Discrimination by State.

If you're gay, you're better off in the Northeast, if you're terminally ill, you're better off in the Northwest. Or so the country stands now where predominantly Northeastern states allow same-sex marriage and Northwestern ones allow aid in dying.

That's the point John Crisp makes at ScrippsNews today:

A good friend is in the middle of a challenging battle with cancer. She reports lying in bed the other night after the lights were out and musing about whether, if she decided to leave her home state of Texas, she would choose a state that permits physician-assisted suicide or one that would allow her finally to marry her long-time, same-sex partner.

Unfortunately, no state in America allows both. For some reason, the states with progressive laws on physician-assisted suicide are in the northwest: Washington, Oregon, Montana. And the states that permit same-sex marriage are mostly in the northeast, like Massachusetts, New Hampshire, and Vermont. Texas isn't likely to permit either one anytime soon.

These two issues may not appear to have much in common, but both have an equally difficult time getting much traction in our country. Some states -- California and Maine, for example -- have made tentative moves toward permitting same-sex marriage and then pulled back, contributing to the frustration that gays and lesbians must feel as they try to gain a completely equal footing with heterosexuals in our culture.

Equality and laws that prevent discrimination against the dying or homosexuals seem to have a regional prevalence. But the issue is more complicated than regional flavor.

Because of Federalism, the autonomy afforded states to make their own laws by the US government, laws have often lingered in places with strong cultural prejudice toward minority groups. The most obvious example is the South and slavery. But other factors are at play with same-sex marriage and aid in dying.

Some state constitutions are more open to personal autonomy, like Montana's which the Supreme Court there ruled on New Years Eve did not prevent aid in dying.

Some states have a stronger religious foothold where everything from education to women's reproductive rights are kept in the last century to appease the powerful church organizations there.

Homosexuality is clearly more tolerated in urban areas, like the Northeast, where gays have gravitated from their rural homes or where living openly doesn't mean risking a lynching.

And a concentration of advocates can make a state more tolerant of their rights, like San Francisco.

While federalism works wonderfully for state-based issues like, say - and this is a stretch but the only two examples I can come up with - protecting local industries or tackling local environmental issues, it's a disaster for protecting minorities and the rights of those discriminated against.

The federal government can legislate laws that override state laws but the bill must specifically tackles such inequalities. Not all federal laws trump state laws. And the US Supreme Court can make case decisions that translate to compliance for all states but, as we've seen with abortion, states then can, under the influence of discriminatory groups there, work to mitigate such laws by limiting access.

Our constitution may claim that equality is guaranteed but cultural forces work tirelessly to maintain discriminatory practice in states where religious bias is strong and powerful. Changing the culture is no easy task but doing so is perhaps the only way to prevent federal court decisions from creating a backlash locally, as abortion did in the 70s and 80s all over the country, or civil rights legislation did in the South.

Would you move to a new state if it provided you more freedoms than the one you're in? Well, I'm in New York City these days and it's a city/state I chose because of tolerance and diversity. As our population becomes more mobile, less tied to home and family, and more urban, values migrate and discriminatory practices are ameliorated. I'd be a fool to suggest that the gutting of rural America is caused by a desire for greater tolerance of "non-traditional" lifestyles but that's certainly a factor in state cultures.

But that kind of movement is a privilege. Not everyone has the resources to pick up and go to a new place. If you're gay in rural Texas, best to keep your head down or get out. And that is the fallacy of US equality. Some states or regions are more equal than others.