Medical aid in dying is a medical practice that allows a terminally ill, mentally capable adult with a prognosis of six months or less to live to request a prescription from their doctor for medication they can decide to self-ingest to control the manner and timing of their death. To be eligible for aid-in-dying medication, an individual must be an adult (18 or older), terminally ill with that six-month prognosis, mentally capable of making their own healthcare decisions, and able to self-ingest the medication.
Medical aid in dying is an end-of-life option that provides terminally ill people with peace of mind and comfort. In 11 authorized jurisdictions, medical aid in dying affords autonomy and compassion and improves end-of-life care for all.
Less than 1% of people who die annually in the authorized jurisdictions use medical aid in dying. These laws help improve end-of-life care overall by spurring patient-physician discussions about the full range of end-of-life care options, including hospice care, and earlier, more effective hospice care utilization.
Oregon was the first state to authorize medical aid in dying through the 1994 Oregon Death with Dignity Act ballot initiative that took effect in 1997. Today it is a legal option in 10 other jurisdictions: California (2015), Colorado (2016), Washington, DC (2017), Hawaii (2019), Maine (2019), Montana (2009), New Jersey (2019), New Mexico (2021), Vermont (2013), and Washington (2008).
‘Just as advocates work to expand end-of-life care options, sometimes existing laws must be protected.’
In the past five years, several states have improved access by passing laws that reduce mandatory waiting periods, expand prescribing authority, and remove residency requirements. In June, Colorado became the 7th state to improve access to medical aid in dying by:
- Allowing advanced practice registered nurses (APRNs) with prescribing authority to provide this option;
- Reducing its waiting period from 15 to 7 days;
- Allowing prescribing providers to waive the waiting period if the patient is not likely to survive it.
Lawmakers continue to introduce new legislation across the country every year, with support from the 72% of voters nationwide who support medical aid in dying as an end-of-life care option. Nineteen states have introduced medical aid-in-dying legislation during the 2023–2024 session: Arizona, Delaware, Florida, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New Hampshire, New York, Pennsylvania, Rhode Island, Tennessee, Virginia and Wisconsin.
The Delaware House, New Hampshire House and Virginia Senate passed medical aid-in-dying legislation for the first time this past April, March and February, respectively. On June 25, the Delaware Senate passed the Ron Silverio/Heather Block End of Life Options Act. It now awaits the Governor’s review to decide if he will sign the bill, allow it to become law without his signature, or veto it. The Virginia legislature ended its 60-day session before the House could consider the bill but may consider it next year.
Just as advocates work to expand end-of-life care options, sometimes existing laws must be protected. Recent challenges in New Jersey and California threatened to invalidate medical aid-in-dying laws. In February, the New Jersey Supreme Court rejected an appeal of a state Appellate Court ruling affirming the dismissal of a lawsuit seeking to overturn the state’s 2019 medical aid-in-dying law.
In March, a U.S. District Court dismissed a federal lawsuit claiming California’s revised End of Life Option Act (EOLOA) discriminates against people with disabilities by coercing them into using medical aid in dying. This decision has been appealed to the 9th Circuit Court of Appeals. The U.S. Congress also has repeatedly sought to repeal Washington, DC’s Death with Dignity Act, which passed eight years ago. Compassion & Choices has successfully opposed these efforts.
Medical aid in dying is making steady progress toward authorization in states across the country, led by terminally ill people who demand this option. Compassion & Choices and Compassion & Choices Action Network are on the ground and in state legislatures advocating for passage and improvement of medical aid-in-dying laws. Our legal team plays an active role in courtrooms improving, protecting, and defending these laws, including representing terminally ill people and clinicians.
Securing end-of-life care options for people across the nation is part of the wider movement for improving end-of-life care and ensuring everyone has the tools and resources to make informed decisions about their care.
For more information about medical aid in dying and state-specific requirements, visit the Compassion & Choices website.
Charmaine Manansala is the chief advocacy officer at Compassion & Choices. She was instrumental in California’s successful campaign to authorize medical aid in dying in the nation’s most populous state and led the efforts to pass similar legislation in the District of Columbia, Hawai’i and New Jersey. Manasala is now in charge of the state teams to authorize, ensure access, protect, and improve medical aid in dying and the full range of end-of-life options.
Photo credit: Shutterstock/Jim Pruitt
