Death with Dignity Laws: What They Actually Say

Oregon voters approved the first medical aid in dying law in the United States in 1994, by 51% to 49%. The law survived a repeal attempt, took effect in 1997, and has been in use for nearly 30 years.^[10] Through 2025, 5,520 people had received prescriptions under it and 3,691 had died using them.^[2]

Today, medical aid in dying is authorized in 13 states and Washington, DC (the newest law, in Illinois, took effect on September 12, 2026). It’s one of the most politically contentious end-of-life issues in America, and also one of the most misunderstood. Here’s what the laws actually say.

Most states require the patient to be a resident. Two don’t. Vermont removed its residency requirement on May 2, 2023, when Governor Phil Scott signed H.190. It was the first state to do so.^[8] Oregon followed on July 13, 2023, when Governor Tina Kotek signed HB 2279, which repealed the residency restriction in the Death with Dignity Act.^[9]

Removing residency doesn’t remove the rest of the law. A non-resident who goes to Vermont or Oregon still needs the terminal diagnosis, the two physicians, the repeated requests, and the waiting period, and the medical care must happen inside that state. The trip is legal. It’s also slow, expensive, and physically demanding for someone who is dying. Plan for weeks, not days.

As of October 2026, thirteen states and Washington, DC have authorized medical aid in dying.^[1][4] The newest law, in Illinois, took effect on September 12, 2026.^[6] Here’s the full list, with the year each jurisdiction acted:

• California (2015)
• Colorado (2016)
• Delaware (2025). The Ron Silverio and Heather Block End-of-Life Options Act was signed May 20, 2025 and took effect January 1, 2026.^[5]
• Hawaii (2018)
• Illinois (2025). Governor JB Pritzker signed SB 1950, the End-of-Life Options for Terminally Ill Patients Act, known as Deb's Law, on December 12, 2025. It took effect on September 12, 2026.^[6]
• Maine (2019)
• Montana (2009). Court ruling only. No statute.
• New Jersey (2019)
• New Mexico (2021)
• New York (2026). Governor Kathy Hochul signed the Medical Aid in Dying Act on February 6, 2026. It took effect August 5, 2026.^[7][12]
• Oregon (1994)
• Vermont (2013)
• Washington (2008)
• Washington, DC (2016)

The practical version: a qualifying patient can use the law today in all thirteen states and DC. New York's law took effect August 5, 2026, and Illinois's Deb's Law took effect September 12, 2026.

Medical aid in dying (MAID), also called physician-assisted death, death with dignity, or aid in dying, is a process by which a terminally ill person can request a prescription for medication that they can self-administer to end their life.

This is distinct from euthanasia, in which a physician administers the lethal medication. In every state where MAID is legal in the United States, the patient must self-administer. The physician provides the prescription; the patient takes the medication themselves.

It’s also distinct from palliative sedation, which is the practice of sedating a dying patient to relieve suffering, and from withdrawing life-sustaining treatment, which is the patient's legal right in 50 states and Washington DC. For patients who want to document their end-of-life care preferences, an advance directive is the legal instrument that communicates those wishes.

As of October 2026, thirteen states and Washington, DC have authorized medical aid in dying. The complete list, with each jurisdiction's year, is in the section above.

Montana's status is unique: a 2009 state Supreme Court ruling found that physicians who assist in dying can’t be prosecuted under existing law, but there’s no statute explicitly authorizing the practice. This creates legal ambiguity that hasn’t been resolved.

Bills keep being introduced in other states each session. The trend is toward expansion, though progress is slow and opposition is significant.

The eligibility requirements for MAID are strict and consistent across states. To qualify, a person must generally:

• Be an adult (18 or older) and a resident of the state (Oregon and Vermont no longer require residency; see the residency section below)
• Have a terminal illness with a prognosis of six months or less to live, as certified by two physicians
• Have decision-making capacity. Be able to understand and communicate a healthcare decision
• Make two oral requests, separated by a waiting period (typically 15 days, though some states have reduced this)
• Submit a written request signed by two witnesses
• Be capable of self-administering the medication

These requirements are designed to prevent abuse and ensure that the decision is voluntary, informed, and considered. The waiting periods and multiple requests are specifically intended to ensure that the person hasn’t made an impulsive decision under temporary distress.

Notably, mental illness alone doesn’t qualify a person for MAID in any U.S. state. This is a significant distinction from some European countries, where the criteria are broader.

The process typically takes several weeks to months from initial request to prescription. Here’s the general sequence:

The patient makes an initial oral request to their attending physician. The physician must confirm that the patient meets the eligibility criteria, including the terminal diagnosis and mental competency. A second physician must independently confirm the diagnosis and competency.

The patient makes a second oral request after the required waiting period. They then submit a written request signed by two witnesses, neither of whom can be a family member, heir, or healthcare provider.

The physician writes a prescription for the medication. Typically a combination of drugs that cause unconsciousness and then cardiac arrest. The patient fills the prescription at a pharmacy and takes it home. They can choose when, or whether, to use it.

Research consistently finds that a significant percentage of people who obtain the prescription never use it. For many, simply having the option, knowing that they have control over how they die, provides enough comfort that they choose to let the illness run its course.

Opposition to MAID comes from several directions.

Some religious authorities oppose MAID based on teachings about the sanctity of life and who may decide when life ends. Positions differ within and across Catholic, Protestant, Jewish, Muslim, and other religious communities.

Disability rights advocates have raised concerns that MAID laws create a system in which some lives are deemed less worth living. And that this could lead to pressure on disabled people to choose death rather than be a "burden." Organizations including Not Dead Yet have been among the most vocal opponents of MAID expansion.

Medical professional organizations are divided. The American Medical Association's Code of Medical Ethics opposes physician participation, says its position isn't neutral, and also says a physician who takes part legally after due moral consideration hasn't violated the Code.^[11] Few physicians take part. A 2016 JAMA review found that fewer than 1% of licensed physicians in Oregon and Washington write these prescriptions in a given year.^[3]

Proponents describe medical aid in dying as an autonomy issue for eligible adults with terminal illness. Opponents, including some disability advocates, raise concerns about prognosis uncertainty, unequal access to palliative and home care, dependency, coercion, and whether safeguards can identify every risk. Disabled people and disability organizations hold differing views. State statutes control eligibility, insurance treatment, required reporting, and death-certificate language.

MAID isn’t suicide. Most states explicitly exclude MAID from the legal definition of suicide, and most insurance policies don’t treat MAID as suicide for purposes of benefit exclusions.

MAID isn’t euthanasia. The patient must self-administer. The physician provides the means; the patient makes the final act.

MAID isn’t a substitute for good palliative care. Advocates for MAID consistently emphasize that it should be one option among many. That good hospice and palliative care should be available to everyone, and that MAID is for the relatively small number of people for whom those options aren’t sufficient.

If you’re in a state where MAID is legal and want to know more about the process, the Death with Dignity National Center maintains a comprehensive resource at deathwithdignity.org. If you’re in a state where it isn’t legal, palliative care and hospice can still do a lot to manage end-of-life suffering.