What Is Medical Aid in Dying?

July 9th, 2025

Medical aid in dying is a medical practice that gives mentally competent individuals with a life expectancy of fewer than six months a prescription for lethal medication that they can administer themselves when they choose to die. Also known as physician-assisted dying or simply aid in dying, the practice was formerly called physician-assisted suicide. However, in recent years, multiple physician groups, including the American Academy of Hospice and Palliative Medicine and the American Academy of Family Physicians, have adopted policies that reject the term suicide in this context. Additionally, in 2008,  the American College of Legal Medicine,a pre-eminent organization that helps shape policy on issues involving medicine and the law, adopted a resolution denouncing the use of the word “suicide” when referring to people who choose to end their lives when they are terminally ill. 

The guiding principle behind aid-in-dying is “death with dignity.” Advocates believe that individuals who are already dying from a terminal illness have the right to determine when and by what means their life ends. Research suggests that most people who pursue the option do so not as a result of unbearable suffering, but because they want to have some control over what remains of their life. For many, just having the prescription is enough to provide that sense of control. According to data provided by Compassion & Choices, over one-third of people who go through the process of obtaining a prescription for MAID never take the lethal drugs. For those who do, exhaustion and fatigue are the primary reasons given for their decision, not physical suffering or pain. 

Aid-in-Dying Safeguards

In the U.S., safeguards are built into aid-in-dying laws in order to protect vulnerable individuals. These typically include requirements such as:

• The individual must be a mentally competent adult. Those with intellectual disabilities or dementia are precluded from participating in MAID. 
• Requests for MAID must be made by the patient in writing; in some states, the request must be made twice with a waiting period between requests.
• A mental health evaluation may be deemed necessary in order to ensure that the individual is not suffering from treatable depression or suicidal ideation related to a treatable cause.
• Two physicians or a physician and another healthcare provider are required to approve the request. 
• The medication must be self-administered through the oral or rectal route. Intravenous administration is prohibited. 

Medical Aid in Dying vs Euthanasia

Medical aid in dying is distinct from euthanasia, which is the intentional killing of another to alleviate their suffering. In the United States, a core tenet of all aid-in-dying laws is voluntary self-administration of the drugs used to induce death. However, this is not the case everywhere. Canada, for example, allows physicians and nurses to administer a lethal dose of medication to any adult who meets certain medical and legal criteria and has voluntarily requested it. Similarly, the Netherlands allows physicians to perform euthanasia on any person over the age of 16 whose suffering is extreme, whether or not they are terminally ill. Belgium, Luxembourg, Australia and New Zealand allow the practice as well. 

It’s important to note that euthanasia may be “active” or “passive.” Active euthanasia, sometimes called “mercy killing” involves doing something to an individual that will certainly cause their death, such as administering a lethal drug or poison. Passive euthanasia involves allowing someone to die by withholding or withdrawing treatment that will keep them alive, such as taking a person off life support. The former is outlawed in many countries, including the United States. However, passive euthanasia is widely practiced, legal and morally acceptable across most of the globe as long as it is done in accordance with the patient’s wishes or those of their next of kin. 

The Long History of Medical Aid in Dying

The concept of medical aid in dying is not a new one. For millennia, humans have explored the possibility of a swift and certain death when faced with intolerable and interminable suffering. In ancient Greece and Rome, for example,”mercy killing” was legal, and physicians would routinely provide lethal poisons to patients who were suffering from severe illness or disability. Even after the Greek physician and philosopher Hippocrates condemned the practice in the Hippocratic Oath, few physicians complied with his edict. Most believed that allowing a patient to linger in agony was a worse offense than helping them die a peaceful death.

During the mid-to-late Middle Ages, however, the rise to power of the Roman Catholic Church began to influence attitudes and cultural norms around physician-assisted death. The teachings of noted theologian and philosopher St. Thomas Aquinas, in particular, became a bedrock of the Church’s position on assisted dying and suicide. Aquinas taught, among other things, that redemptive suffering is consistent with God’s plan, and that suicide, even in the face of prolonged agony, is an irredeemable sin. In accordance with these teachings, the Church adopted the position that anyone who died by suicide would be denied Catholic funeral rites and burial in consecrated ground. The Church maintained this position until the late 1960s, when it began allowing a Catholic funeral and burial for people who had taken their own lives. It further softened its position in 1990, when Pope John Paul II changed the Church’s official teachings on the irredeemable nature of suicide, stating, “ We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for repentance.”

Medical Aid in Dying Through the 19th Century

Throughout the 16th and 17th centuries, cultural and religious opposition to suicide and physician-assisted death remained strong. And while the early settlers of the nascent United States rejected many of the tenets of Catholicism, they continued to adhere to British common law, which classified suicide and physician-assisted suicide as crimes. This opposition softened somewhat during the late 17th century Enlightenment, which introduced a greater emphasis on reason, the pursuit of happiness and personal autonomy. However, during  the early 18th century, the Great Awakening unleashed strong religious backlash against secular rationalism in the American colonies. By the early 1800s, this had solidified into almost complete rejection of the notion of assisted dying, and in 1828 New York became the first state to codify the prohibition in state law. By 1885, most of the U.S.territories had followed suit. 

These legal prohibitions and attitudes prevailed throughout most of the rest of the 19th century both in the U.S. and across the globe.

20th Century Ushers in Change

By the early 1900s, however, changes in medicine and pharmacology ushered in a new wave of interest in both euthanasia and physician-assisted death. In 1905 and 1906, two bills were introduced in the Ohio legislature that would allow aid in dying for terminally ill adults and euthanasia of infants who were ‘hideously deformed.” Both bills were defeated, but they opened up an ongoing debate about the ethics of medical aid in dying that continues to this day. 

Then in 1915, Dr. Harry J. Haiselden, then chief of staff at Chicago’s German-American Hospital, declined to perform potentially life-saving surgery on an infant who was born with multiple physical deformities. The infant died 5 days later, setting off a firestorm of debate that reverberated across the United States. Haiselden’s actions even became the subject of a 1917 film, “The Black Stork,” which sparked many prominent figures, including Helen Keller and Clarence Darrow, to speak out in his defense. Although the idea is abhorrent to most Americans today, their position was that doctors had the right and the duty to decide whether a disabled infant should live or die. 

In fact, neonatal euthanasia was the initial impetus to reform America’s aid-in-dying laws. Around the time of the Great Depression, when Americans were competing for scarce resources and scarcer jobs, the idea that severely physically or mentally handicapped children should be allowed to die was supported by nearly 45% of Americans, according to one public opinion poll. This idea dovetailed with the evolving eugenics movement, which advocated for the sterilization of disabled persons and the prohibition of interracial marriage for the benefit of society as a whole. Support for the concept waned considerably during WWII, however, when news of the Nazi’s mass extermination of millions of Jews and political prisoners, as well as disabled children and the mentally ill, reached America’s shores. 

Nonetheless, the movement towards legalizing medical aid in dying and euthanasia made slow but steady progress through much of the 20th century. In 1945, Switzerland became the first country to allow physicians to legally prescribe a lethal medication for patients who were terminally ill. But in the U.S. the end of World War II and the growth of the Middle Class left Americans less interested in discussions around suffering and death, and support for the concept waned. 

Perhaps as a result of this shift, the Euthanasia Society of America, which was formed in 1938 to promote the concept of medical aid in dying for the terminally ill, refocused its messaging to encourage public acceptance of passive euthanasia, or allowing natural death, versus allowing doctors to help patients die. This idea slowly gained support among Americans, a majority of whom believed that a dying person had the right to refuse treatment to prolong their life. In 1976 California became the first state in the nation to pass a law granting terminally ill individuals the right to authorize the withdrawal of life-sustaining treatment if it seemed that death was inevitable. By 1977, seven other states, New Mexico, Arkansas, Nevada, Idaho, Oregon, North Carolina, and Texas, had signed right-to-die bills into law. The right to refuse medical treatment was eventually codified in federal law in 1990, when Congress passed the Patient Self-Determination Act. 

The First Aid in Dying Law

As the 20th century progressed, a number of “right to die” organizations sprang up across the United States, each advocating for the right of terminally ill individuals to refuse life-saving treatment and receive aid in dying if that was their choice. Of these, perhaps the most influential was the Hemlock Society. Formed by Derek Humphrey in 1980, the organization was extremely successful in promoting the notion that terminally ill individuals have the right to choose the circumstances of their own death, whether by refusing treatment or by self-administering a legally prescribed lethal drug. By the early 1990s, it boasted over 50,000 members, and support for medical aid in dying among American adults reached an all-time high. The organization eventually rebranded itself as End of Life Choices, and in 2005 merged with Compassion in Dying to form Compassion & Choices, which is now the largest end-of-life advocacy organization in the United States. 

Throughout the 1990s, many state legislatures took up the issue of aid in dying with varying degrees of success. The first state to actually allow aid-in-dying was Oregon, which passed the Death with Dignity Act by voter initiative in 1994. But the federal government stopped the implementation of the law through a federal injunction while challenges to its validity worked their way through the courts. Eventually, in 1997, the act became law. Nonetheless, the federal government continued to take steps to make aid in dying difficult for Oregon’s citizens. These included the following: 

• In 1997, President Bill Clinton signed the federal Assisted Suicide Funding Restriction Act of 1997, which prohibits the use of federal Medicare funds for medical aid in dying. 
• That same year, the Supreme Court ruled in Washington v. Glucksberg that there is no constitutionally guaranteed  right to die. States may outlaw aid in dying if they choose.
• In 2001, U.S. Attorney General John Ashcroft issued a directive barring Oregon from implementing the Death with Dignity Act, claiming that the state had usurped the power of the federal government to limit the use of controlled substances in medical practice. That action led to a string of lawsuits that culminated in the 2006 Supreme Court ruling in Gonzalez v Oregon which upheld Oregon’s right to offer aid in dying to its citizens. 

Since that landmark Supreme Court decision, nine other U.S. states and the District of Columbia have enacted aid-in-dying laws. It is now legal in California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico and Washington. Further, Oregon recently passed legislation removing its residency requirement for aid in dying, meaning terminally ill individuals from other states can travel to Oregon to avail themselves of the Death with Dignity Act. 

Current Attitudes Towards Medical Aid in Dying

In the United States, support for medical aid in dying has been strong for decades. According to a 2018 Gallup poll, 72% of Americans believe that euthanasia should be legal and a slightly smaller majority believes that doctors should be allowed to help terminally ill patients “commit suicide.” This majority holds firm among regular churchgoers, but dips to 37% among those who attend church every week. This disparity most likely reflects the strong opposition to medical aid in dying by many religious faiths, including the Roman Catholic Church, many Protestant sects, Islam and Judaism. 

Acceptance of the concept of medical aid in dying also appears less robust among people of color, particularly African Americans and those of Hispanic descent. This appears to be borne out by a study published in Sociology of Health and Illness in 2019, which found that persons who participate in aid in dying are almost exclusively white. In Oregon, for example, where aid in dying has been legal for over 20 years, only 3% of patients who obtained aid-in-dying drugs were any race other than Caucasian. This also holds true in California, which is far more racially and ethnically diverse. Since the implementation of the California End of Life Options Act, 89.5% of those who participated in aid-in-dying have been white. 

This disparity may not reflect negative perceptions of medical aid in dying among people of color, however, but instead be a marker for decreased knowledge about and access to quality end-of-life care. Numerous studies have documented racial disparities in healthcare across all age groups, and this undoubtedly continues as people approach the end of life. Black and Hispanic Americans are far less likely to engage in hospice or palliative care services than whites, for example, and are more likely to request aggressive interventions during the last few months of life. This may reflect cultural beliefs around the notion of what constitutes a good death;  a deep distrust of the healthcare profession due to its historic victimization of Black and Hispanic individuals, or subtle discrimination by doctors who fail to explore end-of-life options with people of color in the same way they do with people who are white. 

In Europe, public opinion on medical aid in dying is more divided. While some countries have adopted laws allowing it, such as Switzerland, Belgium and the Netherlands, other countries have kept strict laws against it. In Great Britain, both aid in dying and euthanasia are illegal and punishable by up to 14 years in prison. The last aid-in-dying legislation proposed there was defeated in 2016. But another proposal to change the law to allow physician assisted death was introduced in 2021, and is currently being debated by the commons health and social care committee, which is expected to report its findings by late 2023. 

Meanwhile, Spain legalized both active euthanasia and medical aid in dying in 2021, but Italy continues to outlaw the practice entirely despite recent proposals to liberalize the law. Many other European countries are actively debating the issue, but it is almost certain that the legality of euthanasia and aid in dying will vary drastically across Europe for some time to come. 

Summary

In summary, medical aid in dying, once known as physician-assisted suicide, is a medical practice that allows individuals who meet certain medical and legal criteria to obtain a prescription that will allow them to take their own life. In the U.S., it is legal in only a handful of states, although public opinion is widely in favor of allowing the practice for competent, terminally ill adults. 

Medical aid-in-dying differs from euthanasia, a practice in which a healthcare professional administers life-ending medicines to an individual who meets certain medical criteria. Euthanasia is illegal in the United States, but it is legal in Canada and a number of countries throughout Europe. 

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