Judy Govatos spent a long time thinking about her own death. The former teacher and non-profit executive went 3 rounds with Stage 4 lymphoma. She went into remission twice, in 2014 and 2019, but the cancer came back, as her doctors had warned it would. In November of last year, at the age of 81, Govatos died.
Her life didn’t end the way she’d hoped. Govatos was a longtime advocate for the passage of medical aid in dying laws – legislation that makes it legal for doctors to prescribe medication at a dosage that will cause a painless death, which terminally ill patients self-administer – and she wanted to take advantage of the option herself. Only, she lived in Delaware.
“I don’t want to die fearfully. I want to die affirming the fact that I’ve had this opportunity to be alive in this amazing world, and to say goodbye and I love you to my family and friends.”
In New Jersey, medical aid in dying for the terminally ill has been legal since 2019, but the law includes specific geographic constraints: it can only be used by residents of the state, and Govatos lived just over the border, in Wilmington. In 2023, alongside another cancer patient who lived in Philadelphia and 2 NJ-based doctors, she sued the state of New Jersey, asking that the law’s residency requirement be removed. Two years later, the case remains unsettled, and both Govatos and the other cancer patient have died.
“I want to avoid the last and worst part of the dying process I know I will experience,” Govatos wrote in a statement before she died. She was “allergic to just about every painkiller they’ve ever tried,” experiencing hallucinations and violent illness, Govatos added. “I don’t want to die fearfully. I want to die affirming the fact that I’ve had this opportunity to be alive in this amazing world, and to say goodbye and I love you to my family and friends.”
Paul Bryman, DO, is now the central plaintiff. He is the medical director of a hospice program in Camden County, and an associate professor at a large South Jersey medical school. “I teach the death and dying course,” he says, “and I’ve been involved with providing end of life care to patients on hospice my entire career. I’m a very strong advocate for patients having the right to decide the course of their own medical care and make choices as to how they want to proceed, both during their life and at the time of their death.”
The 2019 law was extremely controversial in New Jersey. It took 7 years to pass the legislature and then-Gov. Phil Murphy, who signed the bill, said he was conflicted. Some lawmakers still oppose the practice. In the most recent legislative session, 2 North Jersey assemblymen introduced a bill that would appeal the 2019 measure, which was referred to the Assembly Judiciary Committee.
Bryman, who says he was one of the first physicians to participate after the law was passed, was supportive right away. “I’ve seen some very gentle, peaceful deaths, and I’ve seen people have very difficult and uncomfortable deaths,” he says. “And if someone who is mentally competent to make this decision wants to decide of their own free will and accord to participate in medical aid in dying, which is legal in New Jersey, there should be no obstacles for them.”
But for many of his patients, there is an obstacle. They travel across state lines to see him for care, which means Bryman can’t even discuss aid in dying with them. Some, he says, choose to go through the “cumbersome process of becoming a resident.” He’s had dozens of patients, he says, establish residency by renting an apartment or moving in with a relative in order to participate in the law “because they feel so strongly that they don’t want to die either with a lack of dignity or excessive suffering,” he says.
Bryman signed onto the lawsuit, he explains, because he doesn’t think terminally ill patients should be forced to uproot their lives and move so they can have some control over their death. “I had one patient who moved to New Jersey basically almost requiring a hospital bed,” he says. “His caregivers had to take him to get a non-driver’s license in his wheelchair.” For those who can move, establishing residency can take weeks, Bryman adds, “and when you’re talking about someone who is terminally ill, there’s a clock ticking. A few weeks may be too long.”
And many patients simply can’t relocate. “It’s a personal choice how much suffering you should have before you die. How many tests you should have, how much chemotherapy, how much stress your family should go through,” Bryman says. “But I’ve had to decline people’s ability to make that choice because the hurdles to becoming a New Jersey resident were insurmountable.”
Jess Pezley, the senior staff attorney for Compassion & Choices, a non-profit that advocates for medical aid in dying policy, says this is the only healthcare option in New Jersey that requires a patient be a resident. “There’s no reason why residents are more qualified or more deserving of a compassionate end of life option than someone who happens to live in Philadelphia,” she says. Pezley is the attorney representing Bryman in the suit against the state.
“We think that the restriction is unconstitutional,” she continues. “It discriminates against non-residents, and is not adding any sort of protections. It’s just preventing otherwise qualified people from accessing the treatment they want. Residency restriction does not make the law safer. It just makes it harder to access.”
In Vermont and Oregon, two of the first states to legalize aid in dying, similar court challenges in recent years led state legislatures to remove the residency requirements. But in New Jersey, a federal judge
dismissed the initial case filing. In her opinion, the judge wrote that “the residency 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.”
The judge’s concern was that while doctors assisting terminally ill patients are protected from liability in New Jersey, that protection might not extend across state lines if the patient returned to their home to ingest the medication that caused their death.
The plaintiffs appealed the dismissal. In December, appellate court Judge Stephanos Bibas issued an opinion upholding the decision for similar reasons. “Across the Delaware River, assisted suicide is still a crime,” he wrote. “A prescription lawful in Camden can be evidence of a felony in Philadelphia. So, if a New Jersey doctor prescribes a Pennsylvanian lethal pills and she swallows them back in Pennsylvania, the doctor might reasonably fear prosecution. That fear heightens the stakes for New Jersey doctors.”
Pennsylvania does not have an aid in dying law. When the suit was filed, neither did Delaware or New York. Now, both states’ legislatures have passed bills. In New York, as of this writing, Gov. Kathy Hochul has said she will sign the bill. In Delaware, Gov. Matt Meyer signed the act into law last May, with Govatos at his side. It went into effect on January 1, too late for Govatos to use it.
In New Jersey, though the appellate court upheld the dismissal, they also opined that Bryman still has standing to sue on behalf of himself and his patients. If he and the Compassion & Choices organization choose to move forward, the next stop would be the U.S. Supreme Court. Bryman said in a statement he was “deeply disappointed” by the ruling. That Govatos died before a resolution was passed that could offer her relief, Pezley says, “goes to show the pressing need and why we’re bringing these cases.”
Govatos and her former co-plaintiff, Andy Sealy of Philadelphia, who died of breast cancer in 2024 at age 44, are “examples of people who passed away without access to the healthcare option they wanted,” Pezley says. “I think there are countless more who are living in places across the country where they do not have access to medical aid in dying.”
Removing residency requirements in Vermont and Oregon was relatively uncontroversial, but circumstances are different in New Jersey because of the population density along its borders – including both the New York and Philadelphia metropolitan areas – and the ease of travel into the state. As one legal expert pointed out to The New York Times, “it’s easier to get to Newark than Burlington, Vermont.”
But it’s precisely because of the potential impact, Pezley says, that she and her clients are so determined to see access increase. A huge number of people come into New Jersey to receive other medical care, she says. They should be able to ask their doctors for this, too.
“New Jersey is a very centrally located state,” she says. “It has incredible medical services. When it comes to healthcare, the geographic lines are, in a sense, kind of arbitrary, and yet they dictate someone’s death.”
Understanding NJ’s Law
In 2019, the first year that medical aid in dying was legal in the state, 12 NJ residents used the option. In 2024, according to state medical examiner data, that number had increased to 122. To qualify, patients must be adults who are terminally ill, with a prognosis of 6 months or less to live. They must be mentally capable of making healthcare decisions and physically capable of taking the medication themselves. The process involves making 2 verbal requests to a doctor at least 15 days apart. The patient must also make a written request with 2 witnesses and have a consultation with a second physician. Both doctors must medically evaluate the patient and determine that they’re eligible. Then there is a 48-hour waiting period before a prescription can be written. While the law does not specify which medications are used, most prescriptions include a sedative and a dose of an opioid or barbiturate large enough to stop the patient’s heart.
A National Issue
Medical aid in dying is currently legal in 11 states and the District of Columbia. Oregon was the first state to legalize the practice; the bill there went into effect in 1997. At the start of 2025, 10,211 people nationwide have used the option, according to state data compiled by Compassion & Choices. Over the last year, more bills were introduced in a number of states.
Here’s a look at the national legal landscape: Where medical aid in dying is legal:
California
Colorado
Delaware
District of Columbia
Hawaii
Illinois
Maine
Montana
New Jersey
New Mexico
Oregon
Vermont
Washington
States considering legislation:
Indiana
Massachusetts
Minnesota
New Hampshire
New York
North Carolina
Pennsylvania
