While comprehensive comfort care to manage suffering is a universally accepted standard, physician- assisted dying is only legal in fourteen states in the United States of America.
This season of HBO’s series, The Pitt, provided a glimpse of the hearbreaking choices individuals with terminal diagnoses have to navigate. Roxie Hamler was brought to the emergency room with a fractured tibia. We learn that she had been battling terminal lung cancer that has spread to her bones. She never smoked. She was only 40 years old. And she had two young sons who she’ll knew would grow up without her.
“I don’t even know what hurts more,” she tells her doctor, “the cancer or knowing I’m never gonna see my sons grow up.”
It was heartwrenching!
Roxie’s story resonates because it reflects a reality many families face. When someone you love is dying, and the pain becomes unbearable, the question of how that person will spend their final days becomes deeply emotional.
In the show, Roxie receives aggressive comfort care to manage her suffering. Her doctors administer morphine in increasingly higher doses, understanding that easing her pain may also hasten her death. This is standard hospice practice and legal everywhere.
But some families find themselves asking a different question: What if the dying person wants to choose the moment and manner of their death, rather than enduring years of pain and suffering while waiting for the disease to take them?
What is Physician-Assisted Dying?
Physician-assisted dying allows a terminally ill adult to request medication they can take themselves to end their life peacefully. It’s not the same as euthanasia, where a doctor administers the medication directly.
In every state where physician-assisted dying is legal, the patient must be the one to take the final action.
The laws are designed to ensure the decision belongs entirely to the person who is dying. Involuntary euthanasia, where someone’s life is ended without their consent, is illegal everywhere in the United States. The laws we’re discussing here apply only to competent adults who make a voluntary, informed choice.
US States Where Physician-Assisted Dying is Authorized
As of 2026, physician-assisted dying is legal in fourteen U.S. jurisdictions.
Oregon was the first, passing its Death with Dignity Act in 1997. Washington followed in 2008. Montana allows the practice through a 2009 state supreme court ruling rather than legislation.Vermont enacted its law in 2013, followed by California and Colorado in 2016. The District of Columbia authorized medical aid in dying in 2017.
Hawaii, New Jersey, and Maine all passed laws in 2019, and New Mexico followed in 2023. More recently, Delaware’s law took effect on January 1, 2026.
Illinois signed its End-of-Life Options for Terminally Ill Patients Act in December 2025, which takes effect in September 2026. And New York’s governor signed that state’s Medical Aid in Dying Act in February 2026, which takes effect in August of 2026.
Each state’s approach differs in the details, but they share a common framework built around safeguards.
The Core Requirements of Physician-Assisted Dying Laws
States that authorize physician-assisted dying impose strict requirements. These exist to protect vulnerable people from coercion and to ensure the decision is truly voluntary.
Terminal Diagnosis. The person must have a terminal illness expected to result in death within six months. Two independent physicians must confirm this prognosis. This is the same timeframe that typically qualifies someone for hospice care.
Residency. Most states require the person to be a resident of the authorizing state. Proof of residency, such as a driver’s license or voter registration, is typically required. However, Oregon and Vermont have removed their residency requirements. In both these states, qualified non-residents may now access medical aid in dying, though the entire process, from evaluation to administration of the medication, must take place within state borders.
Mental Capacity. The person must demonstrate they can make informed healthcare decisions. If there’s any question about cognitive impairment or mental illness affecting judgment, a psychiatric evaluation may be required.
Voluntariness. The request must be entirely the person’s own choice, free from pressure by family members, caregivers, or anyone else. Written requests typically must be signed in front of witnesses who are not family members or beneficiaries of the person’s estate.
Waiting Periods. Most states require time between the initial request and receiving the medication. This waiting period gives the person time to reflect, change their mind, or explore other options.
Clinician Involvement. The prescribing clinician must confirm the diagnosis, verify the request is voluntary, and inform the patient about alternatives, including palliative care and hospice. Detailed reporting to state authorities is also required.
Self-Administration. The patient must take the medication themselves. A clinician cannot administer it.
The Difference Between Comfort Care and Physician-Assisted Dying
Comfort care, including hospice and palliative medicine, focuses on relieving suffering at the end of life. Doctors may administer medications like morphine to control pain, even knowing those medications could potentially hasten death. The intent of palliative care is to ease suffering, not to cause death. This practice is legal in all fifty states and is a cornerstone of compassionate end-of-life care.
Physician-assisted dying is different. The explicit purpose of the prescribed medication is to end life. The patient takes it with that understanding. The legal frameworks exist to ensure this choice is made freely and with full information.
Roxie Hamler’s situation in The Pitt falls into the first category. Her doctors weren’t helping her die. They were helping her not suffer while she was dying.
What Families Should Consider When Contemplating Physician-Assisted Dying
If you or someone you love is facing a terminal diagnosis, understanding your options is important.
Talk with healthcare providers who understand end-of-life care. Palliative medicine specialists and hospice teams can explain the full range of options, from aggressive pain management to comfort-focused care to, in some states, physician-assisted dying.
Consider consulting with an attorney familiar with healthcare laws in your state. This is especially true if you’re dealing with complex family dynamics, questions about capacity, or concerns about how decisions will be documented.
Communicate openly with family members. End-of-life decisions affect everyone who loves the person who is dying. Clear conversations now can prevent misunderstandings and conflict later.Document your wishes. Whether or not you pursue physician-assisted dying, having a clear Advance Directive or Living Will helps ensure your preferences will be honored.
A Personal Decision
There’s no single right answer to how we face the end of life. Some people find meaning in fighting until the very last moment. Others want peace and control over their final days. Some families find comfort in hospice care. Others want every available option on the table. What matters most is that these choices belong to the person who is living them.
If you’re navigating these questions, know that you don’t have to figure it out alone. An experienced estate planning attorney or healthcare provider can help you understand what’s possible in your state and how to document your wishes clearly. That guidance can bring peace of mind during an extraordinarily difficult time.
