assisted suicide in the united states assisted suicide in the united states assisted suicide is suicide with the aid of another person. in the united states, the term "assisted suicide" is typically used to describe what proponents refer to as medical aid in dying, in which terminally ill adults are prescribed and self-administer barbiturates if they feel that they are suffering significantly. the term is often used interchangeably with physician-assisted suicide (pas), "physician-assisted dying", "physician-assisted death", "assisted death" and "medical aid in dying" (maid). state laws regarding assisted suicide in the united states legal legal under court ruling1 illegal 1 in its 2009 decision baxter v. montana, the montana supreme court ruled that assisted suicide did not violate montana legal precedent or state statutes, even though no montana laws specifically allowed it. assisted suicide is similar to but distinct from euthanasia (sometimes called "mercy killing"). in cases of euthanasia, another party acts to bring about the person's death in order to end ongoing suffering. in cases of assisted suicide, a second person provides the means through which the individual is able to voluntarily end their own life, but they do not directly cause the individual's death. physician-assisted suicide, or "medical aid in dying" is legal in eleven jurisdictions: california, colorado, district of columbia, hawaii, montana, maine, new jersey, new mexico, oregon, vermont, and washington. these laws (excluding montana since there is no law) expressly state that "actions taken in accordance with shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law". this distinguishes the legal act of "medical aid in dying" from the act of helping someone die by suicide, which is prohibited by statute in 42 states and prohibited by common law in an additional six states and the district of columbia. a 2018 poll by gallup displayed that a solid majority of americans, with 72 percent in favor, support laws allowing patients to seek the assistance of a physician in ending their life. nevertheless, assisted suicide remains illegal in a majority of states across the nation. in 2022, the state of oregon ruled it unconstitutional to refuse assisted suicide to people from other states who are willing to travel to oregon to die that way, effectively giving out of state residents the opportunity to die by physician-assisted suicide. before someone travels to oregon to die by physician assisted suicide, those helping the patient travel to oregon might be prosecuted for assisting a suicide. after the barbiturates are acquired, if the patient returns to their home state, those assisting with mixing the fatal dose of barbiturates may be prosecuted for assisting a suicide. vermont removed its residency requirement in 2023 to settle a lawsuit. the punishment for participating in physician-assisted death varies throughout the other states. the state of wyoming does not "recognize common law crimes and does not have a statute specifically prohibiting physician-assisted suicide". in florida, "every person deliberately assisting another in the commission of self-murder shall be guilty of manslaughter, a felony of the second degree". history early movements the first significant drive to legalize assisted suicide in the united states arose in the early years of the twentieth century. in a 2004 article in the bulletin of the history of medicine, brown university historian jacob m. appel documented extensive political debate over legislation to legalize physician-assisted death in iowa and ohio in 1906. in ohio, the legislation was inspired by the campaign of heiress anna sophina hall, whose mother had died a long, drawn-out, painful death from liver cancer. despite hall's efforts, the bill was rejected by the ohio legislature by a vote of 79 to 23. glucksberg v. washington dr. harold glucksberg, in 1994, along with four other physicians, three terminally ill patients, and compassion and dying, brought a case against the state of washington for banning assisted suicide. the case was filed in district court in 1994. following a series of appeals, the u.s. supreme court decided in 1997 in a unanimous decision to uphold washington's ban. they cited the due process clause and argued that assisted suicide is not guaranteed as a fundamental liberty protected by due process. the case allowed individual states to decide independently on the medical aid-in-dying issue. it set the stage for legislative efforts on the state level to either permit or ban physician-assisted suicide. dr. kevorkian assisted suicide in the united states was brought to public attention in the 1990s with the highly publicized case of dr. jack kevorkian. kevorkian assisted over 40 people in dying by suicide in michigan. his first public assisted suicide was in 1990, of janet adkins, a 54-year-old woman diagnosed with early-onset alzheimer's disease in 1989. he was charged with murder, but charges were dropped on december 13, 1990, because there were no michigan laws outlawing suicide or the medical assistance of it so he was not in violation of a law. in 1998, kevorkian videotaped himself giving a man a lethal injection, with the patient's consent, and aired the tape on 60 minutes. this was significantly different from previous cases, where it was always the patients themselves who reportedly completed the suicide process. he was found guilty of second-degree murder and served eight years of a 10–25 year sentence. he was released in 2007, and died on june 3, 2011. legalization by states physician-assisted dying was first legalized by the 1994 oregon death with dignity act, with effect delayed by lawsuits until 1997. the montana supreme court ruled in baxter v. montana (2009) that it found no state law or public policy reason that would prohibit physician-assisted dying. it was legalized by washington (state) in 2008, vermont in 2013, california and washington, d.c., and colorado in 2016, hawaii in 2018, new jersey in 2019, maine in 2020, and new mexico in 2021 it had also been briefly legal in new mexico in 2014 and 2015 due to a court decision that was overturned. brittany maynard in 2014, the death of brittany maynard, an advocate for the legalization of aid in dying, from brain cancer led to renewed debate in the united states over assisted suicide, and was cited as being responsible for bills in several states on the topic. her home state of california, which she left to reside in oregon to access its death with dignity act, became the fifth state to authorize aid in dying, in 2015. jurisdictions where assisted suicide is authorized california main article: california end of life option act in 1992, the group californians against human suffering proposed proposition 161 to allow patients with less than six months to live the right to receive assistance from physicians in dying. this proposition offered more safeguards against abuse by physicians than washington's initiative 119, such as special protections for patients in nursing facilities. this measure failed to pass with 46 percent of the vote. between 1990 and 1995, physicians became increasingly more receptive to the concept of assisted suicide. subsequent efforts were tried to pass assisted death legalization through the california state legislature in 1999, 2005, and 2006, all of which failed. the california legislature passed the california end of life option act, a bill legalizing the practice in september 2015, and the bill was signed into law by governor jerry brown on october 5, 2015, making california the fifth state to authorize medical aid in dying and the second to do so through the legislature. the act began implementation on june 9, 2016. the law went into effect in june 2016. the bill allows medication to be prescribed by a licensed physician to a patient who is over the age of 18, living with a chronic and life altering condition that is irreversible, and must be of sound mind to make these decisions. in may 2018, judge daniel a. ottolia of the superior court of riverside county ruled that the method of enacting the law was unconstitutional, but the law was reinstated by a state appeals court the following month. the 2016 law as passed was only valid for a period of 10 years and was set to need renewal by 2026. on 5 october 2021, california governor gavin newsom signed on to extend the use of the bill until 1 january 2031. the revised bill also shorted the waiting period of approval from 15 days to 48 hours and required health care providers to publish information regarding end of life care on their website. colorado representatives lois court and joann ginal introduced assisted suicide legislation in 2015 in the colorado house. the bill was voted down in committee 8–5. in april 2016, julie selsberg and jaren ducker filed an initiative with the secretary of state seeking to authorize medical aid in dying in november 2016 through the ballot process. on november 8, 2016, colorado voters passed proposition 106, the colorado end of life options act, making assisted death legal among patients with a terminal illness. with 65% voting in favor, colorado became the third state to legalize medical aid-in-dying by a vote of the people, raising the total to six states. district of columbia in january 2015, d.c. council member mary m. cheh introduced the death with dignity act of 2015. on october 5, 2016, the d.c. committee on health and human services voted 3–2 for the death with dignity act. on november 1, 2016, the d.c. council voted 11–2 to advance the death with dignity act. it then went through another vote in the council and the mayor's office. mayor bowser signed the bill on december 23, 2016. after the-30 day u.s. congress review mandated by the federal home rule act, and following the inability of congressional republicans to block the bill, the law went into effect on february 18, 2017, with d.c. becoming the seventh jurisdiction in the u.s. to legalize this. hawaii since 2019, hawaii has legally allowed assisted dying, based on the oregon and washington state models. governor david ige signed a medical aid-in-dying law on april 5, 2018. the law has safeguards to protect against abuse, including two health care providers being required to confirm a patient's diagnosis, prognosis, his or her ability to make decisions, and that the patient's request is voluntary; as well as a counselor being required to determine that the patient does not have conditions that may interfere with decision-making, such as untreated depression. the law requires that the patient must make two oral requests for the life-ending medication, with a 20-day waiting period in between, and sign a written request witnessed by two people, one of whom cannot be a relative. criminal penalties apply to anyone attempting to coerce people into obtaining life-ending medication or tampering with said patient's request. maine the maine death with dignity act was introduced in the state legislature in 2019 by representative patricia hymanson (d-york). the bill passed in the house by 73 to 72 and in the senate by 19 to 16. on june 12, 2019, governor janet mills signed the maine death with dignity act into law making maine the ninth jurisdiction to legalize assisted suicide in the united states. montana aid in dying is legal in montana through a state supreme court decision. in baxter v. montana (2009) the montana supreme court ruled in a 5–2 decision that state law allows for terminally ill montanans to request lethal medication from a physician under existing statutes, in 2009. the attorney general of the state of montana sought an appeal from the montana supreme court, but the court, by a decision of five to two, affirmed the lower court's ruling on the state law. the court did, however, limit the scope of the decision by not determining if the state's constitution protected the right. new jersey a new jersey assembly committee voted in favor of assisted suicide legislation, and the full state assembly voted on assemblyman john burzichelli's bill, known as a 2270, the new jersey death with dignity act, on november 13, 2014, although the bill failed to receive a vote in the senate. the bill would have required patients with a terminal disease to first verbally request a prescription from their attending physician, followed by a second verbal request at least 15 days later and one request in writing signed by two witnesses. in addition, the attending physician would have