Medical Aid in Dying in the United States – Overview of State Regulations
Medical Aid in Dying (MAID) allows terminally ill, mentally competent, and decision-capable adults to self-administer a prescription medication—either by ingesting it orally or by self-administered infusion—in order to end their life with dignity and without further suffering.
All existing MAID laws in the United States are based on the model of the Oregon Death with Dignity Act, which was the first of its kind when it was enacted in 1997 (aidindying.org).
Please note that the information provided reflects the legal status as of January 2026.
Common Core Requirements of U.S. MAID Laws
Before outlining state-by-state details, it is important to note that nearly all MAID laws in the U.S. share the following baseline requirements:
Minimum age: 18 years
Terminal illness with a life expectancy of six months or less, confirmed by two physicians
Mental competence and a voluntary request by the patient
Ability to self-administer the medication
Mandatory information about alternative palliative and hospice care options
Multiple requests (written and oral)
Waiting periods between requests (varies by state)
Witnesses confirming the voluntary nature of the decision
Active Medical Aid in Dying by physicians (e.g., direct administration of medication) is not permitted in the United States. The medication must be self-administered. This approach is similar to the legal frameworks in Germany, Switzerland, and many other countries. Only very few jurisdictions worldwide permit Active Medical Aid in Dying ( aktive Sterbehilfe )
State-by-State Overview
1. Oregon – Death with Dignity Act (since 1997)
The first and longest-standing MAID law in the U.S.
Key rules:
Age 18+, terminal illness (≤ 6-month prognosis)
Two oral requests at least 15 days apart
One written request with two neutral witnesses
48-hour waiting period between written request and prescription
No residency requirement (non-residents are eligible)
Two physicians must confirm diagnosis, voluntariness, and decision-making capacity
2. Washington State – Death with Dignity Act (since 2009)
Very similar to Oregon, with minor variations.
Key rules:
Two oral and one written request
Witnesses confirm voluntariness
Minimum of 15 days between first oral and written request
48 hours between written request and prescription
Residency requirement (out-of-state access not permitted)
3. California – End of Life Option Act (since 2015)
Includes pragmatic changes to the Oregon model.
Key rules:
Age 18+, terminal illness
48 hours between the two oral requests (significantly shorter than 15 days)
Residency requirement (California residents only)
Experience shows no extreme barriers resulting from the shortened waiting period
4. Colorado – End of Life Options Act (since 2016)
Key rules:
Age 18+, terminal illness
Physician conducts assessment and refers for psychiatric evaluation if indicated
Minimum 7-day interval between oral requests
Waiting period may be waived if death is imminent
5. Hawaii – Our Care, Our Choice Act (since 2019)
Key rules:
Age 18+, terminal illness
Minimum 5-day interval between oral requests
Waiting period may be fully waived in cases of very limited life expectancy
Hawaii allows Advanced Practice Registered Nurses (APRNs) to participate in certain cases (special provision)
6. Maine – Death with Dignity Act (since 2019)
Key rules:
Age 18+, terminal illness
Two oral requests 15 days apart
Mental health evaluation if clinically indicated
48-hour waiting period before prescription
7. New Jersey – Medical Aid in Dying for the Terminally Ill Act (since 2019)
Key rules:
Age 18+, terminal illness
Residency requirement (recently upheld by federal court)
Two oral requests 15 days apart
Mental health evaluation and waiting periods similar to Maine
8. New Mexico – Elizabeth Whitefield End-of-Life Options Act (since 2021)
Key rules:
Age 18+, terminal illness
8-hour waiting period between written request and prescription
Witnesses must confirm the patient is not under pressure
Residency requirement
9. Vermont – Patient Choice and Control at End of Life Act (since 2013)
Key rules:
Age 18+, terminal illness
15-day interval between oral requests
No residency requirement (non-residents eligible)
Two independent physicians must confirm the decision
10. Delaware – End-of-Life Options Act (2025–2026)
Key rules:
Age 18+, terminal illness
Patients must be informed about alternative options
Two waiting periods and a second medical opinion required before prescription
Residency requirement
Law expected to take effect in 2026 (New York Post)
11. Montana – Judicial Authorization (since 2009)
Montana does not have a specific MAID statute, but MAID is effectively permitted based on a court ruling (Baxter v. Montana).
In the United States, the legal system is largely based on Common Law, where judicial decisions and legal precedents play a central role. In contrast, Germany and most European countries follow a Civil Law system, which relies primarily on codified statutes as the basis of law.
Key characteristics:
Virtually no formal statewide statutory requirements
Physicians often act cautiously due to the lack of explicit legal protections (Compassion & Choices)
12. Washington, D.C. – Death with Dignity Act (since 2017)
Key rules:
Age 18+, terminal illness
15-day interval between oral requests
Residency requirement
48-hour waiting period before prescription (Compassion & Choices)
Key Differences Between States
Residency: Most states require residency to access MAID. Only Oregon and Vermont allow non-residents.
Waiting periods: Vary widely—from as little as 48 hours (e.g., California, New Mexico) to several days or longer intervals between oral requests.
Mental health evaluations: Mandatory in some states, required only when concerns arise in others.
Witness requirements: Nearly all states require witnesses to confirm that the decision is voluntary.
Final thoughts ..
It’s important to remember that Medical Aid in Dying should always be a last resort, not a standard option. At the heart of these decisions is human dignity, compassion, and the profound need to be seen, heard, and supported at life’s most vulnerable moments. Laws and regulations are only a framework—they cannot replace the care of family, friends, and healthcare professionals who provide comfort, understanding, and presence.In the United States, as elsewhere, the conversation about assisted dying is ultimately about honoring the individual, easing suffering when it is unavoidable, and ensuring that every person’s final days are met with respect, empathy, and love.
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