Death with Dignity Laws: What They Actually Say

In 1997, Oregon became the first state in the United States to legalize medical aid in dying. The law passed by a margin of 51% to 49%, survived a repeal attempt, and has been in effect for nearly 30 years. In that time, approximately 4,000 Oregonians have used it.

Today, medical aid in dying is authorized in 13 states and Washington, DC (two of the newest laws take effect later in 2026). It is one of the most politically contentious end-of-life issues in America, and also one of the most misunderstood. Here is what the laws actually say.

Most states require the patient to be a resident. Two do not. 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 It was the first state to do so.^[8] Oregon followed on July 13, 2023, when Governor Tina Kotek signed HB 2279, which repealed the residency restriction in the Death with Dignity Act.^[9]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 does not 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 is also slow, expensive, and physically demanding for someone who is dying. Plan for weeks, not days.

As of July 2026, thirteen states and Washington, DC have authorized medical aid in dying.^[4] Authorized is not the same as available. Two of the newest laws are signed but not yet in effect. Here is 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 takes effect in September 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 takes effect August 5, 2026.^[7]
• Oregon (1994)
• Vermont (2013)
• Washington (2008)
• Washington, DC (2016)

The practical version: if you are reading this in July 2026, a qualifying patient can use the law today in eleven states and DC. New York's law becomes usable on August 5, 2026, and Illinois follows in September 2026. Until those dates, a terminally ill person in Albany or Chicago has no legal access at home.

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 is 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 July 2026, thirteen states and Washington, DC have authorized medical aid in dying. The complete list, with each jurisdiction's year and the two effective dates still ahead, is in the next section.

Montana's status is unique: a 2009 state Supreme Court ruling found that physicians who assist in dying cannot be prosecuted under existing law, but there is no statute explicitly authorizing the practice. This creates legal ambiguity that has not 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
• Be mentally competent. Able to make and communicate healthcare decisions
• 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 has not made an impulsive decision under temporary distress.

Notably, mental illness alone does not 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 is 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.

Religious opposition is the most prominent. The Catholic Church, many evangelical Protestant denominations, and Orthodox Jewish and Muslim authorities oppose MAID on the grounds that life is sacred and that only God has the authority to end it.

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 has historically opposed MAID but softened its position in 2019 to "engaged neutrality." Individual physicians vary widely in their willingness to participate.

Proponents argue that MAID is a matter of personal autonomy, that competent adults should have the right to choose how they die, and that the evidence from Oregon and other states shows that the safeguards work and that abuse has not occurred at the scale opponents predicted.

MAID is not suicide in the traditional sense. Most states explicitly exclude MAID from the legal definition of suicide, and most insurance policies do not treat MAID as suicide for purposes of benefit exclusions.

MAID is not euthanasia. The patient must self-administer. The physician provides the means; the patient makes the final act.

MAID is not 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 are not sufficient.

If you are 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 are in a state where it is not legal, palliative care and hospice remain powerful options for managing end-of-life suffering.