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'Death With Dignity' Laws by State

Terminal illness is difficult for patients and their families. Watching a loved one suffer through a terminal illness is very painful. But when all hope is lost, and the patient no longer has the will to live, some patients may want to end their lives on their terms. Do they have the right to end their lives? It depends.

Federal law doesn't specifically protect the act of mercy killing or euthanasia, nor does it prohibit the practice altogether. Instead, the right to physician-assisted death (or "death with dignity") is a public health matter left to state law.

This article provides an overview of dignity laws that allow terminally ill patients to choose when and how they die.

State Death With Dignity Laws: An Overview

The vast majority of states do not allow patients to end their lives, either on their own or through the aid of a doctor. However, in 1990 the U.S. Supreme Court ruled that patients or their designated health care agents may refuse life-preserving medical treatment.

A health care agent is a person named by the patient to make health care decisions on their behalf, usually through a durable power of attorney. Health care agents follow patients' wishes in a living will or "do not resuscitate" form.

So while all states allow patients to withhold treatment, only a few allow doctors to assist in a patient's death. Physicians are the only healthcare professionals authorized to prescribe lethal drugs in most states.

In all states with end-of-life laws, the patient is at least 18, has a terminal disease (with less than six months to live), and has the mental capacity to request aid in dying. These states have protections, such as waiting periods or restrictions on the types of healthcare providers who can partner with the patient.

The following is a breakdown of the states that allow assisted suicide or "death with dignity," either through statutes or established case law:

California (End of Life Option Act)

Gov. Jerry Brown signed the End of Life Option Act, modeled after similar laws in Oregon, Washington, and Vermont, into law in 2015. Physicians can prescribe lethal drugs to certain terminally ill patients. Patients expected to die within six months, provide informed consent, have a medically confirmed diagnosis, and who request assistance three times may obtain a prescription for lethal drugs.

  • Legalized through: Legislature
  • Number of months until expected death: Six
  • Minimum age: 18
  • Number of doctor requests: 2 oral (at least 48 hours apart)

Colorado (End-of-Life Options Act)

Colorado voters passed Initiative 106, "Access to Medical Aid in Dying," by a wide margin in 2016. Passage of the ballot initiative amended state law to include the Colorado End-of-Life Options Act. The law specifically states that termination of one's life under the law technically is not "suicide" (since the patient is already facing certain death). Several safeguards are in place to ensure that the patient is mentally capable of making such an important decision, including the opportunity to withdraw the request at the last minute.

  • Legalized through: Voter-approval
  • Number of months until expected death: 6
  • Minimum age: 18
  • Number of doctor requests: 2 oral (at least 15 days apart); 1 written

District of Columbia (D. C. Death with Dignity Act)

Lawmakers in the District of Columbia passed the D. C. Death with Dignity Act in 2016. It became law on February 18, 2017, and was applicable as of June 6, 2017. Under this law, terminally ill persons who want to end their lives voluntarily can request lethal doses of medication from a D.C. licensed physician. Only District of Columbia residents with less than six months to live can use this law.

The terminally ill person must make two separate oral requests – plus one in writing – separated by a 15-day waiting period before an attending physician can prescribe lethal drugs. The patient submits the written request before their second oral request and at least 48 hours before a pharmacist can dispense it. Two witnesses must, in the presence of the patient, attest that the patient is "capable, acting voluntarily, and not unduly influenced to sign the request."

The D.C. Department of Health maintains a portal where attending physicians, pharmacists, or patients can learn more.

  • Legalized through: Legislature
  • Number of months until expected death: 6
  • Minimum age: 18
  • Number of doctor requests: 2 oral (at least 15 days apart); 1 written

Hawaii (Our Care, Our Choice Act)

The Hawaii legislature passed the Our Care, Our Choice Act with overwhelming support. Governor David Ige signed it into law in 2018 (taking effect on January 1, 2019). As with similar laws in other states, the requesting patient is mentally capable of making and communicating health care decisions. The prescribing physician must inform the patient of alternatives (pain management, etc.), notify the next of kin of the request, and offer the patient a last chance to opt-out. The waiting period can be reduced for patients "not expected to survive the mandatory waiting period."

  • Legalized through: Legislature
  • Number of months until expected death: 6
  • Minimum age: 18
  • Number of doctor requests: 2 oral (at least 5 days apart); 1 written

Maine (Maine Death With Dignity Act)

Maine lawmakers approved the Maine Death With Dignity Act in 2019. Approved on June 12, 2019, it became effective on September 19, 2019. Under the Maine Death with Dignity Act, terminally ill Maine residents can ask for a dose of life-ending medication to hasten their death. The patient must have an illness that is incurable and irreversible. They must also have six months or less to live with reasonable medical certainty.

Like many other states with similar laws, the terminally ill patient must make two separate oral requests – plus one in writing – separated by a waiting period before doctors can prescribe lethal drugs. Forty-eight hours must pass after the written request before the physician can write a prescription. A consulting physician must confirm the patient meets the requirements. The patient must give informed consent.

The patient must sign the written request and attest by two witnesses.

  • Legalized through: Legislature
  • Number of months until expected death: 6
  • Minimum age: 18
  • Number of doctor requests: 2 oral (separated by a waiting period); 1 written

Montana (Montana Rights of the Terminally Ill Act)

The Montana Supreme Court issued a ruling in late 2009 that broadened the state's Rights of the Terminally Ill Act to include physician-assisted suicide. However, the Montana statute does not provide a regulatory framework for doctor-assisted suicide. Instead, the ruling shields doctors from prosecution as long as they have the patient's request in writing.

  • Legalized through: Montana Supreme Court decision
  • No additional regulations on assisted suicide

New Jersey (New Jersey Medical Aid in Dying for the Terminally Ill Act)

New Jersey lawmakers approved the Medical Aid in Dying for the Terminally Ill Act in 2019. Approved on April 12, 2019, the Act became effective on August 1, 2019. This law allows an attending physician to prescribe lethal medications for terminally ill patients who want to end their lives.

A terminally ill patient, under this law, is at the "terminal stage" of "an irreversibly fatal illness, disease, or prognosis with less than six months to live. The prognosis is based on reasonable medical certainty.

The terminally ill person must make two separate oral requests – plus one in writing – separated by a 15-day waiting period before doctors can prescribe lethal drugs. The patient must submit the written request before their second oral request and at least 48 hours before the medication is dispensed.

When the patient makes the second verbal request, the physician must offer the patient an opportunity to change their mind. A consulting physician must confirm the prognosis and the patient's statement.

The patient must sign the written request. Two witnesses must sign the request and attest that the patient can act voluntarily.

  • Legalized through: Legislature
  • Number of months until expected death: 6
  • Minimum age: 18
  • Number of doctor requests: 2 oral (at least 15 days apart); 1 written

New Mexico (Elizabeth Whitefield End of Life Options Act)

New Mexico lawmakers approved the Elizabeth Whitefield End of Life Options Act in 2021. The law was approved on April 8, 2021, and it became effective on June 18, 2021. Terminally ill New Mexico residents over 18 years of age, with the mental capacity to make health care decisions and six months or less to live, are eligible for aid-in-dying.

A consulting physician must confirm the prognosis and a mental health provider must ensure their mental capacity to make this decision. Special rules apply to patients receiving end-of-life-care palliative care. Terminally ill patients in hospice do not need a second opinion.

Unlike other states with dignity-in-dying laws, terminally ill New Mexico patients can get assistance with one request. There is a 48-hour waiting period before dispensing medication. Nurse practitioners and physician's assistants can prescribe these medications in New Mexico. Finally, the terminally ill patient can self-administer the medication.

  • Legalized through: Legislature
  • Number of months until expected death: 6
  • Minimum age: 18
  • Number of doctor requests: 1, with a 48-hour waiting period

Oregon (Death with Dignity Act)

Oregon voters passed the Death with Dignity Act in 1994 with 51 percent of the vote, which allows terminally ill patients to obtain a prescription for lethal drugs. A ballot measure attempting to repeal the law lost (with 60 percent of voters opposed). The U.S. Supreme Court upheld this law in 2006.

Under the Oregon Death with Dignity Act, eligible patients must wait 15 days after making an oral request to a doctor and then make another oral and written request, followed by a 48-hour waiting period before medications are made available. The 15-day waiting period does not apply to patients who are imminently dying.

  • Legalized through: Ballot-initiative
  • Number of months until expected death: 6
  • Minimum age: 18
  • Number of doctor requests: 2 oral (at least 15 days apart); 1 written

Vermont (Patient Choice and Control at End of Life Act)

Vermont lawmakers passed the Patient Choice and Control at End of Life Act in 2013. The law protects doctors who follow the steps outlined in the Act from liability. Doctors are then able to prescribe lethal drugs to terminally ill patients.

The state also requires patients of sound mind to make two separate oral requests – plus one in writing – separated by a 15-day waiting period before doctors can prescribe lethal drugs. The initial diagnosis must be certified by a consulting physician.

  • Legalized through: Legislature
  • Number of months until expected death: 6
  • Minimum age: 18
  • Number of doctor requests: 2 oral (at least 15 days apart); 1 written

Washington (Death with Dignity Act)

Voters approved the Washington Death with Dignity Act in 2008 with 58 percent of the vote. The law permits eligible patients with a terminal illness to request lethal drugs to end their lives. Individual hospitals may prohibit participation in euthanasia but must clearly state their policy.

Washington law is very similar to assisted suicide laws in Oregon and Vermont. The statute requires a series of requests and waiting periods while requiring the patient to be of sound mind and capable of clear communication.

  • Legalized through: Ballot-initiative
  • Number of months until expected death: 6
  • Minimum age: 18
  • Number of doctor requests: 2 oral (at least 15 days apart); 1 written

Learn More About Right To Die Laws: Contact a Local Attorney

Death with dignity is an emerging area of the law, and only a handful of states permit physician-assisted suicide. Those who live in one of these states and choose this option must follow specific procedures. If you have additional legal questions about this issue, including euthanasia and advanced directives, contact a healthcare attorney in your state.

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