West Virginia has narrowly approved a ballot question to constitutionally bar people from seeking medical help to end their own lives, while preserving the state’s power to kill convicted felons.

The race was not called until more than a week after Election Day, with 50.4% of the votes in favor of the constitutional amendment, which prohibitions “the practice of medically assisted suicide, euthanasia or mercy killing of a person”.

The prohibition applies both to the person trying to die and to any doctor or health care providers who support the effort. It does not prohibit palliative care or drugs that might be given to relieve pain and suffering, for example, doses of morphine given during hospice care. The ballot initiative explicitly preserves the state’s power to use capital punishment.

In either case, the change might be unnecessary. Assisted suicide is already illegal in West Virginia, and the death penalty was outlawed in the 1960s. However, if you’re going to lift one of these prohibitions into the state constitution, why explicitly exempt the other?

The main result of the election is to tie the hands of future West Virginia lawmakers. With the new constitutional amendment approved, state lawmakers will not be allowed to legalize physician-assisted suicide without first passing another constitutional amendment.

Physician-assisted suicide was already illegal in West Virginia, but the constitutional amendment placed on the ballot was a 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 to ban physician-assisted suicide, instead of legalizing it.

The ballot question was by far the most competitive statewide race in dark 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 state Senate.

That suggests the question of physician-assisted suicide crossed partisan lines for at least some voters — even if the West Virginia Republican Party officially approved a “yes” vote. on the problem.

Opponents of the ballot question said a constitutional ban on assisted suicide is 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 that includes a special exclusion to protect the death penalty. “Constitutions exist to protect individual liberties from government overreach,” the group said a statement about the voting initiative. “This amendment does the exact opposite.”

Unlike other culture war issues, the right to decide when to end one’s life has not (yet) been consumed by partisan politics. In a different state, or even a different election in West Virginia (given how close the results were), the result may be different.