Assisted suicide is the practice of a physician providing a terminally ill patient with lethal medication that the patient takes themselves to end their life. The key distinction is that the patient performs the final act. A doctor prescribes the medication, but the patient decides when and whether to take it. In the United States, the more common legal and clinical term is “medical aid in dying,” and 11 states plus Washington, D.C. currently authorize it, with New York on track to become the 12th after both legislative chambers passed a medical aid in dying bill in 2025.
How It Differs From Euthanasia
“Assisted dying” is a broad umbrella that covers two distinct practices. In physician-assisted dying, a doctor prescribes a lethal dose of medication, and the patient takes it on their own. In voluntary active euthanasia, a physician or other third party directly administers the medication that causes death. The difference comes down to who performs the final act: the patient or the provider.
This distinction matters legally. In the United States, only physician-assisted dying is permitted in states that have authorized it. Euthanasia, where a doctor administers the lethal drug directly, remains illegal throughout the country. By contrast, countries like the Netherlands, Belgium, Canada, Spain, and New Zealand allow euthanasia alongside or instead of self-administered options. Switzerland and Austria permit assisted dying but not euthanasia, similar to the U.S. model.
Who Qualifies
In U.S. states where medical aid in dying is legal, the eligibility requirements are consistent. You must be 18 or older, a resident of the state, and diagnosed with a terminal illness that two physicians confirm will result in death within six months. You must have the mental capacity to make an informed decision, be acting voluntarily, and be physically able to take the medication yourself. Self-administration means an affirmative, conscious act: without the patient’s own action, the medication would not be received.
If either physician has any doubt about a patient’s decision-making capacity, a psychiatric or psychological evaluation is required. In Hawaii, that evaluation is mandatory for every person who pursues the option, regardless of whether concerns exist. After all visits and evaluations are completed, the patient must provide a written statement, witnessed by another person, confirming their decision.
One challenge clinicians call the “five to midnight problem” arises when a patient’s condition deteriorates faster than expected. Someone with a rapidly progressing disease or a neurodegenerative illness may lose the cognitive or physical ability to take the medication before they’re ready to use it. At that point, they no longer qualify, because self-administration is no longer possible.
Built-In Safeguards
Laws authorizing assisted dying include multiple layers of protection against misuse. International best practices, such as those in Australia’s Victoria and Western Australia, require a minimum of three separate requests. First, the patient makes a formal verbal request to a physician. After a mandatory reflection period, a second written request must be submitted, signed and witnessed by two independent individuals who have no financial or personal interest in the patient’s decision. A third and final request is required before the prescription is issued, confirming the patient still wants to proceed.
Mandatory waiting periods between each request, typically seven to fourteen days, give patients time to reconsider and allow physicians to reassess the medical situation. These cooling-off periods are designed to ensure the decision is sustained and deliberate, not impulsive.
What Oregon’s Data Shows
Oregon, the first U.S. state to legalize the practice with its 1997 Death with Dignity Act, provides the longest-running data on how medical aid in dying works in practice. In 2024, 607 people received prescriptions under the law. Of those, 376 died from ingesting the medication. The gap between those numbers is significant: roughly 38% of people who obtained a prescription did not use it that year. For many patients, simply having the option provides a sense of control, even if they ultimately choose not to take the medication.
The reasons patients give for seeking the option are not primarily about pain. The three most frequently reported concerns in 2024 were loss of autonomy (89%), decreasing ability to participate in activities that made life enjoyable (88%), and loss of dignity (64%). These numbers have been consistent for years, suggesting the decision is driven more by the experience of losing independence than by physical suffering alone.
How It Relates to Hospice and Palliative Care
Assisted dying and palliative care are not opposing choices. Research across Canada, the U.S., and several European countries shows that 74% to 88% of people who opt for assisted dying also receive hospice or palliative care services. In Belgium, where both euthanasia and palliative care have developed alongside each other, 71% of individuals who requested euthanasia were already involved with palliative care, and palliative care professionals participated in decision-making or the procedure itself in 60% of cases.
Some jurisdictions have adopted what’s called an “integral palliative care” model, where conventional end-of-life care includes the option of assisted dying rather than treating it as a separate track. In home-based palliative care settings in Toronto, teams have successfully integrated the practice by allowing individual physicians to choose their level of involvement. Some participate in all aspects, others only conduct assessments, and others opt out entirely. This approach accommodates the range of views within the medical profession while still giving patients access.
The Medical Profession’s Stance
The American Medical Association officially opposes physician-assisted suicide, a position it has maintained for years. But the AMA’s own language acknowledges the complexity: it states that “thoughtful, morally admirable individuals” hold deeply considered perspectives on both sides. The organization also clarifies that individual physicians who, after careful moral consideration, legally participate in the practice have not violated the AMA’s Code of Medical Ethics.
Both supporters and opponents share core commitments to care, compassion, respect, and dignity. They simply draw different moral conclusions from those values. Supporters emphasize patient autonomy and the relief of suffering as central goals of medicine, particularly at the end of life. Opponents point to the physician’s traditional role as healer and raise concerns about the difficulty of controlling such practices once permitted. The AMA considers euthanasia, as distinct from patient-administered assisted dying, to be “fundamentally incompatible with the physician’s role as healer.”
Where It’s Legal Now
In the United States, medical aid in dying is authorized in 11 states (Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, New Jersey, Maine, Delaware, and New Mexico) plus Washington, D.C. Oregon was the first, passing its law in 1997. Montana’s authorization came through a 2009 court ruling rather than legislation. New York’s legislature passed a medical aid in dying bill in 2025, and if the governor signs it, New York will become the 12th state.
Globally, euthanasia is legal in twelve jurisdictions: the Netherlands, Belgium, Luxembourg, Colombia, Canada, New Zealand, five Australian states, and Spain. Physician-assisted dying without the euthanasia option is practiced in Switzerland, Austria, and the U.S. jurisdictions listed above. The trend over the past decade has been toward expansion, with more countries and states adopting some form of legal framework each year.