Ten jurisdictions currently allow physician-administered euthanasia: the Netherlands, Belgium, Luxembourg, Spain, Canada, Colombia, New Zealand, Portugal, Ecuador, and every Australian state (along with the Australian Capital Territory). The countries where euthanasia is legal each set their own rules on who qualifies, what medical conditions count, and whether foreigners can apply. A separate group of places, including Switzerland and 14 U.S. jurisdictions, permits only assisted suicide, which is legally distinct: the patient, not the doctor, performs the final act.
Euthanasia vs. Assisted Suicide
The line between the two comes down to who administers the lethal medication. In euthanasia, a physician does it directly. In assisted suicide, the physician prescribes the drug and the patient takes it themselves. Some countries permit both; others allow only one. A country listed as permitting “assisted dying” may not actually allow a doctor to administer the medication, so the specific form matters for anyone trying to understand where they, or a family member, could qualify.
The Netherlands
The Netherlands was the first country to legalize euthanasia, through the Termination of Life on Request and Assisted Suicide Act, which took effect in 2002. The practice remains a criminal offense under the Penal Code, but a physician who follows six statutory “due care” criteria is exempt from prosecution. The doctor must be satisfied that the request is voluntary and well-considered, that the suffering is unbearable with no prospect of improvement, that the patient has been informed of their situation and prognosis, and that no reasonable alternative exists. An independent second doctor must examine the patient, and the procedure must be carried out with proper medical care.1Government of the Netherlands. Is Euthanasia Legal in the Netherlands?
Dutch law does not require a terminal diagnosis. It also permits euthanasia for psychiatric suffering alone, though an additional opinion from a specialist in the patient’s disorder is required. There is no minimum age; minors aged 12 and older can request the procedure, with parental consent needed for those under 16. The Netherlands is one of the few places that recognizes a written advance directive as a substitute for an oral request, which can matter for patients facing advanced dementia or loss of consciousness.
Belgium
Belgium’s Euthanasia Act also passed in 2002. The patient must have a serious and incurable condition causing constant and unbearable physical or psychological suffering that cannot be relieved. In 2014, Belgium became the first country to remove all age restrictions. Minors can request euthanasia only if they are terminally ill, in constant physical pain, and possess what the law calls “capacity of discernment,” which a child psychiatrist or psychologist must confirm. The minor’s legal representatives must also agree.2The Law Library of Congress. Regulation of Assisted Dying Belgium allows advance declarations, but only for patients in an irreversible state of unconsciousness.
Luxembourg
Luxembourg passed its law on March 16, 2009. It closely mirrors the Belgian framework: a competent adult with an incurable condition causing persistent suffering, with a second independent physician consulted before the procedure. The law protects a doctor’s freedom of conscience, so physicians can decline to participate.3Ministry of Health (Luxembourg). Euthanasia and Assisted Suicide Law of 16 March 2009
Spain
Spain’s Organic Law 3/2021 took effect in June 2021 and covers both euthanasia and physician-assisted suicide.4European Parliament. Euthanasia Legislation in the EU Applicants must be 18 or older, Spanish nationals or legal residents who have lived in Spain for at least 12 months, and suffering from either a serious and incurable disease or a chronic, debilitating condition producing suffering they consider intolerable. The procedure is delivered through the National Health System and publicly funded.
Canada
Canada legalized medical assistance in dying (MAID) in 2016 and expanded the program in 2021 through Bill C-7. The most consequential change removed the requirement that a person’s natural death be “reasonably foreseeable,” meaning a terminal diagnosis is no longer required. The revised law created two tracks with different safeguards depending on how close the person is to a natural death.5Department of Justice Canada. Canada’s Medical Assistance in Dying (MAID) Law
When death is reasonably foreseeable, the process requires a written request signed by one independent witness, assessments by two independent practitioners, and an option to withdraw consent at any time. When death is not reasonably foreseeable, additional safeguards apply: a minimum 90-day assessment period, mandatory information about available treatments and supports, and consultation with a specialist if neither assessor has expertise in the patient’s condition. Applicants must be eligible for government-funded health services in their province or territory.6Health Canada. Medical Assistance in Dying: Overview
Colombia
Colombia legalized euthanasia through the courts. In 1997, the Constitutional Court ruled in Case C-239 that a physician who performs euthanasia for a terminally ill patient experiencing unbearable suffering cannot be held criminally liable.7Law Library of Congress. Decision C-239/97 Constitutional Court of Colombia on Constitutionality of Art. 326 of the Criminal Code In 2021, Ruling C-233 removed the terminal-illness requirement, opening access to anyone with a serious, incurable, and progressive condition causing intense suffering. Colombian nationals and foreign residents with valid residency status qualify; tourists do not.
New Zealand
The End of Life Choice Act 2019 took effect on November 7, 2021, after voters approved it in a referendum held alongside the 2020 general election.8Ministry of Health NZ. Review of the End of Life Choice Act Access is limited to New Zealand citizens and permanent residents aged 18 or older who have a terminal illness likely to end their life within six months, are in an advanced state of irreversible physical decline, and experience unbearable suffering that cannot be relieved in a way they find tolerable. A person does not qualify solely because of a mental illness, a disability, or advanced age.
Portugal
Portugal’s Law 22/2023, enacted in May 2023, is the most recent European legalization. It applies to Portuguese nationals and foreign residents; lawmakers explicitly excluded what they described as “medical tourism.” Eligible patients must be adults with a serious and incurable disease or a permanent injury of extreme severity causing intense physical or psychological suffering. Assisted suicide is the default method: a physician may administer the medication directly only when the patient is physically unable to do so. Advance directives cannot be used; the patient must be conscious and competent when the request is made.
Ecuador
On February 7, 2024, Ecuador’s Constitutional Court held that the crime of homicide no longer applies to physicians who perform euthanasia for a patient experiencing intense suffering from a serious, irreversible bodily injury or incurable illness, provided the patient gives free and informed consent. The Court gave lawmakers 12 months to draft implementing regulations, so the practical framework for applying was still being built after the ruling.
Australia
Australia has taken a state-by-state approach rather than passing a national law. Victoria was first, launching its voluntary assisted dying scheme in June 2019. Western Australia followed in July 2021, Tasmania in October 2022, Queensland and South Australia in early 2023, then New South Wales, and the Australian Capital Territory in November 2025. The Northern Territory had not legalized the practice as of late 2025, though legislation was in development. Each state’s law requires a terminal diagnosis with a defined life expectancy, typically six to twelve months, residency in the relevant state, and assessments by multiple physicians.
Countries That Allow Only Assisted Suicide
Two jurisdictions are often assumed to permit euthanasia but do not.
Switzerland
Active euthanasia is illegal in Switzerland. Assisted suicide is permitted provided the person assisting does not act from selfish motives and the patient performs the final act themselves.9Swiss Academy of Medical Sciences. Assisted Suicide Because the law focuses on the helper’s motive rather than the patient’s status, Switzerland imposes no residency requirement. Organizations such as Dignitas and Exit have assisted thousands of foreign nationals, a practice critics call “suicide tourism.” A physician must prescribe the medication, but the doctor does not administer it.
United States
No U.S. state permits euthanasia. Fourteen jurisdictions, including California, Colorado, Oregon, Washington, and the District of Columbia, allow medical aid in dying: a physician prescribes a lethal medication that the patient must take on their own. The Supreme Court ruled in 1997 that no federal law legalizes or prohibits the practice, leaving it to the states. Every state that permits it requires a terminal diagnosis with a prognosis of six months or less, mental competency, and a voluntary request. Oregon, which pioneered the model with its 1997 Death with Dignity Act, removed its residency requirement in 2023, meaning out-of-state patients can seek a prescription there.
Who Actually Qualifies
Across every country, three requirements recur: a qualifying medical condition, suffering that meets a defined threshold, and the patient’s mental competency to consent. Where the laws diverge is in how broadly each element is drawn.
New Zealand and the Australian states hew closest to a traditional terminal-illness model, requiring a condition likely to cause death within six months (or twelve months for neurodegenerative diseases in some Australian states). The U.S. jurisdictions with assisted-suicide laws use the same six-month framework. Canada sits at the other end: since 2021, no terminal prognosis is required, and people with chronic conditions causing enduring suffering can qualify.6Health Canada. Medical Assistance in Dying: Overview The Netherlands, Belgium, Luxembourg, Spain, and Colombia also do not require a terminal diagnosis, focusing instead on whether the suffering is unbearable and the condition untreatable. The Netherlands and Belgium go furthest by allowing euthanasia for psychiatric suffering alone, with additional specialist review.
Every jurisdiction requires the patient to be mentally competent when the request is made. The person must understand their diagnosis and prognosis, appreciate the alternatives, weigh the consequences, and communicate a clear choice. If those abilities cannot be demonstrated, the request will be denied regardless of the severity of the illness.6Health Canada. Medical Assistance in Dying: Overview Informed consent must be given without coercion, and most countries require the patient to reconfirm the decision immediately before the procedure. Canada’s “final consent” requirement can be waived in narrow circumstances for patients whose death is reasonably foreseeable.5Department of Justice Canada. Canada’s Medical Assistance in Dying (MAID) Law
Advance directives, which let a patient set out their wishes while still competent for use if they later lose capacity, are recognized in only a small number of countries. The Netherlands explicitly permits them; a written request drafted in the patient’s own words can replace the oral request otherwise required.1Government of the Netherlands. Is Euthanasia Legal in the Netherlands? Belgium allows advance declarations for patients in an irreversible state of unconsciousness. Portugal prohibits them outright. In most other countries, the patient must be able to confirm consent at or near the time of the procedure.
Residency rules are what stop most people from crossing borders to access euthanasia. Spain requires 12 months of legal residency. New Zealand limits access to citizens and permanent residents. Canada requires eligibility for provincial or territorial health coverage.6Health Canada. Medical Assistance in Dying: Overview Colombia extends access to foreign residents but excludes tourists. Portugal explicitly bars foreign visitors. Australian states require residency in the specific state where the application is made. Switzerland’s assisted-suicide framework remains the outlier, with no residency requirement at all, which is why it has become the destination for people whose home countries offer no legal route.