Right to Die Laws in Each US State

Where will you be when you or your loved one will die? Many people may not be aware of all the laws that surround death, including what states have “the right to die.” What is the right to die? And what does it mean for you and your family to have access to controlling one’s death?

Jump ahead to these sections:

• States that Passed “Death with Dignity” Legislation
• States that Don’t Have “Death with Dignity” Laws
• Alternative Choices

In forty-two states an individual does not have the right to die. The “right to die” refers to laws that allow terminally ill adults to request a prescription medication that induces death, also known as death with dignity laws or aid-in-dying laws. The conversation continues to divide Americans, but support for aid in death continues to grow. According to a 2018 Gallup poll, 72 percent of Americans agree that doctors should be able to help terminally ill patients die. And 54 percent think doctor-assisted death is morally acceptable. 

The fact stands that not many people are filling out advance directives and communicating about death. It is easy to avoid conversation about death for fear that it may be too uncomfortable.

Your upbringing, age, religious belief, and values can all influence your view on the right to die. We have provided some information listed below to assist in making a decision for yourself or your loved one.

States that Passed “Death with Dignity” Legislation

A Death with Dignity law allows your loved one to have the final say in their end of life plans. To protect yourself or your loved one, there are many safeguards in place. End-of-life medication must be requested twice and you must be able to take the medication independently. Other regulations also exist.

It is important to note that physician-assisted death and euthanasia and very different. Euthanasia means the doctor administers the medication to your loved one and is illegal in all fifty states. In physician-assisted death, the doctor only prescribes the medication. Your loved one must ingest the medication independently.

In all states that have passed a physician-assisted death law to date, the person requesting the medication must meet these requirements: 

• At least 18 years of age. 
• Diagnosed with a terminal illness that will lead to death within six months. 
• A resident in the state where a Death with Dignity law is in effect.
• Mentally capable of making his or her own care decision.

Death with Dignity legislation doesn’t apply to patients that are in a vegetative state. The process can be very long. First, you or your loved one must find a physician willing to assist you (doctors have the choice to opt-out of assisting patients). Then you must make two oral requests and one written request, and wait for two waiting periods. The written request must have witnesses and follow signing formalities similar to a will.

Eight states and the District of Columbia have laws allowing your loved one’s physician to aid in their death. The details for each state are below:

• California: The End of Life Option Act came into effect in 2016. Two different physicians must confirm that the patient meets the requirements for receiving end-of-life medication. At the time the bill was passed, 65% of Californians supported the law. . 
• Colorado: Passed in 2016, about 65 percent of Colorado voters approved  Proposition 106, the End of Life Options Act. Colorado’s law further protects your loved one by imposing criminal penalties for tampering with or coercing end-of-life requests. The patient must make the decision to request and to take the  medication out of their free will.  
• District of Columbia: The D.C. Death with Dignity Act of 2016 was implemented in 2017 with overwhelming support. In D.C., it is up to the attending physician to decide if the patient meets the residency rule for medication. 
• Hawaii: The Our Care, Our Choice Act went into effect in Hawaii in 2019. Multiple amendments seeking to make access to physician-assisted death have been introduced in the 2020 legislative session.
• Maine: The Maine Death with Dignity Act was effective as of January 1, 2020. A 2017 poll showed that 73 percent of Maine residents supported the law prior to its passing. Support was spread across all demographics. 
• New Jersey: The Medical Aid in Dying for the Terminally Ill Act was passed in 2019. The law faced pushback on constitutional grounds but was upheld in the N.J. Appellate Court. The Medical Society of New Jersey firmly opposes the law.
• Oregon: This was the first state with a physician-assisted death statue. Oregon’s Death With Dignity Act was enacted in 1997. Starting in 2020, patients with less than 15 days to live no longer need to wait 15 days between the first and second oral request. Patients with less than 48 hours to live are exempt from the 48-hour waiting period between the written request and the prescription.Vermont: The Patient Choice and Control at the End of Life Act was passed in 2013. In 2017, a federal judge dismissed a case challenging the law’s requirement that physicians discuss all end-of-life options, including aid in dying, with their patients.
• Washington: Since 2009, Washington residents have had the option to use the Washington Death with Dignity Act. The act imposes criminal sanctions for altering or forging a request, or coercing a patient to make a request. 

Supporters for Death with Dignity Laws bring up some common points listed below. Use these thoughts as a starting point to look inwards to think about what the best decision for you might be.

• You might not want to suffer any longer or your treatment is too painful.
• You have the right to die the way you want.
• You can plan ahead for your death and have your loved ones around you. If you are in control of when you take the medication then you can make sure your friends and family are present. 

Many end-of-life organizations provide more support for you or your loved one. For example, End of Life Washington provides counseling and support services. While on average few people use the law, it makes a huge difference for those that have the option. 

States that Don’t Have “Death with Dignity” Laws

More states don’t have death with dignity laws than those that do. There are a variety of reasons Americans don’t support the right to physician-assisted death. Here are some of the common arguments: 

• It violates the Hippocratic Oath: A form of this ancient Greek oath is sworn by medical students worldwide. It is often summarized: “First, do no harm”” Supporters of the oath say that death with dignity laws violate the physician’s duty to not harm the patient. 
• It can be abused: Family or physicians may be able to abuse the law. Family members could coerce the dying into asking for medication to gain status or inheritance. Physicians may push the drug to receive compensation.
• It goes against the U.S. Constitution: Supporters of the law argue that the Constitution protects the personal choice to die. Opponents have argued that a requirement that the physician notify the patient of the option violates the physician’s right to free speech and that it goes against the physician’s religious freedoms. 

The following states are not considering physician-assisted death laws now: Alabama, Alaska, Arkansas, Connecticut, Delaware, Florida, Idaho, Illinois, Kansas, Louisiana, Michigan, Mississippi, Missouri, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, West Virginia, and Wyoming.

Death with Dignity law continues to be debated. These states will consider passing the law in 2020: Arizona, Georgia, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Utah, Virginia, and Wisconsin.

Lastly, there is the state of Montana. While Montana does not have a codified physician-assisted death statute, the Montana Supreme Court ruled in 2009 that nothing in state law prohibited a physician from honoring a terminally ill patient’s request for end-of-life medication.

Constitutional rights in Montana allows for both ‘individual privacy’ and ‘human dignity,’ so, Montana residents have the right to death options. Multiple bills have been introduced in the legislature both to explicitly permit and to prohibit aid-in-dying, but none have passed to date. 

Alternative Choices

If you think physician-assisted suicide is a good option for yourself or your loved one but it is not permitted in your state, you do have other options. Below are just a few alternative death options that are legal in every state. 

• You can stop eating or drinking. 
• You can start or stop your medical treatment. 
• Palliative sedation can be used to make yourself or your loved one unconscious. People under palliative sedation die within a few days from the lack of food and water. 

None of these options are easy choices. Before starting any of them, make sure to discuss your health plan and needs with your physician, friends, and family. Death is not easy, and it’s important to be surrounded by support.

Tip: Your healthcare decisions are something you can include in your living will and advance directives. Create your legal health documents, assign someone to make decisions on your behalf, and more with Trust & Will. You don't need any lawyer or office visits to get your voice heard. 

Death is a Journey 

Before making the step to begin a new journey in death, you may want to consider the family and friends you are leaving behind. An end-of-life checklist can assist you in documents and plans you may not have thought about. These may include your burial, memorial, health-care proxy, or even a care plan for your pet.

To have an open conversation about death you must know the laws. From there you can make an informed decision about your or your loved one’s end-of-life plan. For up to date information about end of death laws you can refer to your state’s department of health website. 

The organization Death with Dignity regularly posts updates about changing state regulations. They also provide additional support for terminally ill patients and their loved ones. 

Remember to be easy on yourself or your loved one during this difficult time. With gentle words, caring hearts, and a bit of planning ahead you can make the right end-of-life choice for yourself or your loved one. From creating a free, legal will online with FreeWill to talking to your loved ones about your own final wishes, each step matters. 

Sources

1. Brenan, Megan. “Americans' Strong Support for Euthanasia Persists.” Gallup, May 31, 2018, www.news.gallup.com/poll/235145/americans-strong-support-euthanasia-persists.aspx
2. “End-of-Life Resources for Patients and Families.” Death with Dignity. www.deathwithdignity.org/learn/end-of-life-resources/
3. DiCamillo, M. Strong Voter Support for the “End of Life Option Act.” Field Poll, Field Research Corporation. October 2015.
4. “Polling on Voter Support for Medical Aid in Dying for Terminally Ill Adults.” Compassion and Choices, www.compassionandchoices.org/wp-content/uploads/2018/06/FS-Medical-Aid-in-Dying-Survey- Results-FINAL-updated-7.9.18.pdf
5. “Death with Dignity Program Frequently Asked Questions.” DC Health, www. dchealth.dc.gov/sites/default/files/dc/sites/doh/page_content/attachments/Death%20with%20Dignity%20-%20Frequently%20Asked%20Questions%20%28FAQ%29.03.20.18.pdf
6. “New Jersey Medical Aid in Dying for the Terminally Ill Act Frequently Asked Questions.” July 31, 2019, www.state.nj.us/health/advancedirective/documents/maid/MAID_FAQ.pdf
7. Pugliese, Nicholas. “Assisted suicide is legal in N.J. But key medical society still opposed after vote,” May 7, 2019, www.whyy.org/articles/assisted-suicide-opposed-by-nj-doctors-despite-new-law/
8. Tyson, Peter. “The Hippocratic Oath Today,” PBS, March 26, 2001,  www.pbs.org/wgbh/nova/article/hippocratic-oath-today/