Legal status of PAD/MAID as of August 31, 2019.
​Copyright (c) 2019, Jennifer Ballentine. All rights reserved. For permission to reproduce, email jennifer@irisproject.net. 
In 2019, legislation to legalize physician-assisted death was introduced or carried over from prior years in 20 states. In Hawai'i, the "Our Care, Our Choice Act"  took effect in January, 2019; New Jersey passed the "Medical Aid in Dying Act," effective August 1, and Maine passed a "Death With Dignity Act," bringing the number of jurisdictions in which the practice is explicitly legal to nine: Oregon, Washington, Vermont, California, Colorado, Washington, DC, Hawai'i, New Jersey, and Maine. However, a lawsuit was filed in opposition to New Jersey's law and a temporary injunction was filed and then lifted. The law remains in effect while the lawsuit continues. A lawsuit was also filed in August in Colorado, contesting the Catholic health systems' ability to constrain physicians from participating in the End of Life Options Act while not on facility premises. The law is ambiguous as to the extent of health systems/organizations' control over even employed physicians off site. In response, the Catholic health system (Centura) fired the physician, setting up yet more legal contention. The lawsuit filed in 2016 challenging the California End of Life Option Act continues, but the law remains in effect in the meantime. 

In 2019, bills to legalize medical aid in dying were tabled or defeated in 14 states, and Arkansas passed a bill increasing the penalty for any healthcare provider to assist in a patient's suicide including by prescribing lethal medications to a Class B Felony. A bill in Oregon passed, representing the first expansion to that state's law in more than 20 years, allowing physicians to waive the 15-day waiting period for patients deemed likely to die before the 15 days are up.  
Physician-assisted death has been legalized in Oregon (1997), Washington (2008), Vermont (2013), California (2015), Colorado (2016). A Death with Dignity law was passed in Washington, D.C. in late 2016 and has technically gone into effect, but still faces opposition in the U.S. Congress, and as noted in an article posted below, to date not a single patient has utilized it. In April, 2018, Hawai'i passed the "Our Care, Our Choice" Act, legalizing medical aid in dying in a seventh jurisdiction, effective in January 2019. The legal status of the practice in Montana is controversial: a state Supreme Court ruling in 2009 essentially ruled that if a doctor. who has administered or prescribed a lethal prescription to a terminally ill person. is charged with a homicide, he or she might have a potential defense based on consent. However, the state has no statutory framework for immunity from prosecution nor any regulatory guidelines for the practice. There is also no reliable data available on its prevalence. 

Here are links to the current statutes and a comparison table of the several laws, and to statistical reports on utilization.

Position Statements

State Hospice Organizations

Other Healthcare and Advocacy Groups

NEW National Hospice and Palliative Care Organization, 2019: Supports individual's rights to autonomy but opposes "legally accelerated death" as a societal option; calls for further expansion of and access to early palliative care.

Alzheimer's Association, 1998: Neutral/lean oppose: emphasizes rights of individuals to refuse life-sustaining treatment; encourages support through natural death.

American Academy of Family Physicians (AAFP), 2013: Neutral; recognizes that requests may happen; Work to relieve suffering; Continue care even in face of requests.

American Academy of Medical Ethics (AAME), 2014: Strongly opposes; considers the practice dangerous to patients, providers, and society.

American Association of Hospice and Palliative Medicine (AAHPM), Update 2016: "Studied neutrality": Recognizes risks of unintended long-term consequences for the practice of medicine and the physician--patient relationship. Also recognizes that, in rare cases, suffering can exceed our ability to relieve it, which may generate requests for PAD. Recommends seeking all sources of relief of suffering before considering requests; provides rubric for evaluating requests; Recommends withholding/withdrawing LST, VSED, total sedation as alternatives; For physicians in states where legal, proceed with extreme caution; Studied neutrality as an organization.

American Association of Professional Chaplains (APC), 2014: No explicit mention except in example: being able to articulate ethical pros/cons and relevant state laws if subject raised by patient.

American College of Medical Quality (ACMQ), 2010: Opposes; recommends physicians be allowed to “disengage” with this aspect of pt’s care if pt in legal jurisdiction insists despite aggressive efforts to relieve suffering, while continuing to provide other care.

American College of Physicians, 2017: Reaffirms 2001 position, finding the ethical and legal arguments opposing physician-assisted death to continue to be compelling.

American College of Physicians—American Society of Internal Medicine (ACP-ASIM), 2001: Opposes; references OR results, in particular reasons for requesting. Questions whether it is physician’s role to assist patients in controlling manner, place of death.

American Medical Association (AMA), 2016: Reaffirmed in 2016 comprehensive overhaul of the AMA code of ethics, the AMA unequivocally opposes PAS as “fundamentally incompatible with physician’s role”; statement on EOL care urges best efforts to relieve suffering, nonabandonment, upholding dignity, honoring patient preferences and goals, attending to bereaved.

American Medical Directors Association (AMDA), 1997: Unequivocal opposition to any participation in PAS.

American Nurses Association (ANA), 2013: Code of ethics strictly forbids participation in PAS by nurses as strictly prohibited on basis incompatible with professional role; Recognizes that such a policy does not solve the distress of nurses fielding requests, practicing in states where legal, or may be personally in favor; Emphasizes continued education on communication, methods to relieve suffering of all kinds, professional support.

American Psychiatric Association (APA), December 2016. Opposed for non-terminally persons.

American Psychological Association (APA), no date, but apparently pre-2008: Neither supports nor opposes but recognizes crucial role of psychologists in assessing suicidal intent and offering counseling to distressed individuals and resolves to prepare profession for dealing with issue.

American Society of Health-System Pharmacists (ASHP), Neutral/lean oppose: Emphasizes role of trust in provider-patient; provider-health system; provider-care team relationships; Supports rights of pharmacists to decide whether to participate or not; Provides rubric for decision making.

The Arc (for People with Intellectual and Developmental Disabilities), 2013: PAS must be prohibited for persons with intellectual and developmental disabilities due to inherent risk of undue influence.

Hospice and Palliative Nurses Association (HPNA), 2011: Opposes legalization PAS; Affirms nurses as vigilant advocates for humane and ethical care for alleviating suffering and nonabandonment; Supports public policy that advances access and quality of palliative and hospice care.

National Association of Social Workers (NASW), 2005: Neither supports nor opposes; recommends practice “being present” with patients and families requesting PAS in states where legal. Code of Ethics of the National Association of Social Workers. Washington DC: NASW Press, 2010.

National POLST Paradigm Taskforce statement, 2015, distinguishing POLST (physician orders for life-sustaining treatment) advance care planning tool from physician-assisted death. 

Not Dead Yet, 2015: Talking points and lessons from disability history positing that PAS is a form of "deadly discrimination"

World Medical Association (WMA), 2005: Opposed; PAS is unethical and "must be condemned by the medical profession."

Organizations Opposing

Popular Press, Op-Eds, Talking Points

"Doctor Assisted Suicide Is Contagious, Too. Why Aren't We Sounding the Alarm?" Kansas City Star, June 21, 2018.

"A Year After DC Passed Its Controversial Assisted Suicide Law, Not a Single Patient Has Used It." Washington Post, April 10, 2018.

Jennifer Moore Ballentine, "Compassionate Responses to Suffering at the End of Life," Colorado Medicine, May/June 2017

Jennifer Moore Ballentine, "Law and Sausage: Physician-Assisted Death and the Solution to Suffering," Natural Transitions magazine (7/2016)

"Physician Aid in Dying by Advance Directive," Bioethics Blog Tracker, Bioethics Research Library of Georgetown University (3/2/2017)

"The Effect of Legalizing Assisted Suicide on Palliative Care and Suicide Rates: A Response to Compassion and Choices," Richard Doerflinger, MA, for the Charlotte Lozier Institute (3/3/2017).

"I'm dying of brain cancer. I prepared to end my life. Then I kept living." (Washington Post, 9/29/17). A unique perspective from a current terminal patient.

"About 30 hospitals opting out of Colorado’s medical aid-in-dying law" The Denver Post, January 26, 2017.

"Voting for aid in dying was easy, but one Colorado couple struggled toward a graceful death," The Denver Post, December 14, 2017.

A radio interview on "Colorado Matters" (Colorado Public Radio, 2/27/2016) discussing concerns about the new Colorado End-of-Life Options Act and educational programs to ensure providers understand the law, their responsibilities, and their choices with respect to participation.

"Oregon State Assisted Suicide Reports Substantiate Critics' Concerns," Not Dead Yet (10/4/2016)

"Docs in Northwest Tweak Aid-in-Dying Drugs to Prevent Prolonged Deaths," JoNel Aleccia, Kaiser Health News (2/21/2017).

"'Take My Name Off the List; I Can't Do Any More': Some Doctors Are Backing Out of Assisted Death," Sharon Kirkey, The National Post (Canada, 2/26/2017)

"Doctor-Assisted Suicide? Neutrality is not an option," Frederick J. White, MD, Orlando Sentinel (11/20/16). A physician asserts that neutrality on the question of physician-assisted death equates to support, and that the moral standing afforded to physicians by society requires that they be clear about whether they will or will not kill certain patients.

"No on Proposition 106," The Denver Post opposes legalization of physician-assisted death in Colorado (10/11/16)

"In D.C., a Deadly Experiment on the Poor," Richard Doerflinger, National Review (10/28/16). A cogent unpacking of the Washington state statistics on Death With Dignity to expose concerns relevant to Washington D.C.

"Against Euphemisms--Part 4--Assisted Death," Drew Rosielle, MD, Pallimed blog (7/26/16)

"A Doctor-Assisted Disaster for Medicine," William L. Toffler, MD, Wall Street Journal (8/17/15)

Marilyn Golden, Disability Rights Education and Action Fund, "Why Assisted Suicide Must Not Be Legalized"

Katherine Sleeman, "Assisted Dying Debate, Bristol Museum" (1/26/15)

New Hampshire Public Radio, "Debating Physician-Assisted Suicide: The Risks vs The Right to Choose," (3/6/16)

Ryan T. Anderson, PhD, The Heritage Foundation, "Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality" (3/2015)
​
Eddie Ytuarte, Peace and Freedom Party, California's Feminist Socialist Political Party, "Why I Am Against Physician-Assisted Suicide," 2007.

Ryan T. Anderson, PhD, "Physician-Assisted Suicide Is Always Wrong," Newsweek (3/26/15)

"14 Reasons to Oppose Physician-Assisted Suicide," prepared by the New Jersey Hospice and Palliative Care Organization to defeat proposed bill, 2015.

​Hospice Opposes Physician-Assisted Suicide (1/15/15)

Ira Byock, MD, editorial in LA Times, "We should think twice about 'death with dignity'" (1/30/15)

Ira Byock, MD, editorial in NY Times, "Dying shouldn't be so brutal" (1/31/15)

Ira Byock, MD, Vermont Senate Testimony (1/31/13)

Ira Byock, MD, article in Politico, "Democrats shouldn't endorse suicide," (6/8/2015)

Rachel Aviv, article in The New Yorker, "The Death Treatment,"(6/22/2015), detailing the practices of physician-assisted suicide and euthanasia for depression in Belgium

A 20-minute televised interview with Jennifer Ballentine (opposing), Barbara Combs Lee (President Compassion & Choices, supporting) and two legislator bill sponsors (supporting) (2/1/15).

A brief televised interview with Jennifer Ballentine (opposing) regarding PAS and a difficult patient case in Denver (1/17/15)

Disability Rights Education and Defense Fund, "A Progressive case against an assisted suicide law" (2014)

Ezekiel Emanuel, MD, editorial in NY Times, "Four myths about doctor-assisted suicide" (10/27/12)

E.J. Dionne, Jr., Washington Post blog, "Liberals should be wary of physician-assisted suicide" (11/12)

Vickie Kennedy (widow of Sen. Edward Kennedy), Cape Cod Times op-ed, "Question 2 insults Kennedy's memory" (10/12). Note: Question 2 was a ballot initiative launched in Mass. to legalize PAS. It failed in November 2012.

Harvey Chochinov, MD, The Providence (blog), "We (Canadians) have the right to die but no right to quality palliative care" (2/15)

Wilson, J., CNN online news, “Suicide tourism” to Switzerland has doubled since 2009" (2014).

Engber, M., Slate, "How does assisted suicide work: A guide to Death with Dignity in Oregon" October 6, 2005.

Peer-Reviewed Journal Articles and Chapters

As these articles are mostly published in subscription-based journals or books, we can't post links. However, individual copies may be requested: Contact Us.

NEW! Nowels, D., VanderKeift, G., & Ballentine, J. (2018). Curbside Commentary: Medical aid in dying. American Family Physician, 97(5), 341-343B.

Jones, D.A., & Paton, D. (2015). How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide? Southern Medical Journal, 108, 599-604. doi: DOI: 10.14423/SMJ.0000000000000349.

Ballentine, J.M., Kassner, C., & Byock, I. (2016). Physician-assisted death does not improve end-of-life care. Journal of Palliative Medicine, 19(5). Online: doi: 10.1089/jpm.2016.0035.

Byock, I. (in press). The case against physician-assisted suicide. The Oxford Handbook of Death and Dying. New York: Oxford University Press.

Byock, I. (2010). Dying with dignity. The Hastings Center Report offprint. 

Campbell, C. (2008, Fall). Ten years of “Death with Dignity,” The New Atlantis, 33–46.

Campbell, C. S., & Black, M. A. (2014, Jan). Dignity, death, and dilemma: A study of Washington hospices and physician-assisted death. Journal of Pain & Symptom Management, 47(1), 137–153.

Campbell, C. S., & Cox, J. C. (2010, Sept-Oct). Hospice and physician-assisted death: Collaboration, compliance, and complicity. Hastings Center Report, 26–35.

Chambaere, K., et al. (2015). Recent trends in euthanasia and other practices in Belgium. Letter to the editor, New England Journal of Medicine, 372(12), 1179-1181.

Emanuel, E. (2002). Euthanasia and physician-assisted suicide: A review of the empirical data from the United States. Archives of Internal Medicine, 162, 142–152.

Ganzini, L. et al. (2001). Oregon physician’s attitudes about and experiences with end-of-life care since passage of the Oregon Death with Dignity Act. Journal of the American Medical Association, 285(18), 2363–2369.

Ganzini, L., Goy, E. R., & Dobscha, S. K. (2008). Prevalence of depression and anxiety in patients requesting physicians' aid in dying: Cross-sectional study. British Medical Journal, 337, online publication. doi: 10.1136/bmj.a1682.

Hendin, H., & Foley, K. (2008). Physician-assisted suicide in Oregon: A medical perspective. Michigan Law Review, 106, 1613–1639.

Jackson, A. (2008). The inevitable—death: Oregon’s end-of-life choices. Willamette Law Review, 45, 137–160.

Meier, D. et al. (2003). Characteristics of patients requesting and receiving physician-assisted death. Archives of Internal Medicine, 163, 1537–1542.

Onwuteaka-Philipsen, B. D., et al. (2012). Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: A repeated cross-sectional study. Lancet, published online  July 11, 2012; doi: 10.1016/S0140-6736(12)61034-4.

Orentlicher, D. (2000). Implementation of Oregon’s Death with Dignity Act: Reassuring, but more data needed. Psychology, Public Policy, and Law, 6(2), 489–502.

Pearlman, R. A., & Starks, H. 2004. Why do people seek physician-assisted death? In Quill, T. E., & Battin, M. P. (Eds.). 2004. Physician-assisted dying: The case for palliative care & patient choice. Baltimore: Johns Hopkins University Press, pp. 91–101.

Quill, T. E., & Miller, F. G. (Eds.). 2014. Palliative care and ethics. New York: Oxford University Press.

Steinbok, B. (2005). The case for physician-assisted suicide: Not (yet) proven. Journal of Medical Ethics 31, 235–41.

Steinbrook, R. (2008). Physician-assisted death—From Oregon to Washington state. New England Journal of Medicine, 359(24), 2513–2515.

Stevens, K. (2006). Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians. Issues in Law and Medicine, 21(3), 187–200.

Tolle, S., et al. (2004, Summer). Characteristics of proportion of dying Oregonians who personally consider physician-assisted suicide. Journal of Clinical Ethics, 15(2), 111–122.

Uhlmann, M. M. (Ed.) 1998. Last rights? Assisted suicide and euthanasia debated. Grand Rapids, MI: William B. Eerdmans Publishing Company.

Yang, Y.T., & Curlin, F.A. (2016). Why physicians should oppose assisted suicide. Journal of the American Medical Association, 315(3), 247–248.

Zucker, M.B. (1999). The right-to-die debate: A documentary history. Westport, CT: Greenwood Press.