Death with Dignity Legislation Progress Across All U.S. States, Canada, Europe, & Latin America (Jan 2026 Update)

[Nelson Vergel]

COMPREHENSIVE ANALYSIS:​

Death with Dignity Legislation Progress​

Across All U.S. States (2025-2026)​

January 2026​

EXECUTIVE SUMMARY​

As of January 2026, death with dignity (also called medical aid in dying or MAID) is experiencing significant momentum across the United States. Currently, 13 jurisdictions have legalized MAID, with two more states poised to implement laws in 2026. Nearly 20 states considered MAID legislation in 2025, and approximately 75% of Americans support having this option available. This represents a substantial shift from Oregon's pioneering 1997 law, which stood alone for over a decade.

CURRENT LEGAL STATUS BY JURISDICTION​

FULLY LEGAL (13 Jurisdictions as of January 2026)​

States with Active Laws​

1. Oregon (1997) - Death with Dignity Act​

• First state to legalize via ballot measure (1994, effective 1997)
• Removed residency requirement in July 2023 (HB 2279)
• Physicians can waive 15-day waiting period for imminently dying patients
• Most recent data (2023): 1,281 prescriptions written

2. Washington (2008) - Death with Dignity Act​

• Passed by voter initiative (58% approval)
• Amended in 2023 to shorten waiting period from 15 to 7 days
• Expanded pool of qualified prescribers beyond just physicians
• February 2025: New bill proposed to eliminate 7-day waiting period for certain patients

3. Montana (2009) - Legal via Court Ruling​

• Baxter v. Montana Supreme Court decision
• No specific statute; legal through judicial precedent
• Consent can be used as defense against criminal liability
• Legislators have attempted to remove physician protections

4. Vermont (2013) - Patient Choice and Control at End of Life Act​

• First state to pass via legislative action (not ballot initiative)
• Removed residency requirement in May 2023
• Removed 48-hour waiting period
• Expanded access to telehealth visits
• Amendment pending to allow naturopathic doctors to participate

5. California (2016) - End of Life Option Act​

• Extended in 2021 to remain valid until January 1, 2031
• Shortened waiting period from 15 days to 48 hours (2021)
• Required healthcare providers to publish end-of-life care information
• 2023 data: 1,281 prescriptions, 884 deaths (69% utilization rate)
• 92.8% of users were 60+ years old, 93.8% receiving hospice/palliative care

6. Colorado (2016) - End of Life Options Act​

• Passed by ballot initiative
• 2017-2021 data: 777 patients prescribed, 583 dispensed (75%)
• 74% of patients aged 65+, 84.9% under hospice care

7. District of Columbia (2016) - Death with Dignity Act​

• D.C. Council voted 11-2 to advance
• Followed similar process to state legislation

8. Hawaii (2018) - Our Care, Our Choice Act​

• Amended in June 2023 to shorten reflection period from 20 to 5 days
• Opened procedure to advanced practice registered nurses

9. New Jersey (2019) - Medical Aid in Dying for the Terminally Ill Act​

• Effective August 1, 2019
• Federal court ruled in 2025 that law only covers state residents
• Some confusion about bills waiving 15-day waiting period

10. Maine (2020) - Death with Dignity Act​

• Amendment in committee to allow physicians to waive waiting periods
• Requires two oral requests with 20-day waiting period

11. New Mexico (2021) - Elizabeth Whitefield End-of-Life Options Act​

• Briefly legal in 2014-2015 via court decision (later overturned)
• Permanent legislation passed in 2021
• 2025 amendments expanded access

12. Delaware (January 1, 2026) - Ron Silverio/Heather Block End of Life Options Act​

• Signed May 20, 2025 by Governor Matt Meyer
• Became 12th jurisdiction to legalize
• Governor Carney had vetoed similar bill in September 2024
• Legislature passed 21-17 (House) and 11-8 (Senate)
• Landmark provision: Expands role of Advanced Practice Registered Nurses (APRNs) to prescribe life-ending medication
• Requires two verbal requests 15 days apart, one written request, 48-hour waiting period

13. Illinois (September 12, 2026) - End-of-Life Options Act (SB 1950)​

• Signed December 12, 2025 by Governor JB Pritzker
• House passed 63-42 (May 29, 2025), Senate passed 30-27 (October 31, 2025)
• 71% of Illinois voters supported the legislation
• First Midwest state to legalize MAID
• Requires 5-day waiting period (waived if patient has <5 days to live)

EXPECTED TO BECOME LEGAL IN 2026​

New York - Medical Aid in Dying Act (A136/S138)​

• Status: Governor Kathy Hochul announced December 17, 2025 she will sign with amendments
• Timeline: Legislature expected to pass amended version in late January 2026
• Effective Date: Six months after signing (approximately mid-2026)
• Key Amendments Required:
○ Mandatory 5-day waiting period
○ Required mental health evaluation by psychologist/psychiatrist
○ New York residency requirement
○ Written AND recorded oral attestation from patient
○ Prohibition on financial beneficiaries serving as witnesses
• Context: Bill had been introduced for 9 consecutive years before gaining traction
• Personal Note: Governor Hochul (Catholic) cited her mother's death from ALS as influencing her decision
• Public Support: 72% of New Yorkers support MAID
• Will become 14th U.S. jurisdiction

STATES ACTIVELY CONSIDERING LEGISLATION (2025-2026)​

High Activity States (Bills Introduced in 2025)​

State	Bill/Status	Notes
Massachusetts	Bill introduced, did not advance in 2025	Carries over to 2026
Minnesota	Bill introduced, did not advance in 2025	One of few potential Midwest states
Indiana	Bill introduced, did not advance in 2025	Carries over to 2026
New Hampshire	End of Life Freedom Act (HB254)	Introduced January 2025, did not advance
North Carolina	H410 - Study bill	Directs study on MAID, carries over to 2026
Pennsylvania	Compassionate Aid in Dying Act (HB1109/SB570)	Introduced April 2025, carries over to 2026
Maryland	Elijah E. Cummings Act	Reintroduced February 2025
Connecticut	Bill introduced in 2025	Did not advance
Florida	Bill introduced in 2025	Unlikely to pass
Arizona	Bill introduced in 2025	Did not advance
Kentucky	Bill introduced in 2025	Did not advance
Missouri	Bill introduced in 2025	Did not advance
Nevada	Legislation reintroduced	Governor vetoed previous attempt
Rhode Island	Bill introduced in 2025	Did not advance
Tennessee	Bill introduced in 2025	Unlikely to pass

STATES WITH NO CURRENT ACTIVITY​

The following states have not introduced MAID legislation recently and/or have prohibitions against assisted suicide. Note: 40 states currently prohibit assisted suicide and impose criminal penalties.

Southern States (Generally Opposed)​

Alabama, Arkansas, Georgia, Louisiana, Mississippi, South Carolina, Texas, Virginia, West Virginia

Great Plains/Mountain States (Generally Opposed)​

Idaho, Iowa, Kansas, Nebraska, North Dakota, South Dakota, Oklahoma, Utah, Wyoming

Other States​

Alaska, Michigan, Ohio, Wisconsin

KEY TRENDS AND PATTERNS​

Geographic Patterns​

• West Coast: All three states (California, Oregon, Washington) have legalized MAID
• Northeast Corridor: Growing momentum with Vermont, Maine, New Jersey, Delaware, and soon New York
• Midwest: Illinois breakthrough may signal shift; Minnesota considered possible next
• South: Minimal progress; cultural and religious opposition remains strong
• Mountain West: Limited progress except Colorado

Legislative Pathways​

• Ballot Initiatives: Oregon (1994), Washington (2008), Colorado (2016), California (2016)
• Legislative Action: Vermont (2013), D.C. (2016), Hawaii (2018), New Jersey (2019), Maine (2020), New Mexico (2021), Delaware (2025), Illinois (2025), New York (2026)
• Court Ruling: Montana (2009) - only via judicial precedent

Timeline Acceleration​

• 1997-2007: Only Oregon (10+ year gap before second state)
• 2008-2012: Only Washington added (5-year gap)
• 2013-2019: 5 new jurisdictions in 7 years
• 2020-2026: 6 new jurisdictions in 7 years

Recent Legislative Improvements​

Multiple states have amended their laws to expand access:
• Residency Requirements Removed: Oregon (2023), Vermont (2023) - now allow out-of-state residents
• Waiting Periods Shortened: California (15 days→48 hours), Hawaii (20 days→5 days), Washington (15 days→7 days)
• Provider Expansion: Hawaii and Delaware now allow APRNs to prescribe
• Telehealth Access: Vermont expanded telehealth options
• Imminent Death Exceptions: Oregon, Maine, Illinois allow waiver of waiting periods for imminently dying patients

COMMON LEGISLATIVE REQUIREMENTS​

All existing MAID laws share core requirements:

Patient Eligibility​

• Must be 18+ years of age
• State resident (except Oregon and Vermont)
• Terminally ill with prognosis of ≤6 months to live
• Mentally competent and capable of making healthcare decisions
• Able to self-administer medication (no assistance in ingestion)

Process Requirements​

• Two oral requests (separated by waiting period)
• One written request witnessed by two adults
• Confirmation by attending physician
• Second opinion from consulting physician
• Waiting period between requests (varies by state: 5-20 days)
• Additional waiting period after written request (typically 48 hours)
• Optional psychiatric evaluation if concerns about mental competence
• Must be voluntary and free from coercion

Safeguards​

• Witnesses cannot be heirs or beneficiaries
• Healthcare providers can opt out (conscientious objection)
• Death certificate lists underlying terminal illness, not suicide
• Self-administration requirement (physician cannot administer)
• Legal immunity for participating physicians following protocol

UTILIZATION DATA​

California (2023)​

• 1,281 prescriptions written
• 884 deaths (69% utilization rate)
• 92.8% were 60+ years old
• 97.1% had health insurance
• 93.8% receiving hospice/palliative care

Colorado (2017-2021)​

• 777 patients prescribed
• 583 dispensed (75% fill rate)
• 50.9% male
• 74% aged 65+
• 94.6% white
• 84.9% under hospice care

General Patterns​

• Less than 1% of eligible patients use MAID
• Most are elderly, insured, and already in hospice
• Primary motivations: autonomy, control, avoiding loss of dignity (not depression or lack of resources)

OPPOSITION AND CONTROVERSIES​

Primary Opponents​

• Religious organizations (Catholic Church, Evangelical groups)
• Some disability rights advocates (e.g., Not Dead Yet)
• Patients Rights Action Fund
• Euthanasia Prevention Coalition
• Some medical professional organizations

Key Arguments Against​

• Sanctity of life concerns
• Risk of coercion, especially for vulnerable populations
• Potential for misdiagnosis or inaccurate prognoses
• Concern about untreated depression
• Violates Hippocratic Oath ("do no harm")
• May undermine palliative care investment
• Alleged violation of Americans with Disabilities Act
• "Slippery slope" concerns about expanding eligibility

SUPPORT AND ADVOCACY​

Primary Supporters​

• Death with Dignity National Center
• Compassion & Choices
• End of Life Choices New York (EOLCNY)
• American Civil Liberties Union (ACLU)
• Many medical ethics experts

Key Arguments For​

• Patient autonomy and self-determination
• Compassionate response to intractable suffering
• Relief for patients and families
• "Shortens death, not life"
• Strong safeguards prevent abuse
• Decades of safe implementation in Oregon and other states
• Majority public support (75% nationally)

FEDERAL CONSIDERATIONS​

Current Federal Position​

• U.S. Supreme Court ruled there is no constitutional right to assisted suicide (states decide)
• Federal Assisted Suicide Funding Restriction Act of 1997: Prohibits federal funds for PAS
• Proposed: Patient Access to End of Life Care Act would create exception for states where MAID is legal

Interstate Issues​

• Most states require residency
• Federal court ruled (2025) New Jersey law only applies to residents
• Oregon and Vermont now allow non-residents (as of 2023)

PREDICTIONS FOR 2026 AND BEYOND​

Likely Near-Term Developments​

• New York will almost certainly become 14th jurisdiction (mid-2026)
• Massachusetts, Minnesota, Pennsylvania bills may gain traction with carryover
• More states will consider amendments to expand access:
○ Shortened waiting periods
○ Removal of residency requirements
○ APRN prescribing authority
○ Telehealth options

Expert Predictions​

Professor Thaddeus Mason Pope (Mitchell Hamline School of Law): "Generally blue states pass MAID legislation and red ones do not. Few expect to see MAID authorized in the South or even the Midwest except for Illinois and Minnesota."
• Nearly 20 states considered MAID legislation in 2025
• Public support remains around 75% nationally
• "Decades of experience in other states shows a solid patient safety track record"

Barriers to Further Expansion​

• Strong religious/conservative opposition in many states
• Political polarization (largely Democratic support, Republican opposition)
• Regional cultural differences
• Well-organized opposition groups
• Concerns about vulnerable populations

INTERNATIONAL CONTEXT​

Several countries have also legalized some form of medical assistance in dying:
• Canada (MAID since 2016, controversial expansions proposed)
• Netherlands (since 2002)
• Belgium (since 2002)
• Luxembourg (since 2009)
• Colombia (since 2015)
• Switzerland (long-standing practice)
• Germany (Constitutional Court ruling 2020)
• Spain (since 2021)
• Australia (various states since 2019)
• New Zealand (since 2021)
Note: Some international laws allow euthanasia (physician administration) in addition to assisted suicide (self-administration). U.S. laws only permit self-administration.

CONCLUSION​

Death with dignity legislation has evolved from Oregon's pioneering 1997 law to a growing movement with 13 legal jurisdictions and strong public support. The 2025-2026 period marks significant acceleration, with Delaware, Illinois, and New York representing diverse geographic regions. While expansion will likely continue in politically moderate and liberal states, significant cultural and religious opposition will probably prevent adoption in conservative Southern and Great Plains states for the foreseeable future.
The trend toward expanding access through shortened waiting periods, APRN prescribing authority, and removal of residency requirements suggests that even existing laws will continue to evolve toward greater accessibility while maintaining core safeguards.

SOURCES AND REFERENCES​

• Death with Dignity National Center (deathwithdignity.org)
• State legislative records and government websites
• Wikipedia: Assisted suicide in the United States
• Newsweek: Map Shows Assisted Dying Laws Across US (June 2025)
• Washington Examiner: States considering physician-assisted suicide
• US Funerals Online: Medical Aid in Dying in the United States 2026
• Catholic News Agency reports
• Human Life Action: Assisted Suicide Updates
• Compassion & Choices advocacy organization
• State health department annual reports (California, Colorado, Oregon)
• Academic legal journals and law school publications
• Governor press releases and official statements

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Document prepared January 2026​

 

[Nelson Vergel]

HOW TO ACCESS​

MEDICAL AID IN DYING (MAID)​

Step-by-Step Process Guide​

For States Where Death with Dignity is Legal​

GENERAL TIMELINE​

Minimum: 15-20 days (depending on state)

Typical: 3-6 weeks or longer

Can be expedited: If physician determines life expectancy is less than the waiting period

STEP 1: DETERMINE ELIGIBILITY​

You must meet ALL of these criteria:

Be 18 years or older

Be a resident of the state (except Oregon and Vermont, which now accept non-residents)

Have a terminal illness with prognosis of 6 months or less to live

Be mentally capable of making and communicating healthcare decisions

Be physically able to self-administer the medication (swallow pills/liquid)

Act voluntarily without coercion

STEP 2: FIND PARTICIPATING HEALTHCARE PROVIDERS​

This can be the most challenging step.

Options to Find Providers:​

Ask your current physician if they participate (participation is voluntary)

Contact advocacy organizations for referrals:

Death with Dignity National Center: [email protected]

Academy of Aid in Dying Medicine (AADM): Has "Find a Provider" tool

End of Life Choices Oregon: For Oregon residents/visitors

Patient Choices Vermont: For Vermont residents/visitors

State-specific organizations

Important Notes:​

Not all physicians participate (it's voluntary)

Some healthcare systems prohibit participation

You need TWO providers: a prescribing physician and a consulting physician

Some major health systems have MAID navigators to help coordinate

STEP 3: FIRST ORAL REQUEST​

Day 1 of the official process:

Make your first oral request to your attending physician

Physician documents this in your medical record

Physician confirms your diagnosis and prognosis

Physician assesses your mental capacity

Physician informs you of:

Your diagnosis and prognosis

Potential risks of taking the medication

Expected outcome

Feasible alternatives (hospice, palliative care, pain management)

Your right to rescind the request at any time

The 15-20 day waiting period starts from this date

STEP 4: CONSULTING PHYSICIAN EVALUATION​

During the waiting period:

Second physician examines you

Reviews your medical records

Confirms your diagnosis and prognosis

Confirms you are mentally capable

Confirms you are acting voluntarily

If Either Physician Suspects Impaired Judgment:​

They must refer you for mental health evaluation

Psychiatrist or psychologist assesses your decision-making capacity

Process cannot continue until mental health professional clears you

STEP 5: WRITTEN REQUEST​

Must be completed during the waiting period:

Complete a written request form (state-specific form)

Sign in the presence of two witnesses

Witnesses must also sign

Witness Requirements:​

At least one witness cannot be a relative

Witnesses cannot be:

Heirs to your estate

Your attending physician

Employees of healthcare facility where you're being treated (in some cases)

STEP 6: SECOND ORAL REQUEST​

Minimum 15 days after first oral request (varies by state):

Make your second oral request to your attending physician

Physician offers you the opportunity to rescind your request

Can be done in person or via telehealth (in some states)

State-Specific Waiting Periods:​

Oregon: 15 days (can be waived if life expectancy < 15 days)

California: 48 hours between requests

Washington: 7 days

Hawaii: 5 days

Vermont: 15 days

Other states: Varies, typically 5-20 days

STEP 7: FINAL WAITING PERIOD​

After written request is submitted:

Additional 48-hour waiting period in most states

Physician can write prescription after this period

Attending physician must confirm you are making an informed decision

STEP 8: PRESCRIPTION​

After all requirements are met:

Attending physician writes prescription for life-ending medication

Physician must report the prescription to state health department

Prescription is sent to pharmacy

Current Standard Medication (DDMAPh):​

Compound of: Digoxin, Diazepam, Morphine, Amitriptyline, and Phenobarbital

Typically comes as powder to be mixed with 2 oz of juice

Can also be administered via rectal tube or feeding tube (if patient cannot swallow)

STEP 9: OBTAINING THE MEDICATION​

Prescription can be:

Mailed to pharmacy

Hand-carried to pharmacy

Sent electronically (in some states)

Pharmacist must be informed of the medication's intended use

Participation by pharmacies is also voluntary

You or your representative pick up the medication

Medication is very expensive if not covered by insurance ($400-$3,000+)

Insurance Coverage:​

Many private insurances cover it

Medicare/Medicaid: Federal funds cannot be used (but some state Medicaid programs cover it)

Check with your specific plan

STEP 10: SELF-ADMINISTRATION​

When and where you choose (with limitations):

Timing:​

You can take the medication any time after receiving it

You can also choose never to take it (about 1/3 never use it)

No deadline or pressure

Location:​

Typically at home

Some healthcare facilities allow it; many do not

Must be in the state where prescription was obtained

Administration:​

You MUST self-administer (no one can help you ingest it)

Mix powder in juice and drink it within 2 minutes

Takes effect within 8 minutes (sleep)

Death typically occurs within 1-2 hours

Who Can Be Present:​

Family and friends

Hospice workers (if they choose to attend)

Medical professionals (physician not required to be present)

Death doulas

Anyone can be present EXCEPT they cannot physically help you ingest the medication

IMPORTANT SAFEGUARDS​

You Can Rescind Your Request at ANY Time:​

Before receiving prescription

After receiving prescription

Even on the day you plan to take it

No explanations needed

Simply don't take the medication

Mandatory Waiting Periods Can Be Waived IF:​

Physician determines your life expectancy is less than the waiting period

All other steps must still be followed

Healthcare Provider Protections:​

Physicians can refuse to participate (conscientious objection)

Healthcare systems can prohibit participation

No one can be forced or pressured to participate

Providers who choose not to participate must refer you to other resources

STATE-SPECIFIC VARIATIONS​

Oregon:​

15-day waiting period between oral requests

48 hours after written request

Can waive waiting periods if imminently dying (since 2020)

No residency requirement (since 2023)

Vermont:​

15-day waiting period

Removed 48-hour final waiting period

No residency requirement (since 2023)

Telehealth visits allowed

California:​

Shortest waiting period: 48 hours between requests

Extended law valid until 2031

Must be California resident

Washington:​

7-day waiting period (reduced from 15 days in 2023)

Bill pending to eliminate for certain patients

APRNs can prescribe

Hawaii:​

5-day waiting period (shortest in nation)

APRNs can prescribe (expanded in 2023)

Delaware:​

15-day waiting period

48-hour final waiting period

APRNs can prescribe (landmark provision)

Effective January 1, 2026

Illinois:​

5-day waiting period

Can waive if patient has < 5 days to live

Effective September 12, 2026

New York:​

5-day waiting period (in proposed amendments)

Mandatory mental health evaluation required

Recorded oral attestation required

Expected mid-2026

PRACTICAL CONSIDERATIONS​

Start Early:​

Even with expedited processes, this takes weeks

Don't wait until you're too sick to complete the process

Many patients begin shortly after terminal diagnosis

Hospice and MAID Can Overlap:​

85-94% of MAID users are already in hospice care

Hospice organizations may or may not participate

You can be in hospice while pursuing MAID

Many Who Obtain Prescriptions Never Use Them:​

Approximately 30-35% never fill or take the prescription

Having the option provides peace of mind

Treated like "insurance" – having it just in case

Cost Considerations:​

Physician consultations: covered by insurance typically

Medication: $400-$3,000+ if not covered

Check your specific insurance coverage

Legal Protections:​

Death certificate lists underlying terminal illness, not suicide

Does not affect life insurance benefits

All participants (physicians, family) have legal immunity

RESOURCES FOR ASSISTANCE​

National Organizations:​

Death with Dignity National Center: deathwithdignity.org

Compassion & Choices: compassionandchoices.org

Academy of Aid in Dying Medicine: AADM (provider referrals)

State-Specific:​

End of Life Choices Oregon

Patient Choices Vermont

Each state health department has MAID information

Contact for Help:​

Death with Dignity social workers: [email protected]

They can answer questions and provide referrals (not medical advice)

Typically respond within 48-72 hours

---

This process is intentionally designed with multiple safeguards to ensure voluntary,

informed decision-making while providing terminally ill patients with autonomy

and control over their final days.

Document prepared January 2026​

 

[Nelson Vergel]

COMPREHENSIVE ANALYSIS:​

Euthanasia and Assisted Dying Legislation​

Across European Countries (2025-2026)​

January 2026​

EXECUTIVE SUMMARY​

As of January 2026, Europe represents the global epicenter of euthanasia and assisted dying legislation. Four EU member states (Netherlands, Belgium, Luxembourg, Spain) have fully legalized physician-administered euthanasia, while three additional countries (Germany, Austria, Switzerland) permit assisted suicide through constitutional court rulings. Portugal and Slovenia have passed euthanasia laws but face implementation challenges. The United Kingdom's Parliament voted in June 2025 to legalize assisted dying for England and Wales, with France actively debating similar legislation.

Key Distinction: European countries generally permit active euthanasia (physician administration), whereas U.S. states only allow assisted suicide (patient self-administration). This represents a fundamental philosophical and practical difference in approach.

CURRENT LEGAL STATUS BY COUNTRY​

COUNTRIES WITH FULL EUTHANASIA LAWS (Physician-Administered)​

1. The Netherlands (2002) - FIRST IN THE WORLD​

Status: Active euthanasia and assisted suicide legal

Law: Termination of Life on Request and Assisted Suicide (Review Procedures) Act

First country in world to formally legalize euthanasia (April 1, 2002)

Both physician-administered euthanasia and assisted suicide permitted

Key requirement: Unbearable suffering with no prospect of improvement

NOT required: Patient does not need to be terminally ill

Available from age 12 (with parental consent for minors under 16)

Extended in 2023 to children under 12

2023 data: 9,068 cases (5.4% of all deaths in Netherlands)

Advance directives permitted for patients who lose capacity

Method: Sodium thiopental (coma), then pancuronium (respiratory arrest)

Physicians must consult independent colleague ("SCEN doctor") before proceeding

Post-euthanasia review by committee required

Non-residents: Extremely difficult; physician must have extensive knowledge of patient's history

2. Belgium (2002)​

Status: Active euthanasia legal

Law: Belgian Act on Euthanasia

Legalized May 2002 (shortly after Netherlands)

Based closely on Dutch model

Key requirement: Futile medical condition with constant, unbearable suffering

NOT required: Terminal illness

Unique provision: One-month waiting period for non-terminal patients

Extended to children in 2014 - FIRST IN THE WORLD to allow euthanasia for minors of any age

Children must: have terminal illness, be in great pain, fully understand procedure

Mental illness: One of few countries allowing euthanasia for mental suffering

Cases have increased significantly since legalization

More permissive than Dutch approach for non-terminal cases

3. Luxembourg (2009)​

Status: Active euthanasia and assisted suicide legal

Law: Law on the Right to Die with Dignity (2008, effective 2009)

Legalized February 2008, entered force 2009

Requires unbearable suffering from incurable illness

Patient must be mentally competent

Based on Dutch/Belgian models

4. Spain (2021)​

Status: Active euthanasia and assisted suicide legal

Law: Organic Law Regulating Euthanasia (March 2021)

Legalized March 2021

Allows adults with serious, incurable diseases causing unbearable suffering

NOT required: Terminal illness (though most cases are terminal)

Must have Spanish nationality or legal residence

Two requests required, 15 days apart

Complete knowledge of process and alternatives required

Informed consent mandatory

86% public support

COUNTRIES PERMITTING ASSISTED SUICIDE ONLY​

(Physician administration prohibited; patient must self-administer)

5. Switzerland (Since 1942) - LONGEST STANDING​

Status: Assisted suicide legal; active euthanasia prohibited

Legal Basis: Criminal Code Article (1942)

Oldest continuous assisted suicide regime in world (since 1942)

Unique approach: No specific authorization law

Criminal Code only prohibits assistance with "selfish motives"

Therefore: Assistance without selfish motives remains legal

MOST LENIENT LAWS: No terminal illness requirement

No age limit specified

Physician not required to diagnose patient

Non-residents welcome: Switzerland accepts foreign nationals

Organizations like Dignitas facilitate access for foreigners

Over 500 British citizens have traveled to Switzerland for assisted suicide

Major destination for "suicide tourism"

6. Germany (2020 Court Ruling)​

Status: Assisted suicide legal via constitutional ruling; active euthanasia prohibited

Legal Basis: Federal Constitutional Court ruling (February 2020)

Constitutional Court ruled 2020: ban on professionally assisted suicide unconstitutional

Found right to "self-determined death" in constitution

Includes freedom to seek third-party assistance

Major issue: Bundestag has NOT passed implementing legislation

Court requested legislation; still awaiting comprehensive law

Legal status exists but practical implementation unclear

7. Austria (2022)​

Status: Assisted suicide legal; active euthanasia prohibited

Legal Basis: Constitutional Court ruling, implemented by law (2022)

Court ruled ban violated right to self-determination

Law took effect January 1, 2022

Allows assisted suicide under specific conditions

8. Italy (2019 Court Ruling - LIMITED)​

Status: Assisted suicide partially legal via court ruling; implementation incomplete

Legal Basis: Constitutional Court ruling (September 2019)

Constitutional Court ruled 2019: assisting suicide not always criminal

Applies when patient in "intolerable suffering"

Major problem: National parliament has NOT passed implementing legislation

Regional solution: Tuscany adopted legislation February 11, 2025

First assisted suicide under Tuscany law: June 11, 2025

National government challenging regional law in constitutional court

Legal uncertainty remains at national level

COUNTRIES WITH LAWS PASSED BUT NOT YET IN EFFECT​

9. Portugal (Law Passed 2023 - STALLED)​

Status: Law passed but not in effect; facing legal challenges

Law: Euthanasia legalization (May 2023)

Parliament passed euthanasia law May 2023

Problem: President vetoed TWICE

Constitutional Court challenged parts as unconstitutional (April 2025)

Awaiting government regulations before implementation

Would apply to terminally ill with unbearable suffering

Only for Portuguese nationals and legal residents

Timeline uncertain: No clear implementation date

10. Slovenia (Law Passed July 2025 - REFERENDUM PENDING)​

Status: Law passed but subject to referendum

Law: Assisted Dying Act (July 2025)

Parliament legalized assisted dying July 2025

Voters backed it in November 2024 referendum

Complication: Civil group (supported by conservative opposition) gathered signatures for another referendum

November 23, 2025 referendum voted on implementation

Would give lucid, terminally ill patients with unbearable suffering right to assistance

All treatment options must be exhausted

Catholic Church opposes strongly

COUNTRIES WITH LEGISLATION PENDING OR IN PROGRESS​

11. United Kingdom - England and Wales (Bill Passed Commons June 2025)​

Status: Bill passed House of Commons; under review in House of Lords

Bill: Terminally Ill Adults (End of Life) Bill

Historic vote June 20, 2025: House of Commons approved 314-291 (majority of 23)

Narrower margin than November 2024 vote (330-275, majority 55)

Sponsored by Labour MP Kim Leadbeater

Prime Minister Keir Starmer voted in favor

Current status: Under review in House of Lords (as of December 2025)

Lords can amend but unlikely to block Commons-passed legislation

Some peers accused of filibustering to delay passage

Key Provisions:​

Adults over 18 with less than 6 months to live

England and Wales only (Scotland has separate bill)

Must be mentally competent and terminally ill

Two doctors must approve

Panel approval required (social worker, senior legal figure, psychiatrist)

Patient must self-administer fatal drugs

Independent advocates for people with learning disabilities

Medical professionals can refuse to participate

Cannot raise procedure with people under 18

Implementation timeline: 4 years after passage (potentially 2029)

Public support: 75% of UK population supports legalization

Opposition concerns: Vulnerable people, NHS "suicide service," insufficient scrutiny

Scotland (Separate Legislation)​

Scottish Parliament passed first vote May 2025

Must pass two more parliamentary hurdles

On separate track from England/Wales legislation

12. France (Bill Under Active Debate)​

Status: Bill passed National Assembly; awaits Senate review

Bill: Assisted Dying and Palliative Care Bill

President Emmanuel Macron backs the bill

National Assembly approved May 2025

Delay: Parliamentary dissolution June 2024 stalled progress

Transformed from government bill to MP-sponsored bill

Senate debate scheduled January 2026

Return to National Assembly expected February 2026

Includes companion palliative care bill

Key Provisions:​

Adults 18+ who are French nationals or residents

Incurable illness causing intolerable physical or psychological suffering

Advanced or terminal stage required

Doctor prescribes lethal substance

Unique provision: If patient physically unable to self-administer, doctor or nurse may assist

Medical team assessment required

Mandatory reflection period before prescription

13. Ireland (Committee Recommendation)​

Status: Special committee recommended legislation

Special committee report October 2024 recommended introducing legislation

Proposed: Only for people with 6 months to live (12 months for neurodegenerative conditions)

Coercing someone into assisted dying would be criminal offense

Private bill debated in Parliament May 1, 2025

No legislation passed yet

OTHER COUNTRIES CONSIDERING OR DISCUSSING LEGISLATION​

Malta​

Government conducted public consultation on euthanasia (ended July 2, 2025)

Proposal: Adult residents with incurable terminal illness, <6 months to live

Must have tried all available treatments

Would NOT be allowed based on: mental health, disability, or old age

Consultation could lead to legislative proposal

Cyprus​

Under consideration

No specific timeline

COUNTRIES WHERE EUTHANASIA/ASSISTED SUICIDE IS PROHIBITED​

The majority of European countries still prohibit both euthanasia and assisted suicide. Some notable examples:

Countries Allowing Only Passive Euthanasia (Withdrawing Treatment):​

Finland: Passive euthanasia legal; active euthanasia prohibited

Sweden: Passive euthanasia legal since 2010; active euthanasia prohibited

Countries That Have Debated But Not Passed Legislation:​

Denmark: Neither legalized nor criminalized; occurs in ~1% of deaths

Countries Where Strictly Prohibited:​

Poland: Strongly opposed due to Catholic Church influence

Croatia: Strong Catholic opposition

Hungary: Conservative government opposition

Slovakia: Conservative opposition

Most Eastern European countries remain opposed

KEY DIFFERENCES: EUROPE VS. UNITED STATES​

1. Active Euthanasia vs. Assisted Suicide​

Europe (Netherlands, Belgium, Luxembourg, Spain):​

Active euthanasia permitted: Physician administers lethal medication

Method: IV injection (sodium thiopental + pancuronium)

Patient does not need physical ability to self-administer

More accessible to physically incapacitated patients

United States (All Legal States):​

Only assisted suicide permitted: Patient must self-administer

Method: Patient drinks/ingests medication themselves

No physical assistance allowed in ingestion

Excludes some physically impaired patients from accessing

2. Terminal Illness Requirement​

Europe (More Permissive):​

Netherlands, Belgium: Terminal illness NOT required

Key criterion: Unbearable suffering with no prospect of improvement

Applies to chronic conditions, mental suffering

Belgium: Allows euthanasia for mental illness alone

United States (More Restrictive):​

ALL states require: Terminal illness with ≤6 months to live

Chronic non-terminal conditions excluded

Mental illness alone: NOT eligible

3. Age Restrictions​

Europe:​

Netherlands: From age 12 (parental consent required under 16); extended to under 12 in 2023

Belgium: No minimum age for children (first country to allow for minors of any age, 2014)

United States:​

All states: Must be 18+ years old

No provisions for minors

4. Residency Requirements​

Europe:​

Switzerland: Welcomes non-residents ("suicide tourism")

Netherlands: Theoretically possible but extremely difficult for non-residents

Most countries: Require residency or citizenship

United States:​

Most states: Require state residency

Oregon, Vermont: Removed residency requirements (2023)

5. Advance Directives​

Europe:​

Netherlands: Advance directives permitted for patients who lose capacity (e.g., advanced dementia)

United States:​

All states: Patient must be mentally competent at time of request

Advance directives cannot be used for MAID

TRENDS AND PATTERNS​

Geographic Patterns​

Western Europe: Leading the movement (Benelux countries, Spain, Switzerland)

Southern Europe: Mixed (Spain legalized; Italy limited; Portugal stalled)

Eastern Europe: Generally opposed due to religious/conservative values

Nordic countries: Passive euthanasia only (Finland, Sweden)

UK/Ireland: Moving toward legalization after decades of prohibition

Timeline of Legalization​

1942: Switzerland (oldest continuous regime)

2002: Netherlands and Belgium (first active euthanasia laws)

2009: Luxembourg

2020: Germany (constitutional ruling)

2021: Spain

2022: Austria

2023: Portugal (passed but stalled)

2025: Slovenia (passed, referendum pending), UK (Commons approved), Italy (Tuscany region)

2026+: France (expected), UK implementation

Accelerating Momentum​

2002-2009: Two countries added (Belgium, Luxembourg) - slow growth

2020-2025: Significant acceleration with multiple countries

Multiple major countries (UK, France) actively pursuing legislation

Growing public support across Western Europe (70-86% in various countries)

Expanding Scope​

From terminally ill to chronic suffering: Netherlands/Belgium don't require terminal diagnosis

Mental illness inclusion: Belgium pioneering controversial expansion

Age expansion: Netherlands extended to children under 12; Belgium has no age limit

Dementia patients: Netherlands allows advance directives for dementia

EUROPEAN UNION AND INTERNATIONAL LAW CONSIDERATIONS​

EU Position​

EU has NO competence on euthanasia legislation

European Commission explicitly stated: this is a Member State responsibility

Each country develops its own laws and solutions

No harmonization at EU level

European Convention on Human Rights​

Contains no provisions precluding countries from legalizing euthanasia

Relevant articles:

Article 2: Right to life

Article 3: Prohibition of inhuman and degrading treatment

Article 8: Right to respect for private life

Article 9: Freedom of conscience

Mortier v Belgium ruling: European Court of Human Rights found states could allow euthanasia

UTILIZATION DATA​

Netherlands​

2003: 1,626 cases (1.2% of all deaths)

2023: 9,068 cases (5.4% of all deaths)

Significant increase: Usage has more than quintupled since 2003

Trend: Increased among elderly 80+, nursing home residents, non-cancer diseases

2013 data: 68.7% cancer patients, 65% under age 80

Trend toward broader use beyond imminent death cases

Belgium​

Number of reported cases has increased each year since legalization

Studies show no sign of legislation leading to abuse

Switzerland​

Over 500 British citizens have traveled to Switzerland for assisted suicide

Major destination for international assisted suicide

Organizations like Dignitas facilitate foreign access

OPPOSITION AND CONTROVERSIES​

Primary Opponents​

Catholic Church (extremely active across Europe)

Orthodox Churches (in Eastern Europe)

Conservative political parties

Some disability rights groups

Right to Life organizations

Care Not Killing (UK)

Some medical professional organizations

Key Arguments Against​

Sanctity of life concerns

Slippery slope - expanding eligibility over time

Vulnerable populations at risk (elderly, disabled, poor)

Economic pressure to choose death

Undermines palliative care investment

Changes doctor-patient relationship

Fear of becoming burden to family

Insufficient parliamentary scrutiny in some cases

Specific Controversies​

Mental Illness Eligibility​

Belgium allows euthanasia for mental suffering alone

Critics: concerned about depression, treatable conditions

Difficulty determining if suffering is truly unbearable and untreatable

Children and Minors​

Belgium: No age limit (since 2014) - highly controversial

Netherlands: From age 12, extended to under 12 in 2023

Critics: children cannot fully understand decision

Dementia and Advance Directives​

Netherlands allows advance directives for dementia

Controversy: patient may no longer wish to die when time comes

Question of consent when patient no longer has capacity

UK Parliamentary Process​

Critics: only 18 days between bill publication and vote

Under 10 hours to consider 130+ amendments

Allegations of insufficient scrutiny for such major social change

SUPPORT AND ADVOCACY​

Primary Supporters​

Dignity in Dying (UK)

NVVE (Netherlands Right to Die Society) - 177,000 members

Compassion & Choices (international)

World Federation of Right to Die Societies

Many medical ethics experts

Secular organizations

Key Arguments For​

Patient autonomy and self-determination

Compassionate response to unbearable suffering

Death with dignity rather than prolonged suffering

Decades of safe implementation (Netherlands, Belgium)

No evidence of widespread abuse in countries with established laws

Strong public support (70-86% in various countries)

Inequality: wealthy can travel to Switzerland while poor cannot

People currently die in secret or face prosecution for helping loved ones

Public Support Levels​

UK: 75% support legalization

Spain: 86% support legalization

High support across most Western European countries

CONCLUSION​

Europe has emerged as the global leader in euthanasia and assisted dying legislation, with the Netherlands pioneering the first formal law in 2002. The movement has expanded significantly, particularly since 2020, with major countries like the UK and France actively pursuing legalization. The European approach differs fundamentally from the U.S. model, permitting physician-administered euthanasia rather than limiting access to assisted suicide.

Key trends include: (1) Geographic concentration in Western Europe with strong opposition in Eastern Europe; (2) Expanding eligibility beyond terminal illness to include chronic suffering and mental illness; (3) Inclusion of minors in some countries; (4) High public support (70-86%) across countries considering legislation; (5) Ongoing debates about safeguards, vulnerable populations, and the "slippery slope."

The Netherlands and Belgium demonstrate that euthanasia can be implemented with regulatory oversight and review processes, though usage has increased significantly over time. Switzerland's unique model welcoming non-residents has made it a destination for "suicide tourism." Meanwhile, the UK's June 2025 parliamentary vote represents a potential watershed moment that could influence other English-speaking countries.

The European experience offers valuable lessons in both the possibilities and challenges of legalizing assisted dying, with each country adapting the model to its own cultural, religious, and legal context.

---

Document prepared January 2026

Sources: European Parliament, Euronews, national government websites,

World Federation of Right to Die Societies, academic journals,

and advocacy organization reports​

 

[Nelson Vergel]

COMPREHENSIVE ANALYSIS:​

Medical Assistance in Dying (MAID)​

Canada and Latin America (2025-2026)​

January 2026​

EXECUTIVE SUMMARY​

Canada and Latin America represent dramatically different trajectories in euthanasia and assisted dying policy. Canada has developed one of the world's most expansive Medical Assistance in Dying (MAID) programs since legalization in 2016, with 76,475 MAID deaths (5.1% of all deaths in 2024) and ongoing expansions including mental illness eligibility delayed until 2027. In contrast, Latin America remains largely restrictive, with only three countries having legalized euthanasia: Colombia (1997 court ruling), Ecuador (2024 court ruling), and Uruguay (2025 legislative approval, pending implementation).

Key Distinction: Both Canada and Latin American countries that allow MAID permit active euthanasia (physician administration), unlike the United States which only allows patient self-administration. Canada's program has faced significant international criticism and UN condemnation for concerns about vulnerable populations and inadequate safeguards.

CANADA: MEDICAL ASSISTANCE IN DYING (MAID)​

Legal History and Supreme Court Ruling​

February 2015: Supreme Court ruled in Carter v. Canada that Criminal Code prohibition violated Canadian Charter of Rights and Freedoms

Court gave government until June 6, 2016 to create new law

June 2016: Parliament passed Bill C-14, legalizing MAID nationwide

Quebec had already legalized in 2015 (one year ahead of federal law)

March 2021: Parliament passed Bill C-7, major expansion of eligibility

Response to 2019 Truchon decision declaring 'reasonably foreseeable death' criterion unconstitutional

Current Eligibility Criteria (2026)​

All patients must meet these requirements:

Be eligible for publicly funded health care services in Canada

Be at least 18 years old

Be capable of making healthcare decisions

Have a grievous and irremediable medical condition:

Serious and incurable illness, disease, or disability (NOT mental illness alone)

Advanced state of irreversible decline in capability

Enduring physical or psychological suffering that is intolerable and cannot be relieved under acceptable conditions

Make voluntary request without external pressure

Give informed consent after being informed of alternative treatments including palliative care

CRITICAL: Terminal Illness NOT Required​

Unlike U.S. states and most European countries, Canada does NOT require terminal illness or imminent death. This makes Canada's program one of the world's most permissive.

Two Tracks Based on Natural Death Foreseeability​

Track 1: Natural Death Reasonably Foreseeable​

Fewer safeguards

No minimum waiting period (can be done immediately)

No mandatory reflection period

Patient can waive final consent if they lose capacity (advance arrangement)

Track 2: Natural Death NOT Reasonably Foreseeable​

Additional safeguards required:

At least one assessor must have expertise in the medical condition causing suffering

Patient must be informed of and offered consultations for available means to relieve suffering

Patient and practitioners must discuss and agree patient has seriously considered reasonable alternatives

90-day assessment period minimum (unless assessments completed sooner AND patient at immediate risk of losing capacity)

Methods of MAID in Canada​

Two methods available:

1. Physician/Nurse Practitioner Administration (Most Common)​

Healthcare provider administers lethal medication

Can be intravenous or oral

Practitioner must be present throughout

2. Self-Administration​

Patient takes medication themselves

Less common in Canada

If self-administration fails, practitioner can intervene (via written arrangement)

Providers Who Can Administer MAID​

Physicians (MDs)

Nurse Practitioners (NPs) - where provinces/territories allow

ONLY these professionals can conduct assessments and provide MAID

Conscientious objection permitted - providers not required to participate

Free training curriculum provided by CAMAP (Canadian MAID Curriculum)

Utilization Data and Trends​

Overall Statistics​

2024: 16,499 MAID provisions (5.1% of all deaths in Canada)

Total since 2016: 76,475 MAID deaths

Median age: 77.9 years (2024)

Steady annual increase since legalization

Underlying Medical Conditions (2022 Data)​

Cancer: 63%

Cardiovascular: 18.8%

Other conditions: 14.9% (frailty, diabetes, chronic pain, autoimmune)

Respiratory: 13.2%

Neurological: 12.6%

Palliative Care Overlap​

75% of MAID recipients received palliative care

Among those who required but didn't receive palliative care: 80.5% had access

Mental Illness Eligibility - Repeatedly Delayed​

Current Status (January 2026)​

Mental illness as sole underlying condition: EXCLUDED until March 17, 2027

Originally planned for March 2023

Extended to March 2024 (March 9, 2023 legislation)

Further extended to March 2027 (February 29, 2024 legislation)

Reason for Delays​

Allow provinces/territories to prepare healthcare systems

Practitioners need training and familiarity with guidelines/standards

Develop key resources for assessors addressing complex requests

Consider Special Joint Committee on MAID review

Highly controversial - significant opposition from mental health professionals

Legal Challenge​

Legality of postponement to 2027 is being challenged in court

Advance Requests - Under Consideration​

Current Status​

Advance requests NOT currently allowed in Canada

Patient must have capacity at time of MAID administration

National Conversation Launched​

November 2024 - February 14, 2025: National consultation

October 29, 2025: Report published ("What we heard: National conversation on advance requests")

February 2023: Special Joint Committee on MAID recommended allowing advance requests

Government response: Complex issue requiring further study

What Are Advance Requests?​

A request for MAID made by an individual who still has capacity, before they are eligible or want to receive MAID. Would primarily apply to dementia patients who could request MAID while still competent to be administered later when they lose capacity.

International Criticism and Concerns​

UN Human Rights Experts Condemnation​

UN human rights experts have condemned Canada's MAID program

Concerns about intensity and breadth of program

Particular focus on disability rights violations

Disability Rights Groups Concerns​

Devalues lives of disabled people

Health workers and doctors suggesting MAID to people who wouldn't otherwise consider it

Euthanizing people not receiving adequate government support to continue living

Poverty and Social Support Concerns​

The Spectator, Jacobin, Global News articles: Many opt for MAID because of poverty

Insufficient welfare for disabled people

Unconstitutionally long waiting times for healthcare

Disabled and impoverished people don't have enough support to survive

The Spectator analysis (most popular 2022 article): Canadian government sees MAID as more economical alternative to social programs and welfare

Lack of Oversight​

Standard reviews of MAID cases may be conducted

Canada's process criticized for lacking regional panels and oversight processes

Other countries with legal euthanasia provide more robust oversight

Provincial/Territorial Implementation​

Shared jurisdiction: Federal criminal law sets framework; provinces/territories deliver as health service

Provincial regulatory bodies (Colleges of Physicians and Surgeons) issue binding practice standards

15 regulatory documents identified from 11 of 13 provinces/territories

Interprovincial/territorial variability exists in practice standards

Fragmentation can be challenging for physicians to navigate

LATIN AMERICA: EUTHANASIA AND ASSISTED DYING​

Overview​

Latin America remains largely restrictive on euthanasia, with strong Catholic Church opposition throughout the region. Progress has been driven primarily by court rulings rather than legislative action. Only three countries have legalized euthanasia: Colombia (1997), Ecuador (2024), and Uruguay (2025). Several other countries have dignified death laws that allow refusing life-extending treatment (passive euthanasia) but not active euthanasia.

COUNTRIES WHERE EUTHANASIA IS LEGAL​

1. COLOMBIA - First in Latin America (1997)​

Legal History​

1997: Constitutional Court ruled (Sentencia C-239/97) that euthanasia for terminally ill patients with informed consent should be possible

Court called on government to formulate regulations

Government did nothing for 18 years - doctors afraid to act

2015: Resolution 1216 created mandatory medical protocol

2018: Resolution 825 extended to children and adolescents

July 2021: Constitutional Court extended to non-terminal patients

May 2022: Assisted suicide decriminalized (Ruling C-164)

Current Status​

Unique system: Legal criteria in resolutions, not law

Both euthanasia AND assisted suicide legal (as of 2022)

Only Latin American country with regulated euthanasia

Terminal illness NOT required (since 2021 expansion)

October 2025: Bill passed First Committee of House (23 votes in favor)

Deadline June 16, 2026 for complete legislative process

If passed, would be first Latin American country with comprehensive law

Eligibility - Adults​

Serious and incurable disease OR irreversible bodily injury

Intense suffering

Unequivocal, free, and informed consent

If patient has lost consciousness: family must demonstrate euthanasia desire via recording or writing

If doctor refuses: health authority helps find alternative doctor

Eligibility - Minors (Since 2018)​

Children age 6 and under: Cannot access (don't understand concept of death)

Ages 7-12: Can access with parental approval

Ages 12-14: Can access even if parents disagree

Age 14+: No parental involvement needed

Must have terminal illness, be in great pain, fully understand procedure

Utilization Data​

2015-2019: Only 40 cases

2015-March 2020: 92 adult euthanasias

Numbers increased after 2019

Challenges​

Hospitals sometimes refuse for fear of prosecution

Families forced to seek emergency court rulings

Doctors who support euthanasia call for clearer rules

Legal uncertainty without comprehensive law

2. ECUADOR (February 2024)​

Legal History​

August 8, 2023: Paola Roldán (42, with ALS) filed unconstitutionality action

February 5, 2024: Constitutional Court ruled 7-2 that active euthanasia is legal

Court ruled Article 144 of Criminal Code (simple homicide) constitutional ONLY if doctor not sanctioned for euthanasia

Paola Roldán died March 11, 2024 from "natural causes" before she could use law

April 2024: Ministry of Health issued 24-article rulebook (within 60-day deadline)

Current Requirements​

Serious and irreversible bodily injury OR serious and incurable disease

Constant suffering and pain

Unequivocal, free, and informed consent

Can use representative if patient cannot express consent

Patient can revoke consent verbally at any time before procedure

Conscientious objection by doctors respected

Life-ending drugs must guarantee short and simple procedure

Lethal dose based on international protocols

Death resulting from euthanasia considered natural death

Implementation Timeline​

Court gave Ombudsman's Office 6 months to draft bill regulating euthanasia

National Assembly has 1 year after that to debate and approve

Deadline: July 2025 for comprehensive law

By then: new government, new National Assembly, three new constitutional court judges

Dissenting Opinions​

Judge Teresa Nuques Martínez: Court exceeded jurisdiction, encroaching on legislative powers

Judge Corral Ponce: Human dignity tied to life, not living conditions; euthanasia opens door to culture of death

3. URUGUAY (October 2025) - FIRST LEGISLATIVE APPROVAL​

Legal History​

August 14, 2025: Chamber of Deputies (lower house) approved bill 64-29

October 15, 2025: Senate passed bill 20-11

HISTORIC: First Latin American country to pass euthanasia via legislature (not court)

Bill moved forward over 5 years

Awaiting regulation before implementation

Key Provisions​

Adults with mental competence

Terminal, incurable, irreversible illness causing extreme suffering

Severely diminished quality of life

NO time limit: Unlike U.S./Australia/New Zealand (6-12 month requirement)

NO waiting period required

Anyone with incurable illness causing "unbearable suffering" can seek assisted death

Diagnosis does not need to be terminal

Process​

Request must be made in writing and in person

Treating doctor assesses within 3 days

Second independent doctor gives opinion within 5 days

If doctors disagree: medical board decides within 5 more days

Euthanasia ONLY (not assisted suicide) - must be administered by medical professional

Mental Illness Provisions​

Mental illness alone: NOT explicitly banned

However: requires two doctors to rule patient psychologically fit

Must be mentally competent to make decision

Restrictions​

NO euthanasia for minors (unlike Belgium, Colombia, Netherlands)

Oversight​

New honorary commission monitors procedures

Reports to Health Ministry and Parliament

Public Support​

2020 poll: 82% in favor

2022 poll (Factum): 77% in favor

High secularization in Uruguay eroded Catholic Church resistance

Uruguay bans God from oaths of office, calls Christmas "Family Day"

4. PERU - Single Case Only (2021)​

Legal Status​

Euthanasia technically punishable with prison sentences

Exception: Lima Superior Court of Justice allowed ONE person access

2021: Ana Estrada (44-year-old woman) granted right to assisted suicide

First judicial precedent in Peru

No broader legalization

Conservative politicians like Rafael López Aliaga targeted Ana in presidential campaign

Current Situation​

No legislation passed

Court petitions filed

No tangible results toward broader legalization

COUNTRIES CONSIDERING OR DEBATING LEGISLATION​

Chile​

Current status: Passive euthanasia legal since 2012 (patients can decline treatment)

Active euthanasia and assisted suicide: Still prohibited

2014: Bill submitted by center-left opposition

December 12, 2020: Chamber of Deputies approved bill

Senate: STALLED due to government changes and conservative pressure

May 2025: President Gabriel Boric pledged to push bill forward

Motivation: Letter from Susana Moreira (degenerative muscular dystrophy)

Challenge: November 2025 presidential elections may dominate discourse

Proposed requirements:

Diagnosed by two doctors with serious and incurable disease

Conscious when making request OR previously established request

Unbearable physical ailments

Third party cannot request

Argentina​

Current status: Euthanasia and assisted suicide illegal

2012: Law 26,742 allows patients to reject life-prolonging treatments (passive euthanasia)

Evidence suggests active euthanasia practiced secretly but illegal

Several failed attempts to pass legislation through Congress

Group working on four different bills

Growing public pressure after high-profile cases

Proposed "Alfonso Law" in preparation - named for Alfonso Oliva (36, died 2019 from ALS)

Limited public discussion despite frequent practice

Mexico​

Current status: Euthanasia and assisted suicide illegal

2008: Advance Directive Law passed in Mexico City

Allows deciding to discontinue life-prolonging treatments (passive euthanasia)

Only valid in Mexico City and 13 states (not federal law)

Over 10,000 people signed advance directives

Bills introduced but without tangible results

Public support:

2016 survey: 68% agreed people with painful terminal illnesses should choose

2021 survey: 72% believe euthanasia should be legalized

Brazil​

Current status: Euthanasia illegal

Dignified death legislation allows refusing life-extending treatment

Studies show healthcare professionals and students favor legalization:

68.1% favor legal approval of assisted suicide

73.2% favor euthanasia for terminal pathologies

46.9% approve for neurodegenerative diseases

No legislative action toward active legalization

Other Countries with Debate/Discussion​

Costa Rica: Court petitions filed, no tangible results

El Salvador: Similar legislation considered, not approved

Venezuela: Similar legislation considered, not approved

Cuba: 2023 health law recognized "right to die with dignity," pending regulation

COUNTRIES WHERE STRICTLY PROHIBITED​

Mexico, Brazil, Paraguay: Currently prohibit active euthanasia

Most other Latin American countries have no movement toward legalization

Strong Catholic Church influence throughout region

REGIONAL PATTERNS AND BARRIERS​

Catholic Church Opposition​

Dominant force opposing euthanasia throughout Latin America

Catholic populations strongly influenced by Church teachings

Church argues sanctity of life, God's domain over death

Before Uruguay Senate vote, Archbishop Daniel Sturla called on Uruguayans to defend life

Exception: Uruguay's high secularization weakened Church influence

Court-Driven vs. Legislative Action​

Pattern: Progress driven by court rulings, not legislatures

Colombia: Constitutional Court (1997)

Ecuador: Constitutional Court (2024)

Peru: Individual court case (2021)

Uruguay: Exception - first to pass through legislature

Legislatures generally afraid to act due to religious/political pressure

Public Opinion vs. Political Action​

Strong public support in many countries:

Uruguay: 77-82%

Mexico: 72%

Brazil healthcare professionals: 68-73%

Yet political action lags due to:

Religious institution opposition

Conservative political parties

Fear of electoral consequences

Lack of Comprehensive Laws​

Even where legal (Colombia, Ecuador), implementation challenging

Court rulings create legal uncertainty

Hospitals and doctors fearful without clear legislation

Patients forced to seek emergency court orders

Colombia's bill (if passed by June 2026) would provide first comprehensive law

Regional Influence​

Uruguay's legislative success could influence neighbors

Colombia's comprehensive law (if passed) could serve as model

Regional advocacy network #TomaElControl (#TakeControl) coordinates across countries

DescLAB (Colombia) communicates with advocates in Argentina, Ecuador, and beyond

Some momentum building but still early stages

SECRET PRACTICE AND LACK OF PUBLIC DEBATE​

Evidence that euthanasia practiced secretly in countries where illegal

Dr. Carlos Soriano (bioethicist): "Absence of euthanasia law pushes patients into corner"

Patients resort to buying guns, phenobarbital, or poison

Sometimes left alive with worse suffering

Doctors perform "under the radar" to help suffering patients

Limited public discussion despite prevalence

ADVOCACY AND ORGANIZATIONS​

Key Organizations​

DescLAB (Colombia): Laboratory of Economic, Social and Cultural Rights

Led campaign for 30 years

Filed lawsuit for assisted suicide decriminalization (2021)

Coordinates with advocates across region

Right to a Dignified Death Foundation (DMD, Colombia):

Director: Carmenza Ochoa

Campaigned for three decades

Empatía Uruguay:

Led advocacy for legislative approval

Celebrated October 2025 Senate passage

Association for the Right to Die with Dignity (Mexico)

Various groups in Argentina, Chile, Peru, Ecuador

Notable Cases Driving Change​

Colombia - Martha Sepúlveda: 51, ALS, scheduled Oct 2021 (suspended), later euthanized Jan 2022

Ecuador - Paola Roldán: 42, ALS, lawsuit led to 2024 legalization

Peru - Ana Estrada: 44, granted individual right 2021

Argentina - Daniel Eduardo Ostropolsky: ALS, advocate for "Alfonso Law"

Chile - Susana Moreira: 41, degenerative muscular dystrophy, letter to President Boric

COMPARISON: CANADA VS. LATIN AMERICA​

Scope and Permissiveness​

Canada​

Most expansive program globally

Terminal illness NOT required

5.1% of all deaths (2024)

76,475 deaths since 2016

Expanding to mental illness (2027)

Considering advance requests

Controversial internationally

Latin America​

Highly restrictive overall

Only 3 countries legal: Colombia, Ecuador, Uruguay

Colombia: 40 cases (2015-2019), expanding but still limited

Ecuador: Just legalized 2024, implementation beginning

Uruguay: Awaiting regulation, not yet implemented

Strong religious opposition

Path to Legalization​

Canada​

Supreme Court constitutional ruling (2015)

Legislative action (2016)

Expansion via legislation (2021)

Clear federal framework

Latin America​

Primarily court-driven (Colombia, Ecuador, Peru)

Uruguay: First legislative approval

Legislatures reluctant to act

Implementation challenges even when legal

Eligibility Criteria​

Canada​

Grievous and irremediable medical condition

No terminal illness requirement

Two tracks based on death foreseeability

Adults 18+ only

Mental illness excluded until 2027

Latin America​

Varies by country

Colombia: Terminal illness NOT required (since 2021)

Uruguay: Terminal illness NOT required, no time limits

Ecuador: Serious/incurable disease or irreversible injury

Colombia allows minors (from age 7)

Uruguay excludes minors

Method of Administration​

Both Regions​

Active euthanasia permitted (physician administration)

Unlike U.S. which only allows self-administration

Canada also allows self-administration with physician present

Colombia: Both euthanasia and assisted suicide legal (since 2022)

Uruguay: Euthanasia only (not assisted suicide)

CONCLUSION​

Canada and Latin America represent two dramatically different approaches to medical assistance in dying. Canada has created one of the world's most permissive programs, with no terminal illness requirement, 5.1% of all deaths via MAID, and plans to expand to mental illness. The program has faced significant international criticism from UN human rights experts and disability rights groups concerning vulnerable populations, inadequate oversight, and concerns that poverty drives some MAID requests.

In contrast, Latin America remains largely restrictive, with only three countries having legalized euthanasia through court rulings (Colombia 1997, Ecuador 2024) or legislative action (Uruguay 2025). Strong Catholic Church opposition has prevented broader adoption, and even where legal, implementation faces significant challenges due to lack of comprehensive legislation, hospital resistance, and physician fears of prosecution.

Key patterns include: (1) Canada's rapid expansion contrasts with Latin America's incremental, court-driven progress; (2) Both regions permit active euthanasia (physician administration), unlike the U.S.; (3) Public support exists in many Latin American countries (70-82%) but political action lags due to religious opposition; (4) Colombia's potential comprehensive law (June 2026 deadline) and Uruguay's legislative approval could influence neighboring countries; (5) Secret practice of euthanasia occurs in countries where illegal, highlighting the gap between patient needs and legal frameworks.

The coming years will be critical: Canada's mental illness expansion in 2027 and advance requests debate will test the boundaries of permissiveness, while Latin America's gradual shift from court rulings to legislative frameworks may accelerate regional adoption. Uruguay's success as the first country to pass euthanasia via legislature could serve as a model, while Colombia's comprehensive law (if enacted) would provide the region's first detailed regulatory framework.

---

Document prepared January 2026

Sources: Government of Canada, Health Canada, Department of Justice Canada,

World Federation of Right to Die Societies, academic journals, news reports,

and advocacy organization reports​