Dr. Paul Bryman, Do, Facoi, Agsf, Cmd v. PHIL MURPHY, Governor of New Jersey

PRECEDENTIAL
UNITED STATES COURT OF APPEALS
FOR THE THIRD CIRCUIT
_______________
No. 24-2947
_______________
DR. PAUL BRYMAN, DO, FACOI, AGSF, CMD,
Appellant
v.
PHIL MURPHY, Governor of New Jersey; MATTHEW J.
PLATKIN, in his official capacity as Attorney General of
New Jersey; JUDITH PERSICHILLI, in her official capacity
as New Jersey Health Commissioner; ANTONIA WINSTEAD,
in her official capacity as Executive Director of New Jersey
Board of Medical Examiners; GRACE MACAULAY, in her
official capacity as the prosecutor of Camden County,
New Jersey
_______________
On Appeal from the United States District Court
for the District of New Jersey
(No. 1:23-cv-12601)
District Judge: Hon. Renée Marie Bumb
_______________
Argued: September 17, 2025

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Before: BIBAS, MONTGOMERY-REEVES, and AMBRO,
Circuit Judges
(Filed: December 5, 2025)
Ryan M. Chabot [ARGUED]
David B. Bassett
W ILMER CUTLER PICKERING H ALE & D ORR
7 World Trade Center
250 Greenwich Street
New York, NY 10007
Kevin Diaz
C OMPASSION & CHOICES
520 SW 6th Ave., Suite 1205
Portland, OR 97204
Counsel for Appellants
Stephen Ehrlich [ARGUED]
Francis X. Baker
N EW JERSEY ATTORNEY G ENERAL ’ S O FFICE
25 Market Street
Richard J. Hughes Justice Complex
Trenton, NJ 08611
Counsel for Appellees
_______________
OPINION OF THE COURT
_______________

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BIBAS, Circuit Judge.
Death brings good things to an end, but rarely neatly. Many
terminally ill patients face a grim reality: imminent, painful
death. Some may want to avert that suffering by enlisting a
doctor’s help to end their own lives. New Jersey lets its resi-
dents make that choice—but only its residents.
The Constitution lets it draw that line. States may keep cer-
tain goods and services in-state. Plaintiffs’ claims to the con-
trary are at best legally uncertain.
Through the uncertainty, this much is clear: New Jersey has
sound reasons to limit this grave choice to its own residents.
Protecting vulnerable patients and their doctors (not to mention
avoiding friction with other states) justifies the residency require-
ment under any applicable test.
The Constitution leaves moral questions like these to the
states. New Jersey has answered them carefully, so we will
affirm.
I. ASSISTED SUICIDE , LIMITED TO GARDEN STATERS
A. New Jersey legalizes doctor-assisted suicide for
New Jerseyans
Doctor-assisted suicide is no ordinary policy choice. It asks
legislatures to weigh life against death. On one side stand some
terminally ill patients who understandably want to control and
limit their suffering. On the other side stand the preciousness
of life, efforts to shield the vulnerable from undue influence
and their doctors from prosecution or liability, and the need to
preserve harmony among the states. Legislatures do not make

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that choice lightly. A state may legitimately worry about safe-
guarding the sick and depressed from feeling pressure to die
too soon.
There is no easy answer. Yet most states have stayed with
the same one. More than three dozen keep the door to suicide
shut. Appendix, infra, pp. 16–20 (collecting state laws). At
least thirty-five of those treat assisting suicide as a crime, mak-
ing no exception for medical assistance. Id.
Only ten states plus Washington, D.C., now let doctors assist
suicide; an eleventh is about to join them. Id. Most strike the
same balance. All limit doctors’ assistance to prescribing pills
that the patient takes herself. All insist on safeguards, like wait-
ing periods between the request and the prescription. See Med-
ical Aid in Dying as an End-of-Life Option Offers Death with
Dignity, D EATH WITH DIGNITY (Mar. 29, 2023),
[https://perma.cc/9KSH-V65B]. None lets doctors give lethal
injections. Id. And the vast majority of them (nine out of
eleven, plus D.C.) limit assisted suicide to residents. Medical
Aid in Dying: Residency Restrictions, C OMPASSION &
CHOICES (May 2025), [https://perma.cc/WF4M-QYPK].
New Jersey is one of those nine. In 2019, it legalized doctor-
assisted suicide for terminally ill patients. N.J. Stat. Ann.
§§ 26:16-1 to -20. Under the Act, patients with a prognosis of
six months or fewer to live may ask doctors to prescribe pills
so they can end their own lives. §§ 26:16-3, 16-6(a)(1). They
must be sure of their decision, asking twice orally plus once in
writing. § 26:16-10(a). And they must reside in New Jersey.
§ 26:16-3, -11.

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In turn, prescribing doctors must ensure that the patient’s
choice is free and considered. They must confirm that she is
mentally competent and is asking for the prescription voluntar-
ily. § 26:16-7(c). They must follow specific procedures, keep
records, and verify residency with driver’s licenses, tax returns,
voter registration, or the like. §§ 26:16-6(a)(2), -7(c), -11. If
they do so, the Act shields them from civil and criminal liabil-
ity as well as professional consequences. § 26:16-17.
But across the Delaware River, assisted suicide is still a
crime. 18 Pa. Cons. Stat. § 2505 (2024). 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 rea-
sonably fear prosecution. That fear heightens the stakes for
New Jersey doctors. Still, some out-of-staters want access, and
some in-state doctors want to provide it.
B. Patients and doctors challenge the residency
requirement
Judith Govatos was a Delawarean with Stage IV lym-
phoma. She wanted the option of doctor-assisted suicide at the
end. But she died (without it) after oral argument in this case.
Paul Bryman, a New Jersey doctor, wants to assist patients
like her. Together, they challenged New Jersey’s residency
requirement under three parts of the U.S. Constitution: the
Privileges and Immunities, Equal Protection, and dormant
Commerce Clauses.
At first, Govatos and Dr. Bryman were joined by another
patient and another doctor. Andrea Sealy, a Pennsylvanian,

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suffered from metastatic breast cancer, but she too died without
doctor-assisted suicide before this appeal. Deborah Pasik, another
New Jersey doctor, retired during the litigation.
The District Court dismissed the complaint. It reasoned that
doctor-assisted suicide is not a fundamental privilege that
states must give to nonresidents, that there was no economic
protectionism, and that the law survived rational-basis review.
We review de novo. Kalu v. Spaulding, 113 F.4th 311, 324 (3d
Cir. 2024).
C. The last remaining plaintiff has standing
This case is justiciable. Though Govatos’s claim is moot,
Dr. Bryman satisfies Article III standing requirements as the
regulated party. As the Supreme Court has explained,
“[g]overnment regulations that require or forbid some action
by the plaintiff almost invariably satisfy both the injury in fact
and causation requirements.” FDA v. All. for Hippocratic
Med., 602 U.S. 367, 381 (2024). This includes doctors who
want to assist suicides but are blocked by state law. Washington
v. Glucksberg, 521 U.S. 702, 707 (1997).
Bryman also clears the prudential bar on third-party stand-
ing. While the Court has not definitively outlined when third-
party standing is allowed, it has often resolved the question by
comparing the case at hand to prior standing cases. All. for Hip-
pocratic Med., 602 U.S. at 384 (quoting Allen v. Wright, 468
U.S. 737, 751–52 (1984)); Trump v. CASA, Inc., 606 U.S. 831,
866 (2025) (Alito, J., concurring) (citing Lexmark Int’l, Inc. v.
Static Control Components, Inc., 572 U. S. 118, 127 n.3
(2014)). That settles it for us. Similar claims have been brought

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by doctors before, and we are bound by that precedent. See,
e.g., Glucksberg, 521 U.S. at 707.
Courts need not accept every would-be proxy. But two ter-
minally ill plaintiffs died during this litigation alone. That
underscores the practical barrier to direct patient suits and sat-
isfies whatever prudential considerations may matter here. Cf.
Powers v. Ohio, 499 U.S. 400, 414–15 (1991) (letting a crimi-
nal defendant raise the rights of African Americans struck from
a jury). So Bryman can challenge the law, asserting his patients’
rights to travel and access medical services.
II. THE A CT D OES N OT VIOLATE N ONRESIDENTS ’
P RIVILEGES AND IMMUNITIES
First is Bryman’s challenge under Article IV’s Privileges
and Immunities Clause. Whether we apply heightened scrutiny
turns on whether the Act’s residency requirement abridges a
fundamental privilege or immunity. That is doubtful. But even
if it does, the Act survives.
A. Bryman leans heavily on shaky ground
Bryman rests this claim largely on one case, Doe v. Bolton,
the lesser-known twin of Roe v. Wade. Doe, 410 U.S. 179
(1973); Roe, 410 U.S. 113 (1973), overruled by Dobbs v. Jack-
son Women’s Health Org., 597 U.S. 215 (2022). On the same
day that the Court decided Roe, it struck down Georgia’s abor-
tion restrictions in Doe. In passing, Doe said that the Privileges
and Immunities Clause protects people who travel to other
states for medical care, “[j]ust as [it] protects persons who enter
other States to ply their trade.” 410 U.S. at 200.

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Bryman highlights this language. But Doe barely sketches
the idea, and it did not have to at all. There was no out-of-state
plaintiff challenging Georgia’s law. Id. at 184–85.
On its own terms, Doe offers slim support. Post-Dobbs, its
support is even slimmer. Doe and Roe rose together, on the
same day, with Doe building on Roe’s newly announced right
to abortion. See Doe, 410 U.S. at 195. So overruling Roe
destroyed Doe’s foundation. That leaves Doe’s nod to the Priv-
ileges and Immunities Clause standing alone, if at all.
B. Out-of-staters do not get full privileges, but only
fundamental ones
Article IV’s Privileges and Immunities Clause protects only
a select set of traditional fundamental privileges, those “basic
to the maintenance or well-being of the Union.” Baldwin v.
Fish & Game Comm’n of Mont., 436 U.S. 371, 388 (1978).
Sometimes, it works together with the Equal Protection and
Commerce Clauses to protect a collection of rights associated
with the freedom of movement. See, e.g., Zobel v. Williams,
457 U.S. 55, 60 n.6 (1982); Edwards v. California, 314 U.S.
160, 173 (1941); Hicklin v. Orbeck, 437 U.S. 518, 525 (1978).
The Supreme Court has distilled three strands of those
rights to travel: (1) to enter and exit states; (2) to be treated as
a “welcome visitor” when temporarily in another state; and
(3) to migrate and be treated equally as a new resident. Saenz
v. Roe, 526 U.S. 489, 500 (1999).
Each strand rests on a different constitutional foundation.
This case implicates neither (1) entry or exit nor (3) migration.
Rather, Bryman invokes the second strand for “welcome

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visitor[s]” protected by the Privileges and Immunities Clause.
Saenz, 526 U.S. at 500–02. But visitors need not get all rights,
just a core set of traditional privileges.
The basic privileges include earning a living, using courts,
holding property, and paying equal taxes. Corfield v. Coryell,
6 F. Cas. 546, 551–52 (C.C.E.D. Pa. 1825) (Bushrod Washing-
ton, J.). Following Corfield, the Supreme Court has applied the
Clause mostly to economic privileges. See Toomer v. Witsell,
334 U.S. 385, 403 (1948) (commercial fishing licenses); Hick-
lin, 437 U.S. at 533–34 (employment preferences); S. Ct. of
N.H. v. Piper, 470 U.S. 274, 283 (1985) (bar admission). And
courts have resisted expanding the list. See, e.g., Baldwin, 436
U.S. at 388 (recreational hunting); McBurney v. Young, 569
U.S. 221, 226–27 (2013) (FOIA requests).
McBurney is especially instructive. Virginia limited its state
freedom-of-information act to Virginians. A Rhode Islander and
a Californian demanded the same access, but the Supreme
Court refused. Id. at 224. Because there was no longstanding
privilege of getting such information, it was not fundamental.
Id. at 232–34 (citing Corfield, 6 F. Cas. at 551).
The same is true here. There is no longstanding tradition of
doctor-assisted suicide. On the contrary, there is a centuries-
long tradition against it. That is why the Supreme Court rejected
it as a fundamental right. See Glucksberg, 521 U.S. at 710–19.
Glucksberg likewise dooms any claim that doctor-
assisted suicide is a traditional privilege. Whether a privilege
requires more historical support than a fundamental right or
less, this one—recognized in fewer than a quarter of the
states—has not “at all times[ ] been enjoyed by the citizens of

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the several states.” Corfield, 6 F. Cas. at 551. It is only “of rel-
atively recent vintage.” McBurney, 569 U.S. at 234.
Bryman asks us to reframe the privilege more broadly as
travelling to get general medical care. We are skeptical about
abstracting the claimed privilege to such a high level of gener-
ality. But even if we abstract it that much, Bryman’s support
remains thin. Though Doe appeared to recognize that privilege,
its analysis was cursory. 410 U.S. at 200. And it is the only
medical case involving visitors, not new residents. Still, Saenz
cites Doe approvingly, though only in passing. 526 U.S. at 502.
So for now, let us grant Bryman’s premise.
C. Even if Doe remains good law, the Act stands
Even if general medical care is a fundamental privilege and
doctor-assisted suicide counts as general medical care, New
Jersey’s Act survives scrutiny under the Privileges and Immun-
ities Clause.
When a law touches a fundamental privilege, courts scruti-
nize whether the law’s means fit its ends. Though we rarely do
so on a motion to dismiss, this is the rare case because we have
enough legislative facts to resolve the issue. To show that non-
residents are a “peculiar source of the evil” targeted by the law,
the state must show both a “substantial reason” to treat outsid-
ers differently and a “substantial relationship” between the dif-
ference in treatment and the state’s objective. Toomer, 334
U.S. at 398 (first quotation); Piper, 470 U.S. at 284 (second
and third quotations).
The means fit the ends. New Jersey has good reasons for its
residency requirement. First, it protects doctors. The Act

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shields doctors from criminal and civil liability in New Jersey.
N.J. Stat. Ann. § 26:16-17; Oral Arg Tr. 37:20–38:2 (making
this argument). But it cannot protect doctors from prosecution
in states where assisted suicide remains a crime. States retain
some authority to enforce their own criminal laws beyond their
borders. See United States v. Lee, 359 F.3d 194, 206 (3d Cir.
2004) (Alito, J.); e.g., 18 Pa. Cons. Stat. § 102(a); N.Y. Crim.
Proc. Law § 20.20(2). If New Jersey let nonresidents get pre-
scriptions for lethal pills and those nonresidents return home
with them, the other states could try to prosecute the doctors.
So the law aims to keep both patients and pills in-state.
Relatedly, the Act prevents friction among states. Some
states hold to the traditional bans on assisting suicide; New Jer-
sey does not. Cabining its policy preference in this morally
fraught area preserves interstate harmony. That is one of the
Constitution’s central goals. See, e.g., U.S. Const. pmbl. (set-
ting forth the aim of “insur[ing] domestic Tranquility”).
The Act also protects patients. It bans insurance companies
and other third parties from writing contracts that pressure
patients to follow through once they ask to die. § 26:16-14;
JA 62 (“The Act prohibits provisions in contracts, wills, insur-
ance policies …. That helps protect terminally ill New Jersey-
ans from undue influence…. [T]he State’s ability to guard
against undue pressures affecting terminally ill patients in
other jurisdictions is much more limited. The states’ police
powers to protect health and safety are matters of “local con-
cern,” directed toward the general welfare of their citizens.”)
(citations omitted). But New Jersey cannot police insurance
policies or malpractice claims made under other states’ laws,
so it cannot safeguard nonresidents from coercion as

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effectively. See Ginsberg ex rel. Ginsberg v. Quest Diagnos-
tics, Inc., 117 A.3d 200, 222 (N.J. App. Div. 2015) (explain-
ing that “[p]rofessionals and their patients have a reasonable
expectation that the laws of the state of licensure will govern
the licensee’s activities within the state where the services are
provided” and thus applying local law to medical malpractice);
Viking Pump, Inc. v. Century Indem. Co., 2 A.3d 76, 89 (Del.
Ch. 2009) (noting that, for insurance contracts, “Delaware
courts have applied the law of the jurisdiction that bears the
most significant relationship to the insurance coverage as a
whole”).
Although only these three justifications have been properly
raised and are apparent at this early stage, there may be others
as well. See Glucksberg, 521 U.S. at 730 (considering role of
mental health); §§ 26:16-6(a)(3)–(6), 8, 10(c) (requiring local
mental-health screenings for patients); Oral Arg. Tr. 36:20–
37:16.
In sum, New Jersey’s justifications are weighty, rooted in
real dangers of extending doctor-assisted suicide to nonresidents.
And its response is well tailored to further those justifications.
Even if it could have chosen a means narrower than excluding
all out-of-staters, the Privileges and Immunities Clause requires
only a “substantial relationship” between means and ends, not
a perfect one. Piper, 470 U.S. at 284. The Act satisfies that
standard.
III. T HE A CT C LEARS EQUAL -PROTECTION SCRUTINY
For these same reasons, the Act comports with the Equal
Protection Clause. Residency classifications are not inherently
suspect. See Hooper v. Bernalillo Cnty. Assessor, 472 U.S.

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612, 618 (1985). They trigger heightened scrutiny only if they
infringe on a fundamental right.
There is none here. Glucksberg foreclosed any right to die,
and Bryman knows it. 521 U.S. at 728; see also Vacco v. Quill,
521 U.S. 793, 799 (1997). He claims only a fundamental right
to interstate travel. But that right runs only as far as the Privi-
leges and Immunities Clause for the “welcome visitor.” Saenz,
526 U.S. at 501. So the privileges-and-immunities analysis
above disposes of that claim.
Thus, the Act faces only rational-basis review. Shielding
doctors from liability, preventing interstate friction, protecting
patients from insurers’ pressure, and preventing rash decisions
made in agony or depression are all legitimate governmental
interests, and the Act rationally furthers them.
IV. T HE A CT D OES N OT VIOLATE THE D ORMANT
C OMMERCE C LAUSE EITHER
The Constitution gives Congress, not states, the power to
regulate commerce among the states. U.S. Const. art. I, § 8,
cl. 3. When Congress is silent, the so-called dormant Com-
merce Clause blocks states from favoring their own busi-
nesses or interfering with their neighbors’ businesses. In other
words, it guards against economic protectionism. Nat’l Pork
Producers Council v. Ross, 598 U.S. 356, 369 (2023).
Laws that block the flow of goods or services or openly dis-
criminate against out-of-state businesses raise red flags. See
Hughes v. Oklahoma, 441 U.S. 322, 337 (1979) (limiting
exports); City of Philadelphia v. New Jersey, 437 U.S. 617,
628 (1978) (limiting imports); Granholm v. Heald, 544 U.S.

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460, 467 (2005) (favoring in-state over out-of-state wineries);
New England Power Co. v. New Hampshire, 455 U.S. 331, 338
(1982) (favoring in-state utility customers). Those laws must
be “narrowly tailored to advance a legitimate local purpose.”
Tenn. Wine & Spirits Retailers Ass’n v. Thomas, 588 U.S. 504,
518 (2019) (cleaned up). Only laws with no reasonable, non-
discriminatory alternative pass the test. Dean Milk Co. v. City
of Madison, 340 U.S. 349, 354–56 (1951).
Even neutral laws may be impermissibly protectionist if
they burden interstate markets by regulating in-state products.
Nat’l Pork, 598 U.S. at 377; Hunt v. Washington State Apple
Advert. Comm’n, 432 U.S. 333, 350–54 (1977); Gen. Motors
Corp. v. Tracy, 519 U.S. 278, 298 n.12 (1997). In those cases,
courts ask if the law serves a legitimate local interest and if the
burden on interstate commerce clearly outweighs the benefits.
Pike v. Bruce Church, Inc., 397 U.S. 137, 142 (1970).
The Pike balancing test aims to preserve legitimate state
health and safety regulations, even if the regulations spill
across state borders. Huron Portland Cement Co. v. City of
Detroit, 362 U.S. 440, 443–44 (1960). It bars laws only if they
“build up [a state’s] domestic commerce” by placing “unequal
and oppressive burdens upon the industry and business of other
States.” Guy v. City of Baltimore, 100 U.S. (10 Otto) 434, 443
(1879).
But we need not do means-ends analysis, because New Jer-
sey’s law does none of these things. This is primarily moral,
not commercial, legislation. And the case “quite literally …
[asks whether New Jersey] can deny out-of-state citizens a ben-
efit that it has conferred on its own citizens”—which fits under

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privileges and immunities. McBurney, 569 U.S. at 236; see
Toomer, 334 U.S. at 396–99 (commercial shrimping license
fees); Mem’l Hosp. v. Maricopa Cnty., 415 U.S. 250 (1974)
(striking down a residency requirement for free county medical
care).
Although Bryman tries to fit the case into the dormant Com-
merce Clause, that is not where it belongs. As the Supreme Court
has explained, the dormant Commerce Clause cannot remedy
these types of claims. McBurney, 596 U.S. at 235–36. So this
claim fails too.
* * * * *
In our federal system, states are free to experiment with pol-
icies as grave as letting doctors assist suicide. Other states are
free to keep it a crime. This novel option does not appear to be
a fundamental privilege, let alone a fundamental right, that
states must accord visitors. But even if we reframe it as one,
New Jersey has good reasons to limit it to New Jerseyans: pro-
tecting doctors from prosecution, preventing friction with other
states, guarding patients from coercion, and ensuring that their
decisions are rational and considered. We will thus affirm the
District Court’s dismissal.

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