When opponents of medical aid in dying talk about creating “national safeguards,” that is code for crafting regulatory roadblocks to deny terminally ill adults access to this end-of-life option. The Washington, D.C., legislation catapulted medical aid in dying onto the federal agenda at a time when Congress may have the will to criminalize the practice. Such legislation would invalidate laws not only in California and the District of Columbia, but in Colorado, Montana, Oregon, Vermont, and Washington. These seven jurisdictions collectively comprise 18 percent of our nation’s population. Heavy-handed federal action, either by Congress or the judiciary, would also halt consideration of medical aid in dying in 24 states where such legislation has been introduced since January .