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Medical Aid in Dying in the U.S.: Where It Is Legal and How It Works

Dying · 11 min read · First published 2006 · Updated November 2026

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Photo by Annie Spratt on Unsplash

If you or someone you know is struggling or in crisis, call or text 988 or chat at 988lifeline.org (Suicide & Crisis Lifeline, U.S.). Veterans: dial 988 and press 1. Outside the U.S., find a local line at findahelpline.com. If someone is in immediate danger, call 911.

Medical aid in dying lets an adult with a terminal illness, who is expected to live six months or less and who can make their own medical decisions, ask a clinician for a prescription they may choose to take themselves to end their life. It goes by several names, including medical aid in dying, death with dignity and physician-assisted death. Some people, including many who oppose it, call it assisted suicide. Some state laws, such as New York's, say that acting under the law is not suicide for legal purposes. It is different from euthanasia, because under these U.S. laws the person must take the medication themselves. No one else may give it to them.

As of November 2026, it is legal in 13 states and Washington, D.C. Laws in this area have changed often in recent years, so always check your own state's current law.

How it began: Oregon and the Supreme Court

Oregon was the first state to allow medical aid in dying. Its Death with Dignity Act was approved by voters in 1994 and took effect in 1997.

In 2001, then-Attorney General John Ashcroft issued a rule saying that helping a patient die was not a "legitimate medical purpose" for prescribing controlled drugs. Under that rule, Oregon doctors who wrote these prescriptions could have lost their federal license to prescribe. Oregon challenged the rule in court.

On January 17, 2006, the U.S. Supreme Court ruled 6-3 in Gonzales v. Oregon that the federal Controlled Substances Act does not give the Attorney General the power to stop doctors from prescribing medication for this purpose where state law allows it. Justice Kennedy wrote the majority opinion, joined by Justices Stevens, O'Connor, Souter, Ginsburg and Breyer. Justice Scalia wrote the main dissent, joined by Chief Justice Roberts and Justice Thomas, and Justice Thomas also wrote a dissent of his own. The ruling left Oregon's law in place and left the question to the states.

Oregon publishes a report on its law every year. In 2025, 637 people received prescriptions and 400 people died after taking the medication. From 1997 through 2025, 5,520 people received prescriptions and 3,691 died after taking the medication, so about two-thirds of the people who received a prescription died after taking it. Most had cancer (61% in 2025). Their median age was 76, and 92% were enrolled in hospice. The concerns people named most often were losing autonomy, being less able to enjoy life, and losing dignity.

| | | | | :-: | :-: | :-: | | State or district | Law | In effect since | | Oregon | Death with Dignity Act | 1997 | | Washington | Death with Dignity Act (approved by voters in 2008) | 2009 | | Montana | No statute. In Baxter v. Montana (December 31, 2009), the Montana Supreme Court ruled that a terminally ill patient's consent is a legal defense for a doctor charged with homicide for giving aid in dying. This is a court ruling, not a law passed by the legislature. | 2009 | | Vermont | Patient Choice and Control at End of Life Act (Act 39) | 2013 | | California | End of Life Option Act (made permanent in 2025) | 2016 | | Colorado | End of Life Options Act (approved by voters) | 2016 | | District of Columbia | Death with Dignity Act | 2017 | | Hawai'i | Our Care, Our Choice Act | 2019 | | New Jersey | Medical Aid in Dying for the Terminally Ill Act | 2019 | | Maine | Death with Dignity Act | 2019 | | New Mexico | Elizabeth Whitefield End of Life Options Act | 2021 | | Delaware | Ron Silverio/Heather Block End of Life Options Act | January 1, 2026 | | Illinois | End-of-Life Options for Terminally Ill Patients Act (Deb's Law) | September 12, 2026 | | New York | Medical Aid in Dying Act | August 5, 2026 |

Common safeguards

Each law is a little different, but most share the same basic safeguards. The person must:

  • Be an adult, 18 or older
  • Have a terminal illness that two clinicians agree is expected to lead to death within six months
  • Be able to make and communicate their own health care decisions
  • Ask for themselves, freely and without pressure. A family member, a health care agent or an advance directive cannot make the request for them.
  • Be able to take the medication themselves

And the law requires that:

  • The request be made both out loud and in writing, with the written request signed in front of witnesses. Laws limit who can be a witness, such as relatives or people who would inherit.
  • The doctor talk with the person about other options, including hospice, comfort care and pain control
  • The person be referred for a mental health evaluation if a clinician is concerned that depression or another condition is affecting their judgment. New York requires a mental health evaluation for everyone.
  • The person can change their mind at any time
  • No doctor, nurse, pharmacist or hospital has to take part. Many private facilities may choose not to.

These safeguards come from the state statutes. Montana has no statute, so they do not apply there in the same way.

Under New York's law, for example, age or disability alone does not make someone eligible.

Where the laws differ

Waiting periods. Many states have shortened their waiting periods in recent years, and several allow the wait to be waived when a person is not expected to live through it. For example, Oregon requires 15 days between the two spoken requests but waives it for people with less time than that. Washington and Colorado now require 7 days, California 48 hours and Hawai'i 5 days. Illinois requires 5 days between the two spoken requests. Maine's 15-day wait can be shortened by the doctor, as long as the total waiting time is at least 7 days. Vermont removed its 48-hour wait in 2022. Delaware requires 48 hours between the written request and when the medication can be dispensed. In New York, a prescription cannot be filled until 5 days after it is written, unless the person may die before then.

Who may prescribe. In most states it is a physician. Washington, Colorado, Hawai'i, Delaware and New Mexico also allow certain advanced practice nurses, and Washington and New Mexico allow physician assistants.

Residency. Oregon and Vermont dropped their residency requirements in 2023. Several states, including Delaware, Illinois, Maine, New Jersey, New Mexico, New York and the District of Columbia, require the person to live in the state. Check your own state's rules.

Laws are still changing

People hold deep and sincere views on medical aid in dying, and many faith traditions have spoken to it. For example, the Catholic Church teaches that cooperating in a suicide is against the moral law, and Orthodox, Conservative and Reform Jewish authorities have all upheld Jewish law's ban on euthanasia, though some Reform rabbis have recently questioned it. Others see these laws as a way to give dying people more choice and comfort at the end of life.

Because of that, the laws keep changing. A federal lawsuit against Delaware's law (Curran v. Meyer) was dismissed on December 30, 2025 because the plaintiffs lacked standing, and the plaintiffs appealed to the Third Circuit. As of June 2026 the appeal was still being briefed, and we found no ruling on it. Illinois' law, which took effect on September 12, 2026, faces several federal lawsuits. One, filed by disability-rights groups and others, argues that the law discriminates against people with disabilities, and the court denied a preliminary injunction on September 10, 2026 because the plaintiffs lacked standing. Others, filed by physicians, religious organizations and a pharmacist, challenge the law's requirements to inform patients about or refer them for medical aid in dying, and temporary orders now bar the state from enforcing those requirements against the named plaintiffs. In Washington, D.C., a bill introduced in Congress on January 22, 2026 (H.R. 7196) would bar the D.C. Council from permitting assisted suicide and would repeal the District's law. As far as we could find, it has not passed. Other states are debating new laws or changes.

If you are thinking about end-of-life choices

If you have a serious illness and are thinking about how you want the end of your life to go, you can talk openly with your doctor, your hospice or palliative care team, your family and your faith leader. Hospice and palliative care can ease pain and other symptoms and support your whole family. Hospice FAQs

If thoughts of ending your life come from pain, depression or despair, please reach out now. You deserve care and support.

If you or someone you know is struggling or in crisis, call or text 988 or chat at 988lifeline.org (Suicide & Crisis Lifeline, U.S.). Veterans: dial 988 and press 1. Outside the U.S., find a local line at findahelpline.com. If someone is in immediate danger, call 911.

Sources

Written by Words to Comfort

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