Intended for healthcare professionals


Assisted dying in US and Canada: controversy subsides after legalisation

BMJ 2018; 360 doi: (Published 07 February 2018) Cite this as: BMJ 2018;360:k503
  1. Bob Roehr, freelance journalist, Washington, DC, USA
  1. bobroehr{at}

What happens when the law changes to allow some terminally ill people to choose how and when they die? Bob Roehr reports on doctors’ and public attitudes in the North American jurisdictions that allow medical aid in dying

More than a quarter of Americans and Canadians now have the option of choosing a medically assisted death. California and Canada legalised the procedure in 2016, following five other US states and Washington, DC, in offering terminally ill patients access to drugs to induce death if they meet strict legal criteria (box 1).

Box 1

Assisted dying in North America

Oregon was the first US state to allow assisted dying in 1997. It established strict criteria to access the process, including mental competence, a terminal illness with a life expectancy of less than six months, and agreement of a second physician. Safeguards ensure good pain management and end-of-life care and that the patient does not feel undue pressure to choose the option. It has served as a model for other jurisdictions.

Oregon voters relied on a ballot initiative process to secure their death with dignity act (51% voting in favour in 1994 and 60% in 1997), when politicians refused to enact what their constituents had demanded; political fear of the issue is another precedent that has largely stood the test of time.

Washington state (2008), Montana (2009), and Vermont (2013) followed Oregon’s lead. But the big expansion of coverage has occurred in the past two years as California, Colorado, and Washington, DC, have implemented assisted dying, raising to 18% the portion of the US population now offered the option. All of Canada also joined the fold, though implementation has been inconsistent at the provincial level.

Congress twice tried and failed to pass a national ban on assisted dying after Oregon passed its measure. But opponents did succeed in …

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