Deborah Armstrong has always cared about the way people die. The New Mexico state representative began her 45-year career in health care looking after terminally ill children as a physical therapist. Outside of work, she took on caregiving roles for several dying family members and friends, “all of whom,” she says, “suffered greatly.” But end-of-life issues became more acutely personal for Armstrong, a Democrat from Albuquerque, when her daughter Erin’s cancer mutated in 2019 and spread to her bones, lungs, liver, and brain.

Both mother and daughter were aware that Erin might, at some point in the future, desire more autonomy over her death than New Mexico policy allowed. Medically assisted dying had never been a legal option in the state.

But, in 2021, the picture changed: New Mexico became the latest state to pass an aid-in-dying law, which allows a terminally ill person to request medication from their physician to hasten their death. The legislation was sponsored and shepherded through the state legislature by Armstrong.

New Mexico joins nine other jurisdictions that have enacted aid-in-dying laws in the past quarter century. Given the idea’s broad popularity—74 percent of Americans agree that medically assisted dying should be an option—more states would likely already have passed such laws if it weren’t for one particular lobbying powerhouse—the Catholic Church—which has spent millions of dollars throwing its weight against local efforts. Though Democrats at the state level have successfully pushed legislation forward without Republicans, national politicians from both parties have been scared off by the Church’s immense opposition to the movement. American hospices serve around 1.5 million terminally ill patients each year. If the Catholic Church gets its way, these patients will continue to be denied full autonomy over the way in which they die. 

Following a 1997 Supreme Court ruling that said physician-assisted dying is not a constitutional right, and that states should decide the “morality, legality and practicality” of the issue individually, Oregon became the first state to have an assisted-dying law go into effect, later that year. It then took more than 10 years for a second state, Washington, to pass similar legislation, which was enacted in 2009. Since then, a kind of domino effect has taken place, with eight further jurisdictions enacting aid-in-dying laws, including Washington, D.C., California, New Jersey, and now New Mexico, among others. 

“These laws empower individuals to have a good death: on their own terms and in accordance with their values and beliefs,” the Death with Dignity National Center, an advocacy organization, states on its website. Aid-in-dying legislation is thus both popular and patient centered. Why, then, have just 10 jurisdictions passed such laws?

Any answer to this question should begin with a look at the makeup of these areas. Oregon, Washington, Vermont, California, Colorado, Washington, D.C., Hawaii, Maine, New Jersey, and New Mexico share a common theme: All of them lean Democrat.

“These laws empower individuals to have a good death: on their own terms and in accordance with their values and beliefs,” says the Death with Dignity National Center, an advocacy organization.

New Mexico is one such blue state. Armstrong, spurred by her daughter’s diagnosis, sponsored aid-in-dying acts in 2017 and 2019. They were quickly killed, mainly by GOP representatives who follow the Catholic Church on this issue. Nevertheless, Armstrong continued building support among fellow legislators and the public, and in 2021, she tried again. 

Armstrong’s Elizabeth Whitefield End-of-Life Options Act allows adult residents of New Mexico who are deemed terminally ill (defined as having six months or less to live, according to reasonable medical judgment), have the capacity to make the decision themselves, are able to self-administer medicine, and are not being coerced to request aid-in-dying medication from their physician. While the law states that the medication must be self-administered—the patient must perform an “affirmative, conscious, voluntary action” to take the medication by mouth, by feeding tube, or rectally—this does not exclude assistance being given, Armstrong says. New Mexico’s law goes further than other states in streamlining the process: Patients are not subject to arbitrary time lines that require multiple requests in various forms, and they can get the prescription from nurse practitioners and physician assistants in addition to doctors.

At a hearing on the legislation, Armstrong’s daughter Erin presented powerful testimony:

These last two years have granted me a few terrifying glimpses into the potential for physical suffering, and I’m afraid at the thought that my final days could be filled not with loving goodbyes and memories shared with my loved ones, but with wrenching pain and disorientation . . .

This bill before you is smart. It’s careful. And it’s the kind of thoughtful legislation that this topic and the people of New Mexico deserve. And it will bring me, on a personal level, immeasurable peace as I move forward in my own journey to live, and eventually to die.

Deborah Armstrong maintains that such personal stories were key to getting people on board.

Through a combination of increased public support, the governorship switching from a Republican to a Democrat in 2019, and favorable seat changes, the legislation passed in March. “It means a lot to have that option available for my loved ones,” Armstrong told me. Since the act went into effect on June 18, there have been at least fifty ingestions of the prescription medication. 

In Kentucky, the story is very different. Efforts to pass a similar law last year faced impassable roadblocks. State Representative Josie Raymond, a Democrat, introduced an aid-in-dying act in February 2021. Like Armstrong, the issue means a lot to her: “It became a topic that was really personal to me when my grandfather, who was 94, shot himself in the head in 2019.” His suicide was prompted by an upcoming visit to the doctor and a fear of losing his independence, Raymond told me.

Ultimately, the bill went nowhere. “Democrats don’t pass bills in Kentucky,” Raymond said. She plans to introduce it again but has little hope that it will move through soon.

As of now, only Democrat-leaning states have passed aid-in-dying legislation, but public surveys show that Democrat and Republican voters are not split on the issue. The 2020 Gallup poll on aid in dying showed 85 percent of Democrats and 69 percent of Republicans agreed that physicians should be able to assist in terminal patients’ deaths. The legislation’s broad popularity has clearly not mapped to universal enactment.

This slow progress ultimately comes down to two forces: religion and political polarization.

“The Republican Party has made clear its stance on this particular issue,” says Bianca Easterly, the author of The Chronic Silence of Political Parties in End of Life Policymaking in the United States. In platforms dating back decades, the party has stated its opposition to “assisted suicide,” as it terms it, with overt Christian language, often citing the sanctity of life. It makes sense that the Republican Party line is influenced by religion: 61 percent of Republicans say that religion is very important to one’s life, versus 47 percent of Democrats, according to a 2014 Pew Research Center study. Yet the GOP’s stance on this issue does not align with what most religious Americans think: 59 percent of Christians as a whole, 70 percent of Catholics, 53 percent of Protestants, and 70 percent of people belonging to other religions agree that it is morally permissible for a terminally ill person to request their doctor’s help in ending their life.

One would think that Republicans taking this unpopular stance would have left room for Democrats to run with the issue. But national Democrats have been slow to champion it—mainly for fear of alienating religious lobbies, which have an outsized influence in Congress.

While most Catholics support aid-in-dying laws, the Catholic Church itself does not. In fact, the Church’s efforts to stymie the death-with-dignity movement have been the primary roadblock that advocates face. “The Catholic Church and its affiliated organizations continue to be one of the biggest obstacles to aid-in-dying reform and the right-to-life movement here and abroad,” Easterly told me. Even in states that have managed to pass laws, such as New Mexico, pushback from the Catholic Church was a challenging hurdle to overcome. “The opposition was primarily from the same groups that were there opposing abortion—the Catholic Church specifically,” Armstrong said.

The Church’s influence has been especially potent in states with large Catholic communities. In 2012, deep-blue Massachusetts, a state with a 34 percent Catholic population, held a ballot initiative on assisted dying, allowing residents to decide the issue. In a mid-September poll conducted by Suffolk University and 7News, 64 percent of respondents agreed with aid-in-dying law, and 27 percent were opposed. Yet less than two months later, the initiative was narrowly defeated. The vote switching was deemed to be almost entirely the work of the Catholic Church.

While most Catholics support aid-in-dying laws, the the Catholic Church itself does not. In fact, the Church’s efforts to stymie the death-with-dignity movement have been the primary roadblock that advocates face.

A group formed to oppose the measure, the Committee Against Physician Assisted Suicide, raised more than $4.7 million in the run-up to Election Day. The largest donors, unsurprisingly, were all affiliated with the Church: The Boston Catholic Television Center and the St. John’s Seminary Corporation contributed more than $1 million each, while the Roman Catholic Archbishop of Boston, the Knights of Columbus, and the Catholic Association each contributed six-figure amounts ($617,000, $450,000, and $420,000, respectively). This lobbying effort sends a clear message to the Democratic Party: If it promotes aid in dying to the national agenda, the Catholic Church will put up a well-funded fight.

Recognizing that its message is unattractive to many in an increasingly unreligious United States, the Catholic Church has also partnered with disability organizations in opposition to assisted-dying laws. While polls show that most people with disabilities support assisted-dying laws, several national disability advocacy organizations, such as the American Association of People with Disabilities, oppose aid-in-dying policy on the grounds that the legislation leaves room for coercion, mistakes by health care professionals, and misinformation, and that it “devalues the lives of people with disabilities.” In the run-up to the Massachusetts ballot initiative, the Catholic Church–funded CAPAS group ran advertising that included messaging from disability rights activists.

However, these types of actions do not advance the interests of people with disabilities: Aid-in-dying policy is, in fact, popular among the demographic; there is no evidence of coercion in states with existing assisted-dying laws; and some disability rights activists have been pushing for lower barriers to aid in dying for terminally ill people with disabilities. Nevertheless, lobbying groups forming to thwart the rise of these laws may be having some success with the national Democratic Party.

For decades, Democrats have felt empowered to take a strong stance on abortion despite the wrath it invokes from religious groups and the issue’s polarization. While there is a 35-point difference between party voters on the question of whether abortion should be legal under any circumstances, only 16 points separate voters on the aid-in-dying question. Voters from across the board are uniquely aligned on assisted dying, and that should give Democrats the confidence to pursue it.

Aid-in-dying laws are popular across the party’s base, among both liberal and moderate blocs, and they are also popular with both Republicans and independent voters who can swing in either direction in major elections. Everyone has a loved one for whom they want the most painless and dignified death possible. Eventually, they want that for themselves as well. Democrats are the party trying to deliver that for the American people. They should embrace it. It’s the right policy—both politically and morally.

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Ella Creamer is an intern at Politico. She is a former intern at the Washington Monthly.