2025 was a historic year for the expansion and protection of end-of-life choice in the United States. The year brought remarkable victories, with Delaware, Illinois, and New York each passing new medical aid-in-dying laws, and a successful defense of the existing option in both Montana and California. Once all new laws are implemented, approximately one in three adults in the United States will live in one of the 14 jurisdictions where medical aid in dying is authorized.

This growing wave of support is no accident. For 30 years, U.S. medical aid-in-dying laws have functioned responsibly and predictably — without eligibility expansions beyond their original scope and without the “slippery slope” predicted by opponents. Instead, these laws have fulfilled their promise of increased choice at the end of life and solidified that the highest level of end-of-life care includes the option of medical aid in dying.

The U.S. approach to medical aid in dying is distinct and focused on autonomy. In countries outside of the United States, systems may allow clinician-administered euthanasia and/or non-terminal eligibility, as seen in Canada. In contrast, U.S. laws are intentionally narrow, limiting eligibility to terminally ill adults in their final six months or less of life who can make their own informed healthcare decisions and self-ingest the aid-in-dying medication. 

These safeguards have remained in place since the first medical aid-in-dying law was implemented in Oregon in 1997. (Montana is the only U.S. jurisdiction where medical aid in dying is authorized via state Supreme Court ruling rather than legislation, but medical providers in the state generally follow Oregon’s process and requirements.)

“The U.S. medical aid-in-dying model includes essential safeguards that put the terminally ill individual in the driver’s seat, affirming that this is their choice and their choice alone — every step of the way,” said Dan Diaz, longtime medical aid-in-dying advocate, volunteer, consultant, and Latino Leadership Council member for Compassion & Choices.  

His wife, Brittany Maynard, thrust medical aid in dying into the national spotlight in 2014 when they moved from their home state of California to Oregon so Brittany could avoid the excruciatingly painful death associated with glioblastoma. At that time, medical aid in dying was not authorized in California, and Oregon’s aid-in-dying law required residency.

“Though getting through the process can be arduous, as it was for us at times, the layers of affirmation required of Brittany meant that there was no question at any point that it was her wish to use medical aid in dying.” 

Importantly, medical aid in dying is not a fringe practice. It is part of a continuum of high-quality, patient-centered and patient-directed end-of-life care, alongside options like palliative care and hospice. It is part of a continuum of high-quality, patient-centered end-of-life care. Many factors inform the highest standard of end-of-life care, including timely access to both hospice and palliative services and care support for people living with disabilities. It also requires access to the care you want – whether that’s curative care or the ability to refuse care per your values and priorities. Reaching this standard of care means that every person receives fully informed consent and value-based, patient-directed care.

Evidence also shows that states that have authorized medical aid in dying experience higher rates of hospice utilization, earlier and more meaningful end-of-life conversations, and greater patient satisfaction. 

Transforming end-of-life care includes the fight to provide access to medical aid in dying – which millions of people like you have spearheaded. Three decades of evidence demonstrate that it is an established, carefully safeguarded, and deeply compassionate medical practice that strengthens the full range of end-of-life care, honors individual autonomy, and helps ensure that people facing terminal illness can receive care aligned with their values, beliefs, and priorities at life’s end.