Physician-assisted death is legal in a growing number of U.S. states, but there is no federal law that either permits or prohibits it. As of 2025, eleven jurisdictions allow the practice, each under its own state law. The U.S. Supreme Court ruled in 1997 that there is no constitutional right to assisted death, leaving every state free to permit or ban it as it chooses.
Where It Is Legal
Oregon was the first state to legalize the practice when it passed the Death with Dignity Act in 1997. Since then, the following jurisdictions have enacted similar laws: Washington, Vermont, Montana, California, Colorado, Hawaii, Maine, New Jersey, New Mexico, and the District of Columbia. Montana’s legal status is distinct from the others because it rests on a 2009 state Supreme Court ruling rather than a statute passed by the legislature, which means it has fewer formal safeguards written into law.
Several other states have introduced bills in recent legislative sessions, though none had passed into law at the time of writing. The trajectory over the past decade has been toward expansion, with most new laws closely modeled on Oregon’s original framework.
What the Law Requires of Patients
Every state with an aid-in-dying law imposes the same core eligibility criteria. You must be an adult (18 or older), a resident of the state where you are requesting the prescription, diagnosed with a terminal illness expected to cause death within six months, and mentally capable of making your own medical decisions. The terminal illness is defined in most statutes as “an incurable and irreversible illness or condition that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.”
One critical legal distinction: this is not euthanasia. In every U.S. jurisdiction that permits the practice, the patient must self-administer the medication. Self-administration means taking a conscious, deliberate action to ingest the prescription. A physician cannot inject or otherwise deliver the medication to the patient. This requirement is a legal bright line that separates aid in dying from euthanasia, which remains illegal throughout the United States.
Vermont became the first state to remove its residency requirement in 2023, meaning terminally ill patients from other states can travel there to access the law. All other states still require residency.
Built-In Safeguards
The laws are designed with multiple checkpoints to prevent misuse or coercion. While details vary by state, the standard safeguards include:
- Two physician certifications. Both an attending physician and a consulting physician, each licensed as an M.D. or D.O. in the state, must independently confirm the terminal diagnosis and the patient’s mental capacity. New Mexico is the only state that also allows certain advanced practice providers to serve in these roles.
- Multiple requests. Patients must make two oral requests and one written request. The written request typically requires witnesses.
- Waiting period. Most states require at least seven days between the first oral request and the second. Colorado shortened its waiting period from 15 days to 7 in 2024.
- Mental health referral. If either physician suspects impaired judgment from depression or another mental health condition, the patient must be referred for a psychological evaluation before a prescription can be written.
- No advance directives. A person cannot request the medication through a living will or healthcare proxy. The patient must have decision-making capacity at the time of each request.
In practice, the mental health referral happens less often than you might expect. Oregon data shows that fewer than 5 percent of patients who received prescriptions were referred for a mental health screening, and that rate has been declining over time. Some institutions, like UCSF, have responded by requiring a mental health evaluation for every patient who seeks a prescription, regardless of whether a physician flags a concern.
How the Process Works
The process begins when a patient makes a verbal request to their physician. After the attending physician confirms eligibility, the patient is referred to a second, consulting physician for an independent evaluation. The patient then submits a written request, typically on a standardized form, signed in the presence of witnesses.
After the mandatory waiting period (usually seven days from the first oral request), and once both physicians have signed off, the attending physician writes a prescription for a lethal dose of medication. The patient picks it up from a pharmacy and decides when, or whether, to take it. There is no deadline, and many patients who receive prescriptions never use them.
Oregon’s 2024 data illustrates this clearly. That year, 607 people received prescriptions under the Death with Dignity Act, but 376 people died from ingesting the medication (43 of whom had received their prescriptions in a previous year). A meaningful number of patients find comfort simply in having the option available.
The Federal Legal Landscape
There is no federal law that addresses physician-assisted death directly. The legal framework is entirely state by state, a structure reinforced by the Supreme Court’s 1997 decision in Washington v. Glucksberg. In that case, the Court held unanimously that the Constitution does not guarantee a right to assisted suicide. The ruling did not, however, prevent states from choosing to allow it.
Justice O’Connor’s concurrence captured the logic that has shaped the legal landscape since: the task of crafting procedures to protect individual liberty interests in this area belongs to the “laboratory” of the states. That language gave states explicit room to experiment with their own laws, and Oregon’s Death with Dignity Act, already on the books at the time of the ruling, became the model for every state that followed.
Because the practice is governed entirely at the state level, moving across state lines changes your legal options completely. A prescription written in Oregon carries no legal weight in a state that prohibits the practice, and physicians in states without aid-in-dying laws risk criminal prosecution if they assist a patient’s death. The patchwork nature of the law means that access depends heavily on where you live.