The Reproductive Justice Movement: A Model for a More Inclusive Movement to Improve End-of-Life Options

I am a member—and critic—of the right-to-die movement, which seeks to expand access to assisted dying for people facing incurable, unbearable suffering. Much of my background is in abortion activism. In the 1960s and early 1970s, the mainstream pro-choice movement was led by middle-class White women and focused on the single issue of abortion.

By the early 1990s, women of color, through the Reproductive Justice (RJ) movement, were pushing mainstream pro-choice groups to understand that “choice” must mean not only the choice to have an abortion but also the choice to conceive, carry and raise children in safe, healthy, culturally-appropriate environments.  

Today, the right-to-die movement is led mostly by middle-class White people and focuses primarily on legalizing access to physician aid in dying for terminally ill, mentally competent adults. Applying lessons from the RJ movement to the right-to-die movement might mean understanding that “choice” at the end of life includes not only the choice to hasten death but also the choice to live and die according to one’s values and with better medical, social, financial, and environmental supports for the ill or frail elderly and their caregivers.  

The RJ movement was created in the U.S. to advance and protect reproductive freedom for diverse women by incorporating a core commitment to human rights and addressing medical, social, economic, and racial and ethnic injustices that limit many U.S. women’s reproductive choices. The RJ movement is informed by injustices that include slavery and its legacy, the colonization and even genocide of indigenous people, and the widespread and longstanding adoption of eugenic programs and practices. By developing a movement that insists women should have access to abortion and that the context in which women make the abortion decision should be informed by this history and include better options now, the RJ movement promotes women’s ability to self-determine their own lives.  

The U.S. right-to-die movement could do the same. It could acknowledge America’s historical population control effortsand it could explicitly prioritize a commitment to guard against population control activities. Similarly, it could address America’s unique status among the developed countries where aid in dying is legal in any jurisdiction as the only nation without universal health care, the nation with the highest poverty rate, and the nation with the weakest social safety net. And, it could seek out opportunities to work in coalition with groups acting to improve end-of-life supports for diverse individuals (and their caregivers) whether or not they want assisted dying. 

The RJ movement teaches the importance of having a broad, diverse group of people at the table when setting the agenda for a movement. Today’s right-to-die movement focuses on legalizing medical aid in dying. I support this agenda but I also see it as limited in some of the same ways the mainstream pro-choice movement was limited before the RJ movement emerged.  Could a broad end-of-life movement, informed by the RJ movement, evolve in the U.S?  

To explore these issues, I interviewed veteran abortion and RJ activists about their perspectives on the right to die. Interviewees were in their 60s, 70s, and 80s and lived across the country in urban and rural environments. Half were women of color (African American, Puerto Rican, Native American, Korean American, Native Hawaiian). None of the women I interviewed opposed legalizing aid in dying, provided some safeguards were in place. They did not generally see dying as a “women’s issue,” but they acknowledged that women’s longer life span, higher poverty rate, and cultural role as care givers might make the end of life—whether as the dying person or the caregiver to a dying person—a gendered experience. All interviewees believed that end-of-life issues are important. Some prioritized access to assisted dying as a key concern, while others were more interested in related issues such as increasing the availability of culturally-appropriate assisted living and nursing home facilities or expanding supports for in-home care for elders and their families. 

NWHN has a history of being before its time in terms of raising issues that may not, at first, seem to be “women’s issues.” In 2003, long before the passage of the Affordable Care ActNWHN prioritized affordable, accessible, quality health care for all as one of its top three goals. “Health care for all” applies not just to womenbut to everyone. In 2007, the NWHN partnered with the Black Women’s Health Imperative and the MergerWatch Project to create “Raising Women’s Voices for the Health Care we Need” (RWV). RWV was, and continues to be, based on the idea that “women are grassroots experts in what is wrong with the current health system and what it takes to fix it because of our roles as arrangers of health care for our families. As Baby Boomers continue to age, either our own potentially gendered experience of dying or our role as caregivers might, to quote RWV, make women “grassroots experts” on what is needed in an inclusive end-of-life movement.  

Ninia Baehr wrote her Ph.D. dissertation on what the right-to-die movement could learn from the U.S. abortion and RJ movements. She served as a board member for NWHN for 8 years and currently works as a hospice nurse.