Assisted suicide is legal in Switzerland, the Netherlands, Belgium, Luxembourg, Germany, Austria, Spain, Canada, Colombia, Ecuador, every Australian state and territory, New Zealand, and fourteen U.S. states plus Washington, D.C. The countries where assisted suicide is legal do not all permit the same thing, however. Some allow only self-administered lethal medication; others also allow a doctor to directly end a patient’s life through euthanasia; a handful permit both. Eligibility, residency rules, and the medical threshold that qualifies a patient shift substantially from one jurisdiction to the next.
The Legal Distinction That Shapes Every Law
Almost every national law depends on which side of a single line it sits. In assisted suicide, a doctor prescribes or provides a lethal substance, and the patient must take it without help by swallowing a drink, opening a valve, or performing the final act alone. In euthanasia, a clinician directly administers the substance, typically by injection. The country entries below note which form each jurisdiction permits, because that choice drives who qualifies and what the process looks like.
Switzerland
Switzerland has permitted assisted suicide since its criminal code was drafted in 1937, making it the longest-standing legal framework in the world. Article 115 of the Swiss Criminal Code treats helping someone end their life as legal as long as the person assisting has no selfish motive.1Federal Office of Justice. Euthanasia There is no specific medical statute governing the practice, so nonprofit organizations fill the gap. Dignitas accepts foreign nationals; EXIT serves Swiss residents. Both require medical documentation and a confirmed diagnosis under internal protocols, but the legal threshold itself is broad: there is no requirement that the person be terminally ill. The patient must be physically capable of performing the final act. Clinician-administered euthanasia remains illegal.
Because Switzerland relies on private nonprofits rather than the public health system, the cost is not covered by insurance. Dignitas publishes total fees of 7,500 Swiss francs if the family handles funeral and administrative arrangements, or 11,000 francs if Dignitas manages everything.2DIGNITAS. Costs
The Netherlands, Belgium, and Luxembourg
The Netherlands was the first country to formally legalize euthanasia, through its Termination of Life on Request and Assisted Suicide (Review Procedures) Act, which took effect in 2002. A physician may directly administer a lethal substance or prescribe one for self-administration, provided six due care criteria are met, including a voluntary and well-considered request, unbearable suffering with no prospect of improvement, and consultation with at least one independent physician. Regional review committees evaluate every case after the fact.3Government of the Netherlands. Is Euthanasia Legal in the Netherlands
Belgium passed its own euthanasia law in 2002, using a similar framework. In 2014 Belgium became the only country in the world to remove all age restrictions. Minors may qualify if they have a terminal illness causing unbearable physical suffering, are deemed capable of understanding their decision, have parental consent, and are evaluated by a child psychiatrist or psychologist.
Luxembourg legalized both euthanasia and assisted suicide in 2009. The patient must be an adult with a serious and incurable condition causing constant, unbearable suffering with no prospect of improvement. A second independent physician must confirm the diagnosis, and the treating doctor must report every case to a national oversight commission within four business days.
Germany and Austria
Germany’s Federal Constitutional Court ruled in February 2020 that the right to a self-determined death is protected under the constitution’s guarantee of personal autonomy, striking down a criminal ban on organized assisted suicide services.4Federal Constitutional Court. Criminalisation of Assisted Suicide Services Unconstitutional Germany has been working on legislation to regulate the practice since the ruling, but as of 2026 no comprehensive statute has been enacted. Assisted suicide is legal but largely unregulated at the federal level.
Austria followed a similar path. Its constitutional court struck down a blanket prohibition, and a new law took effect on January 1, 2022. The framework is limited to assisted suicide; clinician-administered euthanasia remains illegal. Applicants must be either terminally ill or have a serious, chronic condition, and must obtain clearance from two physicians.
Spain and Portugal
Spain’s Organic Law on the Regulation of Euthanasia took effect on June 25, 2021, legalizing both euthanasia and assisted suicide through a single statute. Eligible patients must have a serious and incurable illness, or a serious, chronic, and incapacitating condition producing suffering of great intensity. Psychiatric disorders are explicitly excluded as a standalone basis.
Portugal’s parliament passed Law No. 22/2023 after overriding a presidential veto, but the law is not yet operational. A Constitutional Court ruling in April 2025 required clarifications about the procedural framework, pausing implementation until the legislature amends the text. If it takes effect, the law would prioritize self-administration, permit clinician-administered euthanasia only when the patient is physically unable to take the medication independently, and expressly bar nonresidents from access.
Canada
Canada’s Medical Assistance in Dying (MAID) framework is among the most developed in the world. The Supreme Court of Canada’s 2015 decision in Carter v. Canada struck down criminal prohibitions on assisted dying, and Parliament responded in 2016 with federal legislation.5Department of Justice Canada. Canada’s Medical Assistance in Dying (MAID) Law The law permits both clinician-administered and self-administered forms, though in practice the vast majority of MAID deaths involve a physician or nurse practitioner administering a lethal injection.6Canada.ca. Medical Assistance in Dying: Overview
Applicants must be at least 18, eligible for publicly funded health services in Canada, and suffering from a serious and incurable illness, disease, or disability. The person must be in an advanced state of irreversible decline and experiencing enduring, intolerable physical or psychological suffering that cannot be relieved under conditions they consider acceptable. A 2021 amendment removed the requirement that death be reasonably foreseeable, significantly broadening access. If death is not reasonably foreseeable, at least 90 days must pass between the first assessment and the procedure, and one of the two assessors must have relevant expertise in the patient’s condition.
Colombia and Ecuador
Colombia was the first country in the Americas to legalize euthanasia, through a series of Constitutional Court rulings beginning in 1997. The framework was created by judges rather than legislators. The court ordered the health system to provide euthanasia services to qualifying patients and later extended the right to include assisted suicide. Implementation has been uneven, with access depending on the willingness of individual hospitals and physicians.
Ecuador became the second Latin American country to decriminalize euthanasia when its Constitutional Court issued a ruling in February 2024, holding that criminal homicide provisions would no longer apply to clinicians assisting in a patient’s death under defined circumstances. Lawmakers were ordered to draft formal regulations. As of 2026, those regulations are still being developed.
Australia and New Zealand
Every Australian state and territory now has a voluntary assisted dying law in effect. Victoria was first, passing its Voluntary Assisted Dying Act in 2017, followed by Western Australia (commenced July 2021), Tasmania and Queensland (both 2022), South Australia (January 2023), New South Wales (November 2023), and the Australian Capital Territory (November 2025). The laws generally allow both self-administration and clinician-administered assistance, with self-administration as the default. Each state requires a terminal diagnosis with a prognosis of six months or less, extended to twelve months for neurodegenerative conditions. Applicants must be Australian citizens or permanent residents of the relevant state.
New Zealand’s End of Life Choice Act took effect on November 7, 2021, after passing a binding public referendum the previous year.7Ministry of Health NZ. Review of the End of Life Choice Act The law permits both forms for adults with a terminal illness likely to end their life within six months. New Zealand citizens and permanent residents are eligible; the law does not extend to foreign nationals.
United States
As of 2026, fourteen states and Washington, D.C., authorize medical aid in dying. Oregon was the pioneer, enacting its Death with Dignity Act by ballot measure in 1994, with implementation beginning in 1997.8Oregon Health Authority. Death with Dignity Act History Washington followed in 2008, and Montana’s Supreme Court ruled in 2009 that nothing in state law prohibited a physician from honoring a terminally ill patient’s request. Vermont (2013), California (2015), Colorado (2016), Washington, D.C. (2016), Hawaii (2018), New Jersey (2019), Maine (2019), New Mexico (2021), Delaware (2025), Illinois (2025), and New York (2026) have since enacted their own laws.
Every U.S. jurisdiction limits assisted dying to self-administration. A physician prescribes the lethal medication, but the patient must ingest it without clinical intervention. Euthanasia remains illegal everywhere in the United States. Each state requires a terminal diagnosis with a life expectancy of six months or less, and two physicians must confirm both the diagnosis and the patient’s mental capacity. Waiting periods vary: Oregon requires 15 days between oral requests, with an exemption for patients whose life expectancy is shorter than that.9Oregon Health Authority. Frequently Asked Questions – Death with Dignity Act California shortened its waiting period from 15 days to 48 hours in 2022.
Residency Rules and Access for Foreign Nationals
Most jurisdictions restrict assisted dying to their own residents. Australia’s state laws require citizenship or permanent residency of the specific state. New Zealand limits access to citizens and permanent residents. Portugal’s law, if it takes effect, would expressly bar nonresidents.
Switzerland is the outlier. Dignitas accepts foreign nationals, and Switzerland’s law does not impose a residency requirement, which is why most cases of international travel for assisted dying involve Switzerland. Within the United States, Oregon and Vermont have removed their residency requirements. Oregon stopped enforcing its residency provision in 2022 following a federal lawsuit settlement, and Vermont formally eliminated the requirement by legislation in 2023. A patient traveling to either state still must establish a relationship with a prescribing physician there and complete all required evaluations in-state.
Common Eligibility Threads
Despite the wide variation, most jurisdictions share a common framework. Applicants must be legal adults, typically at least 18, with the mental capacity to make their own medical decisions. Belgium is the sole exception, allowing minors to request euthanasia under strict conditions. The request must be voluntary, free from outside pressure, and made repeatedly over a defined period.
The medical threshold varies more. In the United States, Australia, and New Zealand, eligibility is limited to people with a terminal illness and a short life expectancy. Canada, the Netherlands, Belgium, Luxembourg, and Spain extend access to people with serious, incurable conditions causing unbearable suffering, even if death is not imminent. Switzerland is the most permissive: there is no requirement that the patient have a terminal or even a physical illness, though the assisting organizations impose their own medical standards.
Nearly every jurisdiction requires confirmation from at least two physicians. The first certifies the diagnosis and prognosis; the second provides an independent evaluation of both the medical condition and the patient’s decision-making capacity. If there is any doubt about mental competency, a psychological or psychiatric evaluation is typically required.
How Assisted Dying Affects Life Insurance
In the United States, every state with a death-with-dignity law includes a provision stating that the death does not legally constitute suicide. Washington’s law, for example, specifies that a qualified patient’s decision to ingest the prescribed medication “shall not have an effect upon a life, health, or accident insurance or annuity policy.”10Washington State Department of Health. Frequently Asked Questions About Death With Dignity Insurers cannot condition the issuance or pricing of a policy on whether someone has requested assisted dying medication.
Cross-border situations are more complicated. If a patient obtains a prescription under one state’s law but takes the medication in a different state that does not have an assisted dying statute, the legal protections may not follow. The death could be classified as suicide under the second state’s law, potentially triggering a suicide exclusion clause. Most policies exclude suicide within the first two years of coverage, so newer policies carry more risk. Completing the process in the jurisdiction that issued the prescription avoids the problem.
Where the Law Is Still Moving
Whether mental illness alone should qualify someone for assisted dying is the most contested question in this area of law. The Netherlands and Belgium already permit euthanasia for patients whose sole condition is psychiatric, though the practical barriers are high and the cases are a small fraction of total approvals. Canada was set to expand MAID eligibility to people whose sole underlying condition is mental illness, but the government has delayed that change three times. The current legislated date is March 17, 2027.11Canada.ca. Medical Assistance in Dying: Legislation in Canada A special parliamentary committee was reconvened in early 2026 to study the issue, with recommendations expected in late 2026. Spain has taken the opposite position, with its Constitutional Court explicitly ruling that psychiatric disorders cannot serve as the basis for an assisted dying request.
No country forces individual doctors to participate. Every jurisdiction with a legal framework includes a conscientious objection provision. In Canada and several European countries, a physician who refuses is generally required to provide an “effective referral” to a willing provider. Faith-based hospital systems in multiple countries and in many U.S. states prohibit assisted dying on their premises, and in rural areas where a single hospital system dominates, that institutional refusal can effectively block access even where the law permits it.