Euthanasia or assisted suicide is legal in roughly a dozen countries, though the rules differ dramatically from one place to the next. The countries where euthanasia is legal in its fullest sense, meaning a doctor may directly administer a lethal medication, are the Netherlands, Belgium, Luxembourg, Spain, Colombia, Ecuador, Canada, and New Zealand. A separate group, including Switzerland, Germany, Austria, and Italy, permits only assisted suicide, where a doctor provides the drug but the patient takes it themselves. Australia and the United States have legalized assisted dying at the state level rather than nationally. Eligibility, waiting periods, and residency rules vary enough that “legal” tells only part of the story.
Countries Where a Doctor May Administer the Lethal Medication
Active euthanasia carries the strictest legal requirements because the physician performs the final act.
The Netherlands
The Netherlands was the first country to codify active euthanasia, through the Termination of Life on Request and Assisted Suicide (Review Procedures) Act, which took effect in 2002. A physician may administer a lethal dose to a patient who meets six statutory due care criteria, including unbearable suffering with no prospect of improvement and a voluntary, well-considered request. Five regional review committees examine every case after the fact, and a physician found to have breached the criteria can be reported to the Public Prosecution Service and face up to 12 years in prison.1Government of the Netherlands. Is Euthanasia Legal in the Netherlands?
Belgium
Belgium legalized euthanasia through the Belgian Act on Euthanasia of 2002 for patients with constant and unbearable physical or psychological suffering from a serious and incurable condition. In 2014 Belgium became the only country to remove all age restrictions. A minor of any age may qualify if diagnosed with a terminal illness causing severe physical suffering, but only with parental consent and after a pediatric psychiatrist confirms the child has the capacity to understand the request.
Luxembourg
Luxembourg’s euthanasia law, enacted on 16 March 2009, covers both euthanasia and assisted suicide.2Government of Luxembourg. My Will at the End of Life The patient must be an adult, legally competent, and suffering from a serious, incurable condition with no prospect of improvement. A doctor who follows the statutory procedure receives legal immunity.
Spain
Spain’s Organic Law 3/2021 for the Regulation of Euthanasia, effective June 2021, treats euthanasia as a right within the national health system. Applicants must be Spanish nationals or legal residents for at least 12 months and must suffer from either a serious and incurable disease or a chronic, debilitating condition causing intolerable suffering. The process requires two written requests separated by at least 15 days, review by both the attending doctor and a consulting doctor, and final approval by a regional Guarantee and Evaluation Commission.
Colombia
Colombia reached legal euthanasia through constitutional litigation rather than legislation. In 2021 the Constitutional Court issued Sentencia C-233, extending the right to a dignified death beyond terminally ill patients to anyone with a serious, incurable condition causing intense suffering, even when death is not imminent.3Alcaldía de Bogotá. Sentencia C-233 de 2021 Corte Constitucional de Colombia
Ecuador
Ecuador’s Constitutional Court ruled in 2024 (No. 067-23-IN) that the country’s homicide-by-compassion statute could not be used to punish doctors who perform euthanasia for patients with serious and irreversible injuries or incurable diseases causing intense suffering, provided the patient gives unequivocal, free, and informed consent. The court ordered the Ministry of Public Health to issue implementing regulations within two months and directed the National Assembly to pass a formal euthanasia law within 12 months.
Canada
Canada’s Medical Assistance in Dying (MAID) framework allows both physician administration and self-administered medication. Bill C-7, passed in March 2021, removed the earlier requirement that natural death be “reasonably foreseeable” and created a two-track system.4Department of Justice Canada. Bill C-7 – An Act to Amend the Criminal Code (Medical Assistance in Dying) Track one covers patients whose death is reasonably foreseeable. Track two covers patients with chronic but non-terminal conditions and adds a 90-day waiting period plus consultation with a specialist in the relevant condition.5Library of Parliament. Medical Assistance in Dying in Canada After Carter v. Canada
People whose sole underlying condition is a mental illness cannot access MAID. That exclusion was originally set to expire in 2023, but the federal government has extended it twice, pushing the earliest possible expansion to March 17, 2027.6Government of Canada. The Government of Canada Introduces Legislation to Delay Medical Assistance in Dying Expansion by 3 Years
New Zealand
New Zealand’s End of Life Choice Act 2019 came into force in November 2021 after a public referendum approved it alongside the 2020 general election.7Ministry of Health NZ. Review of the End of Life Choice Act A doctor or nurse practitioner administers the medication. The patient must be 18 or older, a citizen or permanent resident, and suffering from a terminal illness likely to end their life within six months, with a serious and irreversible decline in physical capability and unbearable suffering that cannot be adequately relieved.8Health New Zealand. Assisted Dying
Countries Where Only Patient Self-Administration Is Legal
In several countries a doctor may prescribe or supply the lethal medication, but the patient must perform the final act. The distinction matters legally because it shifts the direct cause of death from physician to patient.
Switzerland
Switzerland never formally legalized assisted dying through dedicated legislation. Article 115 of the Swiss Criminal Code makes assisting a suicide punishable only when the person providing help acts from selfish motives. That negative framing created space for nonprofit organizations to facilitate assisted suicide for patients who meet medical criteria. A licensed doctor must review each case and prescribe the lethal dose, which the patient then takes themselves. Active euthanasia remains illegal.
Germany
Germany’s Federal Constitutional Court ruled in February 2020 that the general right of personality under the Basic Law includes a right to a self-determined death, and that this right extends to seeking and using help from willing third parties.9Federal Constitutional Court. Criminalisation of Assisted Suicide Services Unconstitutional The ruling struck down a 2015 law that had criminalized organized suicide assistance. Germany has not yet passed replacement legislation; two draft bills presented to the Bundestag in July 2023 both failed to win a majority. Assisted suicide is permitted in principle, but no regulatory framework governs the process.
Austria
Austria’s Assisted Dying Act (Sterbeverfügungsgesetz) took effect on January 1, 2022, after the country’s Constitutional Court struck down the blanket ban on assisted suicide. Adults who are terminally ill or have a permanent, debilitating condition may arrange for an assisted death. After a mandatory waiting period the patient obtains lethal medication from a pharmacy on providing documentation to a lawyer or notary. Only self-administration is legal.
Italy
Italian law shifted after Constitutional Court Judgment No. 242 of 2019, which carved out a narrow exception to the criminal ban on assisting suicide. Assistance is not punishable when provided to a patient who is kept alive by life-sustaining treatments such as artificial hydration or nutrition, suffers from an irreversible condition causing intolerable physical or psychological suffering, and retains full capacity to make an informed decision.10Constitutional Court of Italy. Judgment No. 242 Year 2019 A public health facility must verify these conditions, and the local ethics committee must be consulted. Italy has not passed comprehensive legislation, so the court ruling remains the operative framework.
Australia and the United States: Legal in Some States, Not All
Two large federations have legalized assisted dying at the subnational level. Access depends on where you live.
Australia
Every Australian state has now enacted a voluntary assisted dying law. Victoria was first, with its Voluntary Assisted Dying Act 2017 taking effect in June 2019.11Victorian Legislation and Parliamentary Documents. Voluntary Assisted Dying Act 2017 Western Australia followed with its own Voluntary Assisted Dying Act 2019, which requires the person to be an Australian citizen or permanent resident, to have lived in Western Australia for at least 12 months, to have an advanced and progressive disease expected to cause death within six months (or 12 months for neurodegenerative conditions), and to be experiencing suffering that cannot be relieved in a way the person considers tolerable.12Western Australian Legislation. Voluntary Assisted Dying Act 2019 Queensland, South Australia, Tasmania, and New South Wales have similar frameworks. All require two independent medical assessments and mandatory reporting to a dedicated review board.
United States
Medical aid in dying is authorized in 13 states and the District of Columbia: Oregon (1994), Washington (2008), Montana (2009), Vermont (2013), California (2015), Colorado (2016), the District of Columbia (2016), Hawaii (2018), New Jersey (2019), Maine (2019), New Mexico (2021), Delaware (2025), Illinois (2025), and New York (2026). Montana stands apart because access rests on a court ruling rather than a specific statute.
All of these jurisdictions follow the model pioneered by Oregon’s Death with Dignity Act. The patient must be an adult diagnosed with a terminal disease expected to cause death within six months, capable of making an informed decision, and voluntarily expressing the wish to die.13Oregon Health Authority. Oregon Revised Statute – Oregon’s Death with Dignity Act The patient self-administers the prescribed medication. Oregon’s statute expressly says nothing in the act authorizes lethal injection, mercy killing, or active euthanasia.14Oregon Public Law. Oregon Code 127.880 – Section 3.14 Construction of Act Federal law does not address the issue one way or the other, leaving it entirely to state regulation.
Who Qualifies
National laws vary, but the safeguards line up on a few common threads.
The most common medical threshold is a terminal diagnosis with death expected within six months. Oregon, Washington, all Australian states, and New Zealand use this standard.15Washington State Department of Health. Death with Dignity Act Several European countries set a broader bar. The Netherlands, Belgium, and Spain allow access for people with serious and incurable conditions causing unbearable suffering, even if death is not imminent. Canada’s two-track system accommodates both: track one for patients near death, track two for chronic conditions that are intolerable but not terminal.16Department of Justice Canada. Canada’s Medical Assistance in Dying (MAID) Law Colombia and Ecuador similarly do not require a terminal prognosis.
Every jurisdiction requires mental capacity to understand the decision and its consequences. Two independent physicians must separately confirm the diagnosis and verify that the request is voluntary and free from external pressure. In Canada’s track two and in several European countries, at least one of those physicians must have expertise in the condition causing the suffering. Spain adds a third layer of review through its regional Guarantee and Evaluation Commission, which includes both a doctor and a legal professional.
Repeated requests and waiting periods are near-universal. Spain mandates two written requests at least 15 days apart. Canada’s track two imposes a 90-day waiting period between the first assessment and the provision of MAID. Oregon and most US states require two oral requests and one written request, with a waiting period between them.
Can Foreigners Travel for It?
Most countries restrict access to their own citizens or legal residents. New Zealand requires citizenship or permanent residency. Spain requires 12 months of legal residency. Western Australia requires 12 months of ordinary residence in the state. Canada requires eligibility for government-funded health services.
Switzerland is the major exception. Because Swiss law targets only selfish motives rather than restricting who may be helped, people from other countries can travel there for assisted suicide if they meet the medical criteria. Nonprofit organizations such as Dignitas facilitate the process for international patients. Traveling to Switzerland for an assisted death is not illegal under Swiss law, but it can trigger a criminal investigation in the traveler’s home country. In England, Wales, and Northern Ireland, for example, helping someone travel abroad to die is technically a criminal offense, though prosecutions are rare.
US residency rules have been eroding. Oregon stopped enforcing its residency requirement in 2022 after a legal challenge, and Vermont eliminated its requirement in 2023. The legal basis rests on the constitutional right to travel for medical care, and similar litigation may eventually reach other states. Most US jurisdictions still require proof of in-state residency through a driver’s license, voter registration, or utility bill.17Washington State Department of Health. Frequently Asked Questions About Death With Dignity