Assisted death is a legal process in which a terminally ill person receives medication to end their life on their own terms. In the United States, it is currently authorized in 13 states and Washington, D.C., and the process follows a structured series of steps designed to confirm that the decision is voluntary, informed, and made by someone with a terminal prognosis of six months or less.
Two Distinct Forms of Assisted Death
The term “assisted death” covers two different practices. In medical aid in dying (sometimes called physician-assisted dying), a doctor prescribes a lethal medication that the patient takes themselves. The patient controls the entire act. In voluntary active euthanasia, a physician or other provider directly administers the drugs, typically through an IV. Euthanasia is legal in countries like Canada, Belgium, and the Netherlands, but not in the United States. Every U.S. state that permits assisted death requires the patient to self-administer the medication.
Who Qualifies
Eligibility requirements are consistent across U.S. jurisdictions. You must be an adult (18 or older), a resident of the state where you’re requesting the medication, and diagnosed with a terminal illness expected to cause death within six months. You must also have the mental capacity to make major medical decisions. If a physician has any concern that a psychiatric condition could be impairing your judgment, they are required to refer you to a licensed psychiatrist or psychologist for evaluation before proceeding.
There is one additional physical requirement that many people don’t initially realize: you must be able to take the medication yourself. Someone else can help you mix the powdered drugs into a liquid solution, but you have to be the one who ingests it, whether by drinking it, administering it through a feeding tube, or through a rectal catheter. Intravenous administration is not a legal option in any U.S. state. If you have a bowel obstruction or other condition that could prevent absorption, your doctor needs to assess whether a safe route exists before writing a prescription.
The Request Process
No one receives a prescription after a single conversation. U.S. laws require multiple requests spread over a waiting period. The general framework, established by Oregon’s 1994 law and adopted with variations by other states, works like this: you make two oral requests to your attending physician, separated by a mandatory waiting period (typically 15 days, though some states have shortened this). You also submit a written request signed in the presence of two adult witnesses.
Those witnesses cannot be relatives, anyone who stands to inherit from your estate, employees of the facility where you receive care, your healthcare proxy, or anyone acting under your power of attorney. They also cannot be your attending or consulting physician. These restrictions exist specifically to prevent coercion or undue influence.
After your attending physician confirms your eligibility and prognosis, a second, independent consulting physician must examine you and agree with the terminal diagnosis, the six-month prognosis, and your mental capacity. Only after both physicians sign off can a prescription be written.
What Physicians Can and Cannot Be Required to Do
No physician in the U.S. can be legally compelled to participate in assisted death. Doctors have a well-established right to conscientious objection, meaning they can decline to write the prescription if it conflicts with their ethical or religious beliefs. In practice, though, most physicians with personal objections are still willing to have the conversation. A survey of Colorado physicians found that only 13% of doctors with conscience-based barriers said they were “definitely not” willing to discuss the topic with a patient, and only 15% said they would refuse to provide a referral to another provider. So even if your own doctor declines, you are likely to be directed to someone who can help.
How the Medication Works
The specific drugs depend on the country and the form of assisted death. In the U.S., where patients self-administer, the medication comes as a powder that is mixed into a drinkable liquid. Earlier protocols relied on a single sedative in a large dose, but newer formulations use combinations of compounds that work together to induce deep unconsciousness and then stop breathing and heart function.
In Canada, where physicians administer the drugs intravenously, the standard protocol involves three medications given in sequence: first a sedative to relieve anxiety, then a large dose of an anesthetic to induce a deep coma, and finally a muscle-paralyzing agent that stops respiration. The process is highly standardized, with the Canadian medical guidelines specifying exact doses for each step.
For oral protocols used in the U.S., the timeline is less predictable. Data from Oregon shows that time from ingestion to death has ranged from as little as one minute to as long as 108 hours. About a third of recorded cases have taken longer than one hour, and roughly 8% have lasted more than six hours. Newer drug combinations introduced in recent years have been associated with longer times to death. The median time to death has roughly doubled since 2015, when experimental multi-drug cocktails replaced older single-drug protocols. This variability is something patients and families should be aware of when planning.
Cost and Insurance Coverage
The cost of the medication itself varies widely depending on your insurance situation. Among patients studied at one institution, copayments for those with private insurance coverage ranged from $2 to about $1,236. However, roughly two-thirds of patients in that group either paid cash or were enrolled in a federally funded plan (Medicare, Tricare, or similar) that did not cover the medication at all. Federal law prohibits the use of federal funds for assisted death, so if you’re on Medicare, you should expect to pay out of pocket for the drugs themselves. The clinical visits, consultations, and mental health evaluations leading up to the prescription may still be covered under your regular insurance.
Where It Is Legal in the U.S.
As of 2025, medical aid in dying is authorized in California, Colorado, Delaware, Hawaii, Illinois, Maine, Montana, New Jersey, New Mexico, New York, Oregon, Vermont, Washington, and Washington, D.C. Oregon was the first state to legalize the practice in 1994. The most recent additions are Delaware and Illinois (both 2025) and New York (2026). Montana’s legal status rests on a court ruling rather than a specific statute, which makes the process there less clearly defined than in other states. Approximately 20% of the U.S. population now lives in a jurisdiction where assisted death is legal.
Each state’s law follows the same general framework, but waiting periods, residency requirements, and specific procedural details vary. Some states have eliminated residency requirements in recent years after legal challenges, so it’s worth checking current rules for the specific state you’re considering.