When it began in the aftermath of Roe v. Wade, the March for Life turned the nation’s conscience toward the particular horror of abortion and the taking of human life that it entails. The four decades since have seen millions of deaths from abortion in the United States alone.

In each of those deaths, the world lost a unique and irreplaceable person.

Unfortunately, the loss of those lives to abortion is not the only casualty of Roe. Rather, the callous acceptance of — and, in some quarters, celebration of — the right to abortion has also planted the seeds for a broader disrespect for vulnerable human life.

Those seeds are now bearing bitter fruit in the way in which the lives of those who are disabled, ill and elderly are being treated in fact and in law.

The new legislative year brings the question of physician-assisted suicide to the legislative docket of several states, which will consider whether or not the lives of those who are ill, elderly or otherwise vulnerable should be protected or not.

Sadly, even the nation’s capital recently joined the small but growing number of jurisdictions that have answered that question with a resounding “no, those lives shouldn’t be protected.”

These legislative proposals that are brewing would allow physician-assisted suicide with such scant safeguards that they would be laughable if they were not tragic. However, the arguments in favor of these legislative initiatives have their roots directly in the soil of Roe.

They reflect Roe’s legacy that some lives are worth defending and others are not. In the context of abortion, an infant who is eagerly anticipated by loving parents is celebrated, fought for, and loved months before birth. Yet, a similar infant who is not so fortunate and who is not wanted is easily discarded as a matter of right.

In the context of those who are ill, those who have access to health care, a loving, supportive family, treatment for pain, and access to emotional and psychological care are encouraged to fight against deadly diseases.

However, those who are impoverished, who believe that they burden loved ones, or who are not well treated for physical and emotional pain, are given the opportunity to end their lives. In many cases, they are encouraged to do so by circumstances in which insurance may cover the costs of their suicide but not their medical treatment.

In the context of those with disabilities, a similar inconsistency reigns.

Nationally and internationally, advocacy groups celebrate the passage of legislation, the enactment of programs, and the funding of initiatives to enhance the lives of those who live with disabilities. Yet, these advantages apply only to those who have survived a prenatal diagnosis that indicated the presence of the disability.

Just when legal protections for those living with disabilities increases, the sad reality is that more advanced prenatal diagnosis techniques condemn many with disabilities to an early death. Stunningly few children with Down syndrome are born each year, and this is a result likely to be replicated as prenatal testing for other conditions increases rapidly.

Ironically, even some fierce pro-life advocates who would defend the lives of healthy infants have been willing to concede an exception for those children who will live with a disability.

They reflect Roe’s legacy that personal autonomy is to be valued at all costs — even over life itself.

The circumstances that may lead to an abortion are complex, often heart-breaking, and agonizingly difficult. The circumstances that may lead someone who is struggling with advanced illness, living with a painful disability, or suffering from the limitations brought on by age are also complex, often tragic, and frequently accompanied by an understandable despair.

Yet, the rhetoric of those who advocate for the end of life in these circumstances argues that the autonomy of the woman carrying the child or the suffering patient should be the value that prevails.

There is much to be said for autonomy, and in most circumstances it is a value to be cherished and protected in a nation that values freedom.

However, in the context of abortion, this autonomy does not take into account the autonomy of the child. It ignores the fact that what appears to be free choice is, all too often, a “choice” compelled or influenced by others — including the father of the child, the family of the woman, or the circumstances of the pregnancy.

In the context of those who are ill or elderly, the celebration of personal autonomy in a decision to end life does not take into account the financial pressures that often drive that decision or the overwhelming desire not to burden others that leads to the ending of life.

Contrary to common perception, it is not physical pain that drives the decision to take advantage of physician-assisted suicide. It is fear of being a burden or losing autonomy that tops the list. More importantly, an exaggerated sense of personal autonomy belies the fact that the individual is not the only one with an interest in his or her life.

Autonomy notwithstanding, the world is the poorer for all those who have not been born. The world is the poorer when those who are not young and strong are devalued. And the world is at risk when autonomy is allowed to justify the taking of life. Indeed, autonomy is often restricted when far lesser things are at stake than life itself.

They reflect Roe’s legacy that legal requirements, procedural protections, and seemingly detailed guidelines can legitimize acts that, for the vast majority of human history, were recognized as wrong. Perhaps they reflect the way in which Roe can dull the conscience into believing that legality can create legitimacy and that a society can satisfy itself that there can be a regulated, rational way to do a wrongful act.

Abortion statutes split hairs over the meaning of a partial birth abortion and assisted suicide statutes feign certainty about the disinterestedness of witnesses or the absence of depression. Yet, the veneer of legality in both cases belies the fact that the underlying and irreversible acts that they facilitate raise grave moral concerns.

Roe’s legacy of devaluing unwanted human lives, misconstruing autonomy, and dulling the conscience with legalisms is one that has left four decades of lost lives in its wake.

However, it has also laid the groundwork for more tragedies to come.

Lucia Silecchia is a professor of law at The Catholic University of America Columbus School of Law, specializing in elder law, ethics, and Catholic social thought.