Euthanasia is the practice of ending someone’s life to relieve their suffering. Laws governing euthanasia, including which specific methods are acceptable, vary by region.

Euthanasia refers to deliberately ending someone’s life, usually to relieve suffering. Doctors sometimes perform euthanasia when requested by people who have a terminal illness and are in a lot of pain.

It’s a complex process and involves weighing many factors. Local laws, someone’s physical and mental health, and their personal beliefs and wishes all play a role.

Read on to learn more about the different types of euthanasia, when people use them, and where they’re legal.

There are several types of euthanasia. What people choose depends on various factors, including someone’s outlook and level of consciousness.

Assisted suicide vs. euthanasia

Assisted suicide is sometimes called physician-assisted suicide (PAS). PAS means a doctor knowingly helps someone end their life. This person is likely experiencing persistent and unending suffering. They may have also received a terminally ill diagnosis. Their doctor will determine the most effective, painless method.

In many cases, doctors will provide people with a drug they can take to end their life. For example, they may prescribe a lethal dose of opioids. In the end, it’s up to the person to decide whether they take the drug.

With euthanasia, a doctor is allowed to end the person’s life by painless means. For example, they may use an injection of a lethal drug.

Active euthanasia vs. passive euthanasia

When most people think of euthanasia, they think of a doctor directly ending someone’s life. This is known as active euthanasia. Purposely giving someone a lethal dose of a sedative is considered active euthanasia.

Passive euthanasia is withholding or limiting life-sustaining treatments so that a person passes more quickly. A doctor may also prescribe increasingly high doses of pain-relieving medication. Over time, the doses may become toxic.

This makes the distinction between passive euthanasia and palliative care blurry. Palliative care focuses on keeping people as comfortable as possible at the end of their life.

For example, a palliative care doctor might allow someone approaching death to stop taking a medication that causes unpleasant side effects. In other cases, they might allow someone to take a much higher dose of a pain medication to treat severe pain. This is often a standard part of good palliative care. Many don’t consider it euthanasia.

Voluntary euthanasia vs. nonvoluntary euthanasia

If someone makes a conscious decision to seek help with ending their life, people consider that to be voluntary euthanasia. The person must give their full consent and demonstrate that they fully understand what will happen.

Nonvoluntary euthanasia involves someone else, usually a close family member, making the decision to end someone’s life. This generally occurs when someone is completely unconscious or permanently incapacitated.

Nonvoluntary euthanasia usually involves passive euthanasia, such as withdrawing life support from someone who’s showing no signs of brain activity.

People have debated over the ethics and legality of euthanasia and PAS for centuries. Today, laws about euthanasia and PAS are different across states and countries.

In the United States, PAS is legal in:

  • California
  • Colorado
  • District of Columbia
  • Hawaii
  • Maine
  • Montana
  • New Jersey
  • New Mexico
  • Oregon
  • Vermont
  • Washington

Each of these jurisdictions has different legal requirements. Not every case of PAS is legal. In addition, many states currently have PAS measures on legislative ballots, so this list may grow.

Outside the United States, countries with some sort of legal protection for PAS or other types of euthanasia include:

  • Australia
  • Austria
  • Belgium
  • Canada
  • Colombia
  • Germany
  • Luxembourg
  • the Netherlands
  • New Zealand
  • Portugal
  • Spain
  • Switzerland

It’s important to note that specific laws vary by country. Some countries allow PAS only, while others allow different types of euthanasia. In some cases, such as in Australia, laws vary by each state within the country.

Euthanasia and PAS are not officially legal in Japan, but a court ruling in 1995 paved the way for physician-assisted voluntary euthanasia under very specific criteria.

Euthanasia is a topic of ongoing debate. There’s been a good amount of research into people’s opinions about it and how frequently people use it.

Opinions

Public attitudes toward euthanasia have changed in many countries over the last several decades. A 2023 study including 35 high income countries found that opinions of euthanasia had shifted more positively in all but two countries over the past 40 years.

A 2024 Gallup poll found that 71% of U.S. survey respondents believed that a doctor should be allowed to end a patient’s life using painless means. This number has been relatively steady for the past 30 years but was as low as 36% in 1950.

Both the international study and Gallup poll found that religion and political beliefs were significant factors in people’s opinions.

Interestingly, a 2019 survey of 1,000 U.S. doctors found that while 60% agreed that PAS should be legal, only 13% of those who favored its legality said they would perform the practice. Nearly one-half of the doctors surveyed also expressed that they believed insurance companies might favor PAS over potentially lifesaving treatments.

Prevalence

In countries where it’s legal, a 2024 review found euthanasia accounts for 0.26% to 3.03% of nonviolent deaths. More than 60% of those deaths were related to cancer.

A 2016 review found that in Washington state and Oregon, less than 1% of doctors write prescriptions for PAS each year.

There are many arguments both for and against euthanasia and PAS. Most of these arguments fall into four main categories:

Morality and religion

Some people believe euthanasia is murder and find it unacceptable for moral reasons. Many also argue that the ability to decide your own death weakens the sanctity of life. In addition, many churches, religious groups, and faith organizations argue against euthanasia for similar reasons.

Physician judgement

PAS is only legal if someone is mentally capable of making the choice. However, determining someone’s mental capabilities isn’t very straightforward. One 2018 study found that doctors aren’t always capable of recognizing when someone is fit to make the decision.

Ethics

Some doctors and opponents of PAS are concerned about the ethical complications doctors could face. For more than 2,500 years, doctors have taken the Hippocratic oath, which encourages them to care for and never harm those under their care.

Most agree that the Hippocratic oath expressly forbids euthanasia since it results in harm to the person and their loved ones, who must watch their loved one die. But others argue that the Hippocratic oath supports PAS since it ends physical pain and brings no more harm.

Personal choice

“Death with dignity” is a movement that encourages legislatures to allow people to decide how they want to die. Some people simply don’t want to go through a prolonged dying process, often out of concern for the burden it puts on their loved ones.

Making decisions about PAS for yourself or a loved one is extremely difficult, even if everyone’s in complete agreement.

The National Hospice and Palliative Care Organization offers many free resources on its website through its CaringInfo program. This program is designed to help people navigate complicated end-of-life issues, from state laws to finding spiritual support.

The National Institute on Aging also offers resources, such as providing important questions to ask and tips for talking with doctors and other medical professionals about end-of-life care.

Euthanasia, including physician-assisted suicide, remains a controversial issue for all involved: people with terminal illnesses, their loved ones, and the medical professionals involved with their care. Even when everyone’s on the same page, there can be legal, ethical, and logistical challenges.

Discussing your end-of-life plans with your loved ones and your healthcare team can help relieve some of the challenges. It’s also important to check local laws and ensure you understand the specifics.