New Hampshire lawmakers are revisiting a bill on options for end-of-life care this year that stirs deep philosophical divisions over the right to exercise personal liberty versus concerns about undermining the state’s mental health goals by normalizing suicide.

For proponents, the law is meant to give individuals the power to make decisions about their final moments, rather than have others do it for them at great pain and expense. For opponents, it creates a slippery slope that devalues the lives of vulnerable groups, including those with disabilities.

Last year, the Senate voted down the proposed legislation, but not before it drew some passionate testimony. Residents from around the state shared personal stories, medical professionals weighed in with expertise, and advocacy groups made strong cases for and against the bill.

Wednesday’s hearing on House Bill 254 which would legalize options for end-of-life care or medical aid in dying is expected to attract a large crowd. Over 400 testimonies have already been submitted online.

As part of our coverage, the Monitor has put together information answering frequently asked questions raised during the last session’s debate, along with the perspectives of those who support and oppose the bill.

What is the purpose of HB 254 or options for end-of-life care?

The bill allows individuals over 18 years old with terminal illnesses and a prognosis of six months or less to choose a self-administered method to end their lives. To be eligible for these medications, individuals must receive verification from two healthcare providers.

Opponents worry about the unreliability of some diagnoses, citing instances of patients with a brain injury who were given months to survive and went on to live another 20 years.

Why is there opposition to the bill?

Opponents of the bill worry about how it could impact some of the most vulnerable populations — veterans, young adults, individuals with disabilities, those struggling with their mental health and seniors. They fear these groups may feel pressured to pursue this end-of-life option due to a perceived burden on their families.

There’s also a broader fear that the bill could normalize suicide and shift attention away from the need to expand access to compassionate, high-quality palliative care for everyone.

Why do people support the bill?

Advocates for the bill argue that it gives terminally ill individuals the power to make their own choices about how their lives end, allowing them to die with dignity rather than spending their final days confined to a bed, languishing in pain or under heavy medication. They also support the bill, stating that it is simply a choice and includes adequate safeguards to ensure it is not abused if passed.

What criteria must be verified by healthcare providers?

The first prescribing provider would need to verify that the person meets various criteria, including ensuring the individual is mentally sound, has a prognosis to live six months or less, has voluntarily made the decision and is fully informed about alternatives, among other factors.

After this, a second healthcare provider must review and confirm these qualifications to ensure they are met.

What method of administering the medication is required?

Even if a patient is terminally ill and fulfills all the criteria, the eligibility for this option hinges on the ability to self-administer the medication. It cannot be taken as injections or infusions.

How many states have legalized end-of-life care options?

Currently, 10 states — California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont and Washington — along with Washington D.C., have legalized medical aid-in-dying. Efforts in other states like Massachusetts are underway to pass a similar bill. Vermont and Oregon are the only states allowing non-residents to travel to their states for this option, which opponents here call “suicide tourism.”

Does New Hampshire’s bill allow non-residents to receive end-of-life care?

Yes, it does and some opponents worry that the legislation could turn New Hampshire into a “death capital,” attracting people from other states seeking to end their lives.

How many out-of-state residents have traveled to other states to access end-of-life care options?

Since 2022, Oregon has allowed medical aid-in-dying for qualifying patients regardless of residency, with 26 out-of-state residents having used the service as of January 2024, according to state data.

Vermont also passed similar legislation in 2023, granting access to medical aid-in-dying for non-residents, but data on how many out-of-state patients have used the service is not yet available.

 

Sruthi Gopalakrishnan can be reached at sgopalakrishnan@cmonitor.com