Illinois Judge Could Block Medical Aid-in-Dying Law Before Saturday Start Date

A federal judge in Chicago is expected to rule within days on whether to stop Illinois from becoming the first Midwestern state to allow terminally ill adults to obtain life-ending medication from a physician, after hearing arguments Friday over whether the law puts people with disabilities at risk.

The End-of-Life Options for Terminally Ill Patients Act, known as EOLA, is set to take effect Sept. 12. U.S. District Judge John Tharp heard roughly two hours of arguments at the Dirksen Federal Building on a request for a preliminary injunction and told both sides he would decide before the law's start date.

The lawsuit was brought by disability rights groups, a physician and several disabled Illinois residents. Their attorney, Thomas Geoghegan, told Tharp the law upends centuries of medical tradition rooted in the Hippocratic oath's directive to "first do no harm" and will damage the trust between disabled patients and their doctors. He argued the law amounts to a different standard of care applied specifically to people with disabilities and terminal diagnoses, and that it violates the Americans with Disabilities Act, the Affordable Care Act and due process protections.

Geoghegan pointed to research on physician bias, arguing doctors may misjudge the quality of life of a disabled patient and steer them toward ending their life rather than exploring other treatment or hospice options. He told Tharp that risk is sharper in the United States than in countries such as Canada or those in Europe that already allow medical aid in dying, because those countries have socialized medicine while many Americans with disabilities are uninsured, underinsured or carrying medical debt.

"You can go out into the street right now and run into someone who's a defendant in a medical debt case," Geoghegan said, arguing that financial pressure could push disabled patients toward lethal medication out of desperation rather than free choice.

Elizabeth Morris, a litigator from Attorney General Kwame Raoul's office defending the law, told Tharp the statute already builds in the safeguard Geoghegan says is missing: physicians cannot raise the option of life-ending medication with a patient. Only the patient can initiate that conversation. The law applies only to adults given less than six months to live, a prognosis two independent physicians must confirm. Patients must ask for the medication both verbally and in writing, undergo a mental evaluation to confirm they are capable of making the decision without coercion, and be physically able to take the medication themselves. Doctors are also required to walk patients through hospice and pain management alternatives before any prescription is written.

Morris argued those steps amount to "a very thorough process to slow things down and give doctors the opportunity to assess patients," and said doctors remain accountable to the state through licensing requirements and medical malpractice law even without a separate review board built into EOLA.

Geoghegan countered that the absence of what he called "an objective, state engaged standard" for physicians deciding who qualifies leaves too much discretion in individual doctors' hands, which he said is enough on its own to violate due process rights for people with disabilities.

Opponents of the law, including the Catholic Conference of Illinois, have consistently referred to it as assisted suicide rather than medical aid in dying, the term used by supporters and written into the statute. Disability rights organizations opposed the measure throughout the roughly two years lawmakers spent debating it before Gov. JB Pritzker signed it earlier this year over objections from religious groups.

A second legal challenge to EOLA is already working its way through federal court. Religiously affiliated health systems and doctors sued last month, and a different federal judge in Chicago approved a temporary restraining order, agreed to by both sides, that excuses those plaintiffs from having to discuss life-ending medication with patients. That order holds until the 7th Circuit Court of Appeals rules in a related case stemming from a 2016 Illinois law that requires providers who don't perform abortions to refer or transfer patients to those who do, or give them written information about where to go. A federal judge in Rockford issued a mixed ruling in that case last year, and both sides appealed.

With Tharp's decision expected before Saturday, the law's status for at least its opening days depends on whether he finds the disability rights groups likely to succeed on their ADA, ACA and due process claims. If he denies the injunction, EOLA takes effect as scheduled Sept. 12 and Illinois becomes the first state in the Midwest to permit the practice. If he grants it, the law would be paused while the broader case over its constitutionality continues in his courtroom.