Voters in West Virginia have passed a constitutional amendment banning assisted suicide

West Virginians narrowly approved a ballot question that would constitutionally ban people from seeking medical help to end their own lives — while preserving the state’s power to kill convicted criminals.

The race wasn’t called until more than a week after Election Day 50.4 percent of the votes in favor of the constitutional amendment, which prohibits “the practice of medically assisted suicide, euthanasia, or killing a person out of mercy.”

The ban applies to both the person trying to die and any doctors or caregivers who assist. It does not prohibit palliative care or the medications that can be dispensed to relieve pain and suffering, for example, doses of morphine administered during hospice care. The ballot initiative explicitly preserves the state’s power to administer the death penalty.

In both cases the amendment may be unnecessary. Assisted suicide is already illegal in West Virginia, and the death penalty was banned in the 1960s. But if you want to enshrine one of those bans in the state constitution, why explicitly exempt the other?

The most important outcome of the elections is tying the hands of future West Virginia lawmakers. Now that the newly approved constitutional amendment is in effect, state lawmakers will no longer be allowed to legalize physician-assisted suicide without first passing a new constitutional amendment.

Physician-assisted suicide was already illegal in West Virginia, but the constitutional amendment put to a vote there was in response to legalization efforts in other states. Oregon was the first state to legalize assisted suicide in 1997, and it is now legal in eight other states and Washington DC, through a combination of legislation and voting initiatives. This was the first time voters were asked whether they should ban physician-assisted suicide, rather than being asked to legalize it.

The ballot question was by far the most competitive race statewide in deep red West Virginia. President-elect Donald Trump won the state by 42 points, and Republican Senate candidate Jim Justice won by 41 points in the race to replace retiring Sen. Joe Manchin (D-W.Va.). Republicans also won the state’s gubernatorial race, both congressional races and supermajorities in the state House and Senate.

That suggests that the issue of physician-assisted suicide crossed party political lines for at least some voters — even as the Republican Party of West Virginia officially approved a “yes” vote about the issue.

Opponents of the ballot question said a constitutional ban on assisted suicide was unnecessary and an attack on the rights of West Virginians to die with dignity.

The West Virginia chapter of the American Civil Liberties Union (ACLU) highlighted the contradiction of a supposedly pro-life amendment, including a special exception to protect the death penalty. “Constitutions are there to protect individual freedoms from government overreach,” the group said a statement about the voting initiative. “This amendment does exactly the opposite.”

Unlike other hot-button culture war issues, the right to decide when to end your life has not (yet) been eaten up by partisan politics. In another state, or even in another election in West Virginia (given how close the results were), the outcome may be different.