Medical aid in dying (MAID) is not yet legally available in 45 of 56 U.S. jurisdictions. But its legal status has been in a state of rapid change across the country over the past decade.
Before 2008, MAID was legal only in Oregon. Today, it is explicitly lawful in eleven U.S. jurisdictions (CA, CO, DC, HI, ME, MT, NJ, NM, OR, VT, WA). Moreover, the rate and pace of legalization has been accelerating. Four MAID jurisdictions enacted their statutes within only the past three years. Moreover, there are widespread and ongoing legislative and judicial efforts to legalize MAID in more than thirty other states.
Despite all this activity, MAID in the United States is still anchored in a model that was designed more than 25 years ago. Most notably, all U.S. statutes require (among other things) both (1) that the patient has a prognosis of six months or less and (2) that the patient self-ingest the medication. These and other criteria materially limit access to MAID and reduce its safety.
In contrast, Canada has substantially advanced MAID access and safety in at least three ways. First, it is available in all provinces. Second, the law does not impose any strict temporal eligibility requirements. Third, almost all Canadian MAID is directly administered by clinicians, reducing the risk of adverse outcomes.