by name, of people who were not terminally ill but starved and dehydrated themselves to qualify for assisted suicide. They brazenly call the voluntary stopping of eating and drinking (VSED) a “bridge” to access suicide assistance, but a better term is “loophole”- a cruel way for those who want to die to kill themselves slowly until someone prescribes poison to speed things along. Abuses of state laws like HB 140 are usually addressed by reforming the statutes, but sadly, cases like these are used as rationale by lawmakers to relax or outright remove existing protections altogether so people who aren’t terminally ill let alone dying would no longer “need” to torture themselves through dehydration and starvation long enough to obtain help to die by suicide in a faster, easier way.

State laws have never been reformed to fix significant issues, like how researchers revealed in the British Medical Journal way back in 2008 that Oregon doctors were failing to make required psychiatric referrals – only 2 out of 60 patients (3.3%) received a psychiatric referral. Instead of addressing this issue, lawmakers added more discretion to the law in 2019 to exempt the 15-day waiting period in certain cases. The law was reformed again in 2023, but not to fix implementation abuses, just to drop the residency requirement to endanger vulnerable people in other states. The latest Oregon Health Authority report now shows that of the 367 patients who died by assisted suicide in 2023, only 3 were referred for a psychiatric assessment. That is fewer than 1% (.08). Likewise, even when you exclude the 23 non-residents, failure to enforce existing supposed safeguards helps explain the nearly 6-fold increase from 60 in 2008. Unreformed and purposefully relaxed safety standards are what have allowed the death toll to climb 573% since the 2008 BMJ article. Once a state embraces killing over caring, the killing only increases. What may seem reasonable now will certainly not remain so if you do not veto HB 140.

Governor, the bottom line is that you should not be at peace with signing any law that declares entire groups of human beings as disposable. My goal here is to inform you that what supposed safeguards may comfort you in the current draft of HB 140 are more than just arbitrary criteria for determining what lives don’t matter: these limits for who may access poison are clearly fungible and changeable for the worst. History proves it. On principle, you should reject any unjust law that relegates any population to a lesser status as second-class citizens who get suicide assistance vs. everyone else who gets suicide prevention when they cry out for help. You may be okay with how HB 140 decides what Delaware residents in desperate circumstances get pushed off the ledge on request to fall to their death (rather than talked down from the ledge as we usually do), but I assure you that the qualifications on which lives don't matter will likely expand to other populations if you make the mistake of signing HB 140 and opening this Pandora's Box.

You are being presented a choice that is literally vital. To decide not to veto HB 140 is to sign off on a state-wide death warrant for those most vulnerable. This is your moral duty and a burden you do not want on your conscience. Learn from the past, listen to your innate instinct to protect those most in need of compassion and VETO HB140.

Sincerely,
Jacqueline Harvey Abernathy, Ph.D., M.S.S.W.
Dallas, Texas

Assisted suicide causes pain and suffering for family members.

By Dr Jacqueline Abernathy Ph.D., MSSW

Jacqueline Abernathy

On Thursday, February 29, the Colorado State Assembly Senate Health & Human Services Committee voted in a rare bi-partisan 7-1 approval for assisted suicide expansion Bill SB 068. The committee has a 6 to 3 Democrat majority, so passage was sadly expected since this issue settled down party lines in recent years, but this was not a party-line vote but a nearly unanimous endorsement of an issue so contemptuous, that it took over two and a half hours of alternating two-minute testimonies to get through all the registered witnesses, myself included. Across my twenty-plus years of activism and 12 years of post-doctoral academic scholarship on end-of-life laws in the United States, I have testified in many capitols, sometimes waiting to conclude hearings lasting over ten hours. This hearing marked two milestones for me: my first time to testify remotely against assisted suicide and my first experience as a witness in a state where it was already legal. The latter was eye-opening. I heard new arguments from those in favor of easing access to self-destruct that gave me new insight into problems this practice creates that I never before considered, namely the emotional trauma of waiting for the means to kill yourself and the pain that knowing this self-imposed, unnecessary act will cause.

The testimony I heard was sobering and the lack of public engagement was a disconcerting sign of how desperately we must fight back on assisted suicide. As always, the case in favor of assisting a suicide was purely anecdotal, devastating accounts of sick and scared people who see suicide as the only way out of their circumstances, whereas my testimony and other opponents were pragmatic points of concern for the vulnerable and appeals to refuse violence as a substitute for real medical care and true compassion. Witnesses in opposition pointed out the dangers of SB 068, a bill that would strip the requirement that only physicians can prescribe lethal drugs, and reduce the waiting period from two weeks to just two days. Furthermore the bill would allow suicide tourists to obtain the lethal poison after just 48 hours to reflect upon this ultimate, irreversible decision: it would allow non-Coloradans to visit for the purpose of suicide and to subvert the laws in their home states, effectively creating a market large enough to sustain specialty suicide clinics that would profit off desperate, terrified people trading their money for a deadly dose of barbiturates from a total stranger with an ideological and financial stake in enabling many people to destroy themselves as possible. 

 

The talking points suggested that loosening the assisted suicide provisions was rooted in improving flaws in the law Coloradans and would have some face validity if the bill did not expand eligibility to non-residents. But as I said in my testimony, the amendments clearly accommodated out-of-state visitors so adding these individuals to the bill makes it appear that these changes are meant to cater to them, and residents are an afterthought who get to share the supposed benefits of quicker, easier access to assisted suicide. Stories from bill supporters were, as always, deeply heartbreaking and disturbing. It aches my heart to hear what people endure and wish so much that it didn’t wrongly appear that opposing assisted suicide means that we do not equally wish to see an end to their pain.

 

Most often assisted suicide is not about pain, but ableism when people can no longer enjoy life as much due to their condition which implies that life is only valuable for the physically able-bodied. There is also the fear of what dying from an underlying condition will entail vs. a certainty when choosing the means to kill. The reduction from fourteen days to 48 hours before a patient could take their own life was a key theme among witnesses who concurred that this wait was emotionally agonizing for those who were fearful that they might die naturally during the interim or the impending knowledge that they would be dead immediately once the medication was dispensed.

 

It was one such particular story that struck me the most deeply. A bereaved sister named Lindsay Menough recalled losing her brother, Eric Carlson, to assisted suicide in 2020. She testified in his honor that self-violence was his preferred alternative to dying naturally from brain cancer, not because he was in pain but because he “could no longer live independently and would die naturally within 6 months.” 

 

I also lost my sibling to the same underlying condition Mr. Carlson faced. Elizabeth Harvey died of cancer in 2022, from a tumor that spread to her brain. I could relate to the pain in this woman’s voice and the agony associated with watching a sibling battle such a merciless malady, but what hurts me the most is how different our experiences were in the same circumstance because legal assisted suicide enabled a torment I couldn’t imagine and thanks to my sister’s strong convictions against violence, an act she would have never subjected us to even if it has been a legal option. Menough spoke favorably of assisted suicide like it was a mercy but spoke of how cruel it is to know when someone who does not have to die yet still puts an unnecessary doomsday clock counting down the time they have left with you rather than treasuring whatever time they are given. She said, “Imagine your loved one would die on a particular day. Imagine that those days counting down would be like simply waiting, knowing the awful inevitable end was coming.” I can’t imagine because it is not meant to be this way. I know what it is like not knowing when that day would be when my sister would die much like I don’t know when anyone’s time will end, but with my sister, I knew that the day would soon come when Beth could no longer speak to me and would soon after, take her last breath. 

 

My experience was nothing like what this poor woman described while waiting for her brother to die by assisted suicide, impatiently awaiting the first available chance to end his life once he could do so with the assistance of “medication.” Menough explained, “The seventeen days from when Eric made a decision until the day he finally passed away were excruciating for Eric, for me, and for our entire family. The clock ticked, the days changed and with every passing second my brother grew more and more frustrated because he was simply there, able-bodied, of a sound mind, just waiting to die.” 

 

Able-bodied, of a sound mind is very much alive and able to live life to the fullest, the way my sister actually did until that life was over. Menough stated, “Eric lived a full life up until his last breath.” as If choosing to take his last breath as soon as possible didn’t throw that full life away, and recounts that he enjoyed aspects of being alive shortly before taking poison to die months ahead of schedule. “An hour before he started the process, we were walking in his woods. He enjoyed his favorite cocktail in front of the fireplace while listening to the Rolling Stones with the people he loved most.” Near the end, I was grieved by knowing time was limited with my sister to take walks and listen to music together. I knew eventually she would need heavy pain control and be mostly sedated and that even before she ultimately died, I would lose her because I would never be able to talk to her again, but I was comforted in that my sister didn’t arbitrarily cut that time short on purpose. 

 

Menough lost her brother and the time she should have had, which can only further complicate the same grief from the same kind of loss that I too endured. She concluded as if assisted suicide preserved the value of Erik’s life rather than taking that value away completely, stating, “He never lost any part of himself in the process of battling brain cancer.” I am glad she thinks this is so, but in taking his life, I think he truly lost all of himself while also taking himself from those who loved him. He let suicide steal months of fireside cocktails and nature walks. 

 

My sister never let cancer steal anything more from her or any of those she loved to the extent she was able to fight back. I got to have every conversation with her and enjoy every single moment of her company that she had left before she eventually fell into a coma and passed away peacefully. Had she taken a poison cocktail to become comatose months early while waiting for the poisons to kill her, she would have let her disease take more from her than it had to. 

 

This bereaved sister was lobbying to cut the time to even less before people could further limit their lives that were already cut short by a terminal disease. The torment of knowing when the last day would be was an additional and unnecessary trauma caused by assisted suicide. She wanted to shorten this torment not realizing that the torment should not exist and nor should letting a terminal diagnosis coerce you into just throwing away what precious life you have left. Our experiences prove that assisted suicide does not make loss easier, only harder. It was not until I heard stories like this that I came to understand just how much assisted suicide steals from those in dire circumstances. Once able to destroy lives, assisted suicide laws only grow into bills like SB 068 where the victims cry for it to steal even more from those already devastated by terminal illness. Although my fellow witnesses like Menough were fighting in honor of her late brother to only increase pain like hers, she is also a victim of pain I was spared by a sister who was committed to loving us with all the time she had left. We need to convey to those hurt by assisted suicide that the answer is not to make it easier to endure added unnecessary pain, but not to enable such pain at all.

 

I encourage more life advocates to turn out against the companion bill in the House committee once announced and for Colorado residents to make their values known to their representatives. Even as a non-Coloradan, I intend to continue fighting for the vulnerable people that inspired me to testify like I always have, but now, I will do it also for those hurt by assisted suicide who will, unfortunately, be testifying on the opposite side without knowing that there is a better way to face terminal illness than with elective violence. 

 

I will do so, not just in honor of my late sister but for other bereaved siblings like myself and more so, for victims like Menough. Stories like hers that I heard at this hearing and the inevitable added damage detailed in my testimony only prove how necessary it is for us to fight back against bills like SB 068 that only make an already bad law somehow, far worse. I hope you will join me as we continue to fight assisted suicide not just in Colorado, but everywhere it threatens human life.