Assisted dying is an umbrella term for practices in which a person with a serious illness receives medical help to bring about their own death. It typically involves a doctor prescribing or administering lethal medication to a patient who has voluntarily and repeatedly requested it. The term covers two distinct practices: one where the patient takes the medication themselves, and one where a doctor administers it directly. More than a dozen countries now permit some form of assisted dying, each with its own rules about who qualifies and how the process works.
Assisted Dying vs. Euthanasia
The core distinction comes down to who performs the final act. In assisted suicide (also called physician-assisted dying or medical aid in dying), a doctor prescribes a lethal medication, but the patient takes it on their own, usually by drinking a liquid mixture. In euthanasia, a doctor directly administers the drugs, typically through an injection. Both practices require the patient’s explicit, voluntary request, and both fall under the broader heading of “assisted dying” or “assisted death.”
These terms carry different legal weight depending on where you live. Some jurisdictions permit only self-administered assisted dying. Others, like the Netherlands and Belgium, allow euthanasia as well. The language used in legislation also varies: Oregon calls it “Death with Dignity,” Canada uses “Medical Assistance in Dying” (MAiD), and Australia refers to “Voluntary Assisted Dying.”
Where Assisted Dying Is Legal
The Netherlands became the first country to decriminalize euthanasia in 2002, and Belgium passed its own law the same year. Luxembourg followed in 2009, and Spain in 2021. All four allow both euthanasia and assisted suicide.
Several other countries permit assisted suicide but not euthanasia. Germany’s constitutional court struck down a ban on professionally assisted suicide in 2020. Austria legalized assisted suicide for people who are terminally ill or have permanent debilitating conditions in 2021. Italy’s constitutional court ruled in 2019 that assisted suicide must be permitted for patients with terminal conditions who depend on life-sustaining treatment, and in early 2025, Tuscany became the first Italian region to adopt specific legislation. Switzerland has allowed assisted suicide for decades and is home to organizations that provide the service to both residents and people from abroad. Canada’s MAiD program, introduced in 2016 and expanded in 2021, is among the most broadly accessible systems in the world.
In the United States, Oregon pioneered the practice with its Death with Dignity Act in 1997. At least ten states now have similar laws, including California, Colorado, Washington, Vermont, New Jersey, and Hawaii. New York signed its Medical Aid in Dying Act into law in early 2026. All U.S. laws require the patient to self-administer the medication; no state permits euthanasia.
Who Qualifies
Eligibility requirements differ by jurisdiction, but several criteria appear in nearly every legal framework. The patient must be a mentally competent adult capable of making and communicating their own healthcare decisions. Most laws require a terminal illness, though the definition of “terminal” varies. In Oregon and other U.S. states, two independent doctors must confirm a prognosis of six months or fewer to live. Canada takes a different approach, using a two-track system: one for people whose death is “reasonably foreseeable” and another, with stricter safeguards, for people whose death is not imminent but who have a condition causing intolerable suffering.
If a doctor suspects that depression, anxiety, or cognitive impairment could be influencing a patient’s request, the patient is referred to a psychiatrist or psychologist for evaluation. The goal is to confirm that the decision reflects genuine, sustained intent rather than a treatable mental health crisis. Patients must also demonstrate that they understand their diagnosis, their prognosis, all available alternatives including palliative care, and the near certainty that taking the prescribed medication will result in death.
Built-In Safeguards
Every jurisdiction builds multiple checkpoints into the process. Oregon requires two independent physicians to confirm the terminal diagnosis and assess the patient’s mental capacity. Most systems require the patient to make at least two formal requests separated by a waiting period, and some, like Australia’s Victoria and Western Australia, require three separate requests: a verbal request, a written request witnessed by two independent people, and a final confirmation before the medication is prescribed.
Waiting periods between requests typically range from seven to fourteen days, giving the patient time for reflection and the medical team time for reassessment. Witnesses must have no financial or personal interest in the patient’s decision. Canada mandates additional psychiatric oversight whenever there is uncertainty about a patient’s decision-making capacity. For patients whose death is reasonably foreseeable, Canada has removed the previously required ten-day reflection period, recognizing that for some patients, the wait itself causes unnecessary suffering.
Importantly, patients retain the right to change their mind at any point. The prescribing doctor is expected to continue providing care regardless of whether the patient ultimately takes the medication.
What the Process Looks Like
In places that allow only self-administration, such as the United States, the process begins with a conversation between patient and doctor, followed by the formal request and assessment process. Once approved, the doctor writes a prescription for a lethal dose of medication, most commonly a barbiturate. The patient picks up the prescription from a pharmacy and decides when, where, and whether to take it.
Taking the medication usually means crushing a large number of pills and mixing the powder into a drink, or pouring a prepared liquid through a feeding tube. The taste is extremely bitter, so it is typically mixed with a sweet liquid. In jurisdictions that allow euthanasia, a doctor first administers a sedative to induce deep unconsciousness, then a second drug that stops the heart.
The time from ingestion to death after self-administration is less predictable than many people expect. Oregon’s data shows it has ranged from under a minute to over four days. About a third of recorded deaths took longer than an hour, and roughly 8% took more than six hours. Median time to death has increased since newer drug combinations replaced the older single-drug protocols. For euthanasia, where drugs are administered intravenously, the process is faster and more predictable.
Many People Never Take the Medication
One of the most striking patterns in assisted dying data is how many people who qualify and receive a prescription never use it. In Oregon’s 2025 data, 637 people received prescriptions. Of those, 358 (56%) died from taking the medication. Another 100 (16%) never took the drugs and later died of other causes. For many patients, having the prescription provides a sense of control and peace of mind, even if they ultimately choose not to use it.
Cancer is by far the most common underlying illness, accounting for 61% of Oregon cases. Neurological diseases like ALS make up 14%, followed by heart disease at 11%. The primary reasons patients give for seeking assisted dying tend to center on loss of autonomy, inability to enjoy life, and loss of dignity, rather than uncontrolled physical pain.
How It Differs From Palliative Sedation
Palliative sedation is a separate practice in which a doctor uses medication to lower a dying patient’s consciousness in order to relieve symptoms that cannot be controlled any other way, such as severe agitation, breathlessness, or pain. The intent is to relieve suffering, not to cause death, and the sedation can theoretically be reversed. It is typically used only when death is expected within two weeks or less.
Assisted dying, by contrast, is intended to cause death. The medication is not titrated to symptoms; it is given in a lethal dose. Consent requirements also differ. Assisted dying always requires the patient’s explicit, contemporaneous consent. Palliative sedation can be initiated for patients who have lost the capacity to consent, following discussions with family or through advance directives. This makes palliative sedation an option for some patients for whom assisted dying is not available.
Costs and Insurance
The direct cost of a completed assisted dying case, including physician consultations, medication, supplies, and regulatory oversight, has been estimated at roughly $3,000 in systems where it has been measured. In Canada and Australia, where public healthcare covers the process, patients generally face no additional out-of-pocket expenses. In the United States, coverage depends on the state and the patient’s insurance plan, though the medications themselves are relatively inexpensive compared to ongoing end-of-life care. The physician visits required during the assessment process are typically billed as standard medical consultations.