Physician-assisted death is legal in more than a dozen countries and a growing number of sub-national jurisdictions. The list has expanded rapidly since 2020, with new laws taking effect in Spain, Portugal, Australia, Ecuador, and New Zealand, joining longstanding frameworks in the Netherlands, Belgium, Switzerland, Canada, and parts of the United States. The specific rules, eligibility criteria, and terminology vary widely from place to place.
The Netherlands, Belgium, and Luxembourg
The Netherlands and Belgium were the first countries to formally legalize euthanasia, both passing laws in 2002. Luxembourg followed in 2009. All three allow a physician to directly administer a lethal substance (euthanasia) as well as prescribe one for the patient to take themselves (assisted suicide).
Eligibility criteria in the Netherlands require that a person’s suffering be unbearable with no prospect of improvement, that no reasonable treatment alternative exists, and that the request be voluntary and well-considered. Multiple physicians must confirm these conditions are met. Belgium’s criteria are similar but with one notable difference: minors can request euthanasia in cases of terminal physical illness, making Belgium the only country in the world with no minimum age requirement. Both countries allow access for people with psychiatric conditions as the sole diagnosis, though the review process in those cases is more extensive. Belgium and the Netherlands both require a one-month waiting period between the written request and the procedure.
Switzerland’s Unique Model
Switzerland occupies a distinctive position. Euthanasia (where a doctor administers the substance) is illegal. But assisted suicide has been permitted since the adoption of Article 115 of the Swiss penal code, which treats assisting a suicide as a crime only when the motive is selfish. Altruistic assistance is legal, and unusually, it does not need to be performed by a physician.
This legal framework has given rise to organizations like Dignitas and Exit, which help both Swiss residents and foreigners access assisted suicide. Switzerland is the only country that routinely accepts non-residents for assisted dying, which has led to the phenomenon sometimes called “suicide tourism.” There is no specific medical eligibility written into the penal code itself. Instead, the right-to-die organizations apply their own criteria, typically requiring evidence of a serious illness or unbearable suffering.
Canada
Canada legalized Medical Assistance in Dying (MAID) in 2016 and has since expanded access significantly. Initially limited to people whose natural death was reasonably foreseeable, a 2021 amendment removed that requirement. You no longer need a terminal diagnosis to be eligible.
Current eligibility requires that you be at least 18, mentally competent, and have a grievous and irremediable medical condition. That means a serious illness, disease, or disability in an advanced and irreversible state of decline, causing unbearable physical or mental suffering that cannot be relieved under conditions you find acceptable. The request must be voluntary, and you must give informed consent.
One significant restriction remains: if your only medical condition is a mental illness, you are not currently eligible. That exclusion has been extended multiple times and is now set to remain in place until at least March 2027. If you have a mental illness alongside another qualifying condition, eligibility is assessed on a case-by-case basis.
Australia
Australia has moved remarkably fast. Victoria became the first state to pass voluntary assisted dying legislation in 2017, with the law taking effect in June 2019. Within five years, every Australian state followed: Western Australia in 2021, Tasmania in October 2022, Queensland and South Australia in January 2023, and New South Wales in late 2023. By the end of 2023, assisted dying was operational in all six states for the first time in the country’s history.
The federal government also restored the right of the Northern Territory and the Australian Capital Territory to pass their own assisted dying laws in December 2022, reversing a 25-year ban. Those territories have not yet enacted their own legislation but now have the power to do so. Eligibility criteria vary somewhat between states, but all require a terminal diagnosis, decision-making capacity, and a voluntary request free from external pressure.
Other European Countries
Spain legalized euthanasia and assisted suicide in 2021, becoming the fourth European country (after the Netherlands, Belgium, and Luxembourg) to do so. Access requires a serious and incurable disease or a chronic, debilitating condition that causes intolerable suffering.
Portugal’s law decriminalizing euthanasia and physician-assisted suicide took effect in July 2023, after several years of legislative attempts and presidential vetoes. Doctors and other medical professionals can decline to participate on moral or religious grounds, similar to the conscience protections in Portugal’s abortion law.
Germany’s situation is more complex. In February 2020, the country’s Constitutional Court struck down a law that had criminalized providing assisted suicide as a regular service, ruling it unconstitutional. This effectively made assisted suicide legally permissible, but Germany has not passed new legislation to regulate it. The result is a legal gray area. Two German physicians were convicted of manslaughter in 2024 for assisting patients’ suicides, with courts finding that the patients were not competent to make the decision freely at the time. The Constitutional Court has said lawmakers have broad options for regulating assisted suicide, including criminal law measures, as long as the practice remains realistically accessible.
Austria’s Constitutional Court issued a similar ruling shortly after Germany’s in 2020, and Austria subsequently passed legislation in 2022 permitting assisted suicide under regulated conditions.
Latin America
Colombia was one of the first countries in the world to decriminalize euthanasia, through a Constitutional Court ruling in 1997, though implementing regulations took many more years to develop. The practice is available to people with terminal illnesses who are experiencing intense suffering.
Ecuador decriminalized euthanasia for all citizens in February 2024, making it only the second Latin American country to do so. The details of implementation are still developing.
New Zealand
New Zealand’s End of Life Choice Act took effect in November 2021, following a binding public referendum in which 65% of voters supported the law. Eligibility is limited to adults with a terminal illness likely to end their life within six months, who are experiencing unbearable suffering that cannot be eased, and who can make an informed decision.
United States
There is no federal law on assisted dying in the United States. Instead, individual states have passed their own legislation, and only physician-assisted suicide (where the patient self-administers the medication) is permitted. No U.S. state allows euthanasia.
Oregon was the first, passing its Death with Dignity Act in 1997. Data from 2023 shows 560 people received prescriptions under the law that year, and 367 people died from ingesting the medication. About 60% of those who receive prescriptions ultimately use them. The most common underlying condition was cancer (66%), followed by neurological disease (11%) and heart disease (10%).
As of early 2025, assisted dying laws are in effect in Oregon, Washington, Vermont, California, Colorado, Hawaii, New Jersey, Maine, New Mexico, and the District of Columbia. Montana permits it through a court ruling rather than legislation. Several other states have considered bills in recent legislative sessions.
All U.S. states with assisted dying laws require a terminal diagnosis with a prognosis of six months or fewer, though some states have relaxed residency requirements in recent years after legal challenges.
How Eligibility Criteria Compare
The biggest dividing line globally is whether you must have a terminal illness. The United States, Australia, and New Zealand all require a terminal diagnosis. Canada, the Netherlands, Belgium, and Colombia do not, instead focusing on whether suffering is unbearable and irremediable, regardless of life expectancy.
- Terminal illness required: United States, Australia, New Zealand
- Terminal illness not required: Canada, Netherlands, Belgium, Luxembourg, Spain
- Psychiatric suffering alone can qualify: Netherlands, Belgium
- Non-residents accepted: Switzerland (through right-to-die organizations)
- Non-physicians can assist: Switzerland
Nearly all jurisdictions require that the person be an adult, mentally competent, and making a voluntary request free from coercion. Most require assessment by at least two physicians and a waiting period between the initial request and the procedure. Belgium is the sole exception on age, allowing minors to request euthanasia in limited circumstances. Switzerland is the sole exception on physician involvement, permitting non-medical individuals to assist in a suicide as long as their motives are not selfish.