Govatos v. Murphy

1

JUDITH GOVATOS, et al., Plaintiffs, v. PHILIP D. MURPHY, et al., Defendants.

No. 23-cv-12601 (RMB/EAP)

United States District Court, D. New Jersey

September 18, 2024

Ryan Chabot, David B. Bassett (pro hac vice), Kelsey Quigley (pro hac vice), WILMER CUTLER PICKERING HALE AND DORR LLP, Kevin Diaz (pro hac vice), Amitai Heller (pro hac vice) COMPASSION & CHOICES On behalf of Plaintiffs Judith Govatos; Andrea Sealy; Dr. Paul Bryman, DO, FACOI, AGSF, CMD; and Dr. Deborah Pasik, MD, FACR Melissa Schaffer, Francis X. Baker, Christopher Ioannou OFFICE OF THE ATTORNEY GENERAL OF NEW JERSEY On behalf of Defendants Philip D. Murphy, Governor of New Jersey; Matthew J. Platkin, Attorney General of New Jersey; Dr. Kaitlan Baston, MD, MSc, DFASAM, Commissioner of the New Jersey Department of Health; Antonia Winstead, Executive Director of the New Jersey Board of Medical Examiners; and Grace C MacAulay, Prosecutor of Camden County, New Jersey (all in their official capacities)

OPINION

RENEE MARIE BUMB, Chief United States District Judge:

In Glucksberg v. Washington, 521 U.S. 702, 728 (1997) the Supreme Court determined that medical aid in dying is not a fundamental right protected by the substantive component of the Due Process Clause. The Court acknowledged then that “Americans are engaged in an earnest and profound debate about the morality, legality, and practicality of physician-assisted suicide.” Id. at 735. In so holding, the Court allowed that debate to continue and devolved the issue to the states-permitting the differing judgments of the democratic process. Id. In 2019, after its own decadelong debate, the New Jersey Legislature enacted the New Jersey Medical Aid in Dying for the Terminally Ill. Act, P.L. 2019, c. 59 (the “Act”). The Act authorizes a “qualified terminally ill patient” to obtain medication that the patient may choose to selfadminister to cause the patient's own death. N.J. STAT. ANN. § 26:16-2(a). Intending to guide providers and protect vulnerable adults from abuse, the Legislature imposed several safeguards, including a requirement that the terminally ill patient must be a resident of New Jersey to qualify under the Act. See, e.g., id. § 26:16-4(a). Plaintiffs- a group comprising nonresident patients with terminal illnesses and New Jersey physicians-have sued to challenge this residence requirement. Defendants have filed a Motion to Dismiss. It is the constitutionality of the Act's residence requirement that is the narrow issue before this Court.

Specifically, this case presents the question whether the State's residence requirement for medical aid in dying violates three provisions of the United States Constitution: (1) the Privileges and Immunities Clause of Article IV, § 2; (2) the dormant Commerce Clause of Article I, § 8; and (3) the Equal Protection Clause of the Fourteenth Amendment. As far as this Court can discern, it is a matter of first impression. No other court has addressed whether a state's residence requirement for medical aid in dying violates the Constitution.^[1]

At its core, the issue is whether the Constitution requires a state to extend to nonresidents a non-fundamental privilege that it affords to its own residents. Notwithstanding a terminally ill person's genuine desire to access medical aid in dying, this Court concludes that the answer is no, the Constitution does not so require. Here, the New Jersey Legislature determined that access to medical aid in dying should be limited to residents of the State. Because medical aid in dying “is not basic to the maintenance or well-being of the Union,” Baldwin v. Fish & Game Comm'n of Mont., 436 U.S. 371, 388 (1978), the Privileges and Immunities Clause does not protect a nonresident's access to it. Nor does the dormant Commerce Clause govern this case.

The Act is not driven by “economic protectionism,” see Nat'l Pork Producers Council v. Ross, 598 U.S. 356, 369 (2023) (plurality op.) (explaining that policing against such protectionism “lies at the ‘very core' of our dormant Commerce Clause jurisprudence” (citation omitted)); it merely provides access to a service that would not otherwise exist at all, see McBurney v. Young, 569 U.S. 221, 235 (2013). Finally, the Act's residence requirement neither targets a suspect class nor trammels a fundamental right, so it is subject to rational-basis review. See City of Cleburne v. Cleburne Living Ctr., 473 U.S. 432, 440-41 (1985). And the residence requirement makes sense: While medical aid in dying is permitted in New Jersey, it is indistinguishable from the criminal act of assisted suicide in neighboring states. By limiting the pool of eligible patients to State residents, the requirement is rationally related to the legitimate objective of protecting from out-of-state liability providers and advocates who assist terminally ill patients in seeking medical aid in dying.

Accordingly, for these reasons, as more fully expressed below, the Court will GRANT Defendants' pending motion and DISMISS this case.

I. BACKGROUND

A. New Jersey's Medical Aid in Dying for the Terminally Ill. Act.

In 2019, the State Legislature enacted the New Jersey Medical Aid in Dying for the Terminally Ill. Act, P.L. 2019, c. 59 (the Act). The Act established “the right of a qualified terminally ill patient, protected by appropriate safeguards, to obtain medication that the patient may choose to self-administer in order to bring about the patient's humane and dignified death.” N.J. STAT. ANN. § 26:16-2(a). And it specified that any action taken in accordance with the Act “shall not constitute suicide or assisted suicide,” which otherwise remains illegal. Id. § 2C:11-6, amended by 2019 N.J. Laws c. 59, s. 28. With the Act's passage, New Jersey became the ninth jurisdiction in the country to permit qualified patients to access “medical aid in dying.”^[2], ^[3]

New Jersey's authorization of medical aid in dying was “the product of a neardecade long debate among policy makers, religious organizations, experts in the medical community, advocates for persons with disabilities, and patients, among many others.” Philip D. Murphy, N.J. Governor's Statement Upon Signing Assembly Bill No. 1504 (2nd Reprt.) (Apr. 12, 2019), https://dspace.njstatelib.org/server/api/core/bitstreams/3a40f3d-d35a-4ce5-92c7-769c2f1a822a/content [https://perma.cc/RSL5-4PCV]. Legislators recognized that the “public welfare requires a defined and safeguarded process” to accomplish the purposes of the Act. N.J. STAT. ANN. § 26:16-2(c). That process is intended to: “(1) guide health care providers and patient advocates who provide support to dying patients; (2) assist capable, terminally ill patients who request compassionate medical aid in dying; (3) protect vulnerable adults from abuse; and (4) ensure that the process is entirely voluntary on the part of all participants, including patients and those health care providers that are providing care to dying patients.” Id.

Accordingly, to achieve these goals, the Act established a series of guardrails.^[4]First and foremost, medical aid in dying is only available to adults of sound mind who have voluntarily expressed a desire to receive end-of-life medication. Id. § 26:16-4. To obtain a prescription for such medication, a qualified terminally ill patient must make two oral requests and one written request to the patient's attending physician, subject to certain waiting periods. Id. § 26:16-10(a); see id. § 26:16-3 (defining “qualified terminally ill patient” to require compliance with the Act to obtain prescription for end-of-life medication). The written request must be in substantially the same form as provided under the statute (see id. § 26:16-20) and signed by at least two witnesses. Id. § 26:16-5(a). One of those witnesses must be disinterested. See id. § 26:16-5(b). Additionally, to write a prescription for end-of-life medication, a physician must, among other requirements, determine that the patient has capacity to seek medical aid in dying, is acting voluntarily, and has six months or less to live because of a terminal illness. Id. § 26:16-6(a)(1); see id. § 26:16-3 (defining “terminally ill” to mean that the patient is in the “terminal stage of an irreversibly fatal illness, disease, or condition with a prognosis, based upon reasonable medical certainty, of a life expectancy of six months or less”). The attending physician must refer the patient to a consulting physician who must independently confirm the patient's diagnosis and prognosis and determine that the patient is capable and acting voluntarily. Id. § 26:16-6(a)(4); see id. § 26:16-4(b) (conditions for request for medication).

Furthermore, the Act addresses the impact of medical aid in dying on certain contracts, protecting patients and their beneficiaries. The Act specifies that contracts, wills, insurance policies, annuities, and other agreements cannot condition or restrict a person's decision to “make or rescind a request for medication” under the Act. Id. § 26:16-14(a). Similarly, any obligation owing under such instruments cannot be affected by the Act, a person's decision to make or rescind a request for medication under the Act, or any other action taken under the Act. Id. § 26:16-14(b). Likewise, procurement or issuance of a life, health, or accident insurance policy or annuity, or the premium or rate charged for the policy or annuity, cannot take into account the making or rescinding of a request for medication under the Act. Id. § 26:16-14(c).

The Act also protects providers and others who voluntarily assist in addressing a request for medical aid in dying. For example such persons are immune from civil and criminal liability or professional disciplinary action for any good faith action taken in...