A New Jersey law that permits terminally ill people to seek life-ending drugs applies only to residents of the state and not those from beyond its borders, a federal appeals court ruled.

The Philadelphia-based 3rd U.S. Circuit Court of Appeals rejected arguments challenging New Jersey's residency requirement while acknowledging how fraught end-of-life decisions can be. The court noted that not all states have adopted the same approach.

“Death brings good things to an end, but rarely neatly,” U.S. Circuit Court Judge Stephanos Bibas wrote in the Friday opinion. "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 residents make that choice—but only its residents."

In addition to New Jersey, the District of Columbia and 10 other states permit assisted suicide in terminal cases. The majority of states limit the option to its residents. Oregon and Vermont authorize it for everyone.

The case was brought by a Delaware woman with stage 4 lymphoma who wanted the option of doctor-assisted suicide and challenged the New Jersey residency requirement but died after oral arguments in the case. Delaware will begin to allow doctor-assisted suicide on Jan. 1.

A New Jersey doctor who sought to help patients like the Delaware woman also challenged the law. Initially, there were other plaintiffs, including a Pennsylvania woman who had metastatic breast cancer but who died before the appeal of a lower court's dismissal of the challenge, as well as another New Jersey doctor who has retired.

Messages seeking comment Wednesday were left with attorneys for the people challenging the law.

New Jersey Democratic Gov. Phil Murphy signed the legislation in 2019, saying that while his Catholic faith might lead him not to end his own life if he were terminally ill, he wouldn’t deny the choice to others.

The law requires two doctors to sign off on a request and that the terminally ill patient be deemed an adult resident of New Jersey who can make such a decision, who voluntarily expresses a wish to die and who has a prognosis of six months or fewer to live.

It requires patients to request the medication twice and says they must be given a chance to rescind their decision. At least one of the requests must be in writing and signed by two witnesses.

At least one witness cannot be a relative, entitled to any portion of the person’s estate, the owner of the health care facility where the patient is getting treatment or a worker there, or be the patient’s doctor.

Under the law, patients must administer the drug themselves, and their attending physician would be required to offer other treatment options, including palliative care.

A lower court dismissed the challengers' complaint, reasoning that doctor-assisted suicide is not a fundamental privilege states must afford to non-residents.

The appeals court agreed.

“In our federal system, states are free to experiment with policies as grave as letting doctors assist suicide. Other states are free to keep it a crime,” the opinion said. “This novel option does not appear to be a fundamental privilege, let alone a fundamental right, that states must accord visitors.”