Background   Provider Assisted Death by Prescription (PAD-P) describes a provider prescribing a lethal medication to a competent, terminally ill patient who self-ingests it for the purpose of hastening death (1). In the U.S., this practice is legal in some states and often labeled Medical Aid in Dying (MAID), Physician-Assisted Suicide (PAS), or Physician-Assisted Death/Dying (PAD), terms that can be controversial, confusing, and/or euphemistic (1,2). For example, in Canada, the acronym MAID stands for Medical Assistance in Dying but on a practical basis refers to voluntary active euthanasia (the administration of a lethal medication by a clinician) which is illegal in the U.S. For the purposes of clarity, we will utilize the term PAD-P in this Fast Fact. Providers should be prepared to discuss the topic of PAD-P knowledgeably, regardless of personal views. This Fast Fact discusses state law commonalities, eligibility criteria, epidemiology, patient demographics, and reasons for PAD-P requests specific to the U.S. Ethical, clinical and practical considerations of PAD-P in the U.S. are discussed in Part II of this Fast Fact.

Core commonalities and eligibility criteria   PAD-P has become legalized in a growing number of U.S. states (though certainly not all) since the enactment of the first law in Oregon in 1997. While state laws vary, most are modeled on Oregon’s original statute and share similar patient eligibility and process requirements listed below (3). Providers should know the specifics in their state (including if a state takes a non-statutory approach) and this Fast Fact does not provide legal advice.  

• Age ≥18 years or older.
• Intact decision-making capacity/competency. 
• Diagnosed with a terminal illness with a prognosis of 6 months or less, confirmed by two providers.
• Voluntary request that is free from coercion. 
• Self-ingestion of the lethal prescription (see Fast Fact #526 for clarification on self-ingestion). 
• Physical presence in the state where PAD-P is legal at the time of request, prescription, and ingestion. 
• At least one verbal request and one written request with two witnesses.

Other requirements of PAD-P more often vary by state (3):  

• Mandatory waiting periods.
• Some states allow non-residents to access their law (and proof of residency varies by state).
• Witnesses may need to be “disinterested” – unrelated, not a beneficiary, and not in a provider role. 
• Providers may be two physicians, or a physician and an advance practice provider.
• Some states mandate a mental health evaluation; others require it only if capacity is in doubt.

Epidemiology   It is challenging to accurately track PAD-P deaths in the U.S. because reporting requirements and data collection vary across states. Death certificates cannot be used to track PAD-P as they list the terminal illness, not PAD-P, as the cause of death. Available data suggest that across jurisdictions where PAD-P is legal, PAD-P deaths make up less than 1% of total annual deaths, though rates vary by state and rates increase as laws mature (4,5).  Aggregated data from nine U.S. jurisdictions over 23 years (1998–2020) show that patients who use PAD-P are typically older (median age 74) and predominantly non-Hispanic white; slightly less than half are women; most have some college education; and cancer is the most common underlying diagnosis (4). Available reports suggest that most patients who use PAD-P are enrolled in hospice and/or palliative care services at the time of death (4,6,7).

Common reasons for patient requests   A widespread misconception is that patients most often request PAD-P due to intolerable physical pain or other illness-related symptoms.  While true for some (8), data indicate that the most common reasons behind PAD-P requests include loss of autonomy, impaired ability to participate in enjoyable activities, fear of being a burden, and wanting to control the time and manner of death (9-11).  Some patients cite the fear of developing intolerable pain or symptoms in the future (12), and request PAD-P as a ‘backup’ option in case their condition worsens.  Roughly one third of patients who request PAD-P end up not using it (5-7). It is important to be aware of the reasons behind PAD-P requests which patients in an emotionally vulnerable state may not verbalize initially. Exploring these concerns, providing reassurance about the dying process, and ensuring referral to hospice and/or palliative care services may provide great benefit and relief of the patient’s concerns.  See Fast Fact #156 and Fast Fact #159 for how to respond to requests for hastened death.

References  

1. Sams RW, Jaggard P.  A moratorium on the euphemism MAID. Journal of the American Medical Directors Association 2024; 25(6):105004.
2. American Medical Association Council on Ethical and Judicial Affairs. Reconsidering the Terminology to Describe Physician Assisted Suicide. CEJA Report 3-A-25. American Medical Association; 2023.
3. Pope TM. Medical Aid in Dying: Key Variations Among U.S. State Laws. SSRN Electronic Journal. Published online 2020. doi:https://doi.org/10.2139/ssrn.3743855.
4. Kozlov E, Nowels M, Gusmano M, et al. Aggregating 23 years of data on medical aid in dying in the United States. Journal of the American Geriatrics Society. 2022;70(10):3040-3044. https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.17925.
5. Diaz K. Medical Aid-in-Dying Utilization Report – Compassion and Choices. https://compassionandchoices.org/. Published 2024. Accessed August 22, 2025. https://compassionandchoices.org/resource/medical-aid-in-dying-utilization-report/.
6. Oregon Health Authority. 2024 Oregon Death with Dignity Act Data Summary. Published March 27, 2025. Accessed August 22, 2025. https://www.oregon.gov/oha/ph/providerpartnerresources/evaluationresearch/deathwithdignityact/Documents/year27.pdf.
7. Colorado End-of-Life Options Act: 2024 Data Summary, with 2017-2024 Trends and Totals. Colorado Department of Public Health and Environment. Accessed August 22, 2025.
   https://cdphe.colorado.gov/center-for-health-and-environmental-data/registries-and-vital-statistics/medical-aid-in-dying#Annual.
8. Meier DE, Emmons CA, Litke A, et al. Characteristics of patients requesting and receiving physician-assisted death. Arch Intern Med. 2003;163(13):1537–1542. doi:10.1001/archinte.163.13.1537.
9. Ganzini L, Goy ER, Dobscha SK. Oregonians’ reasons for requesting physician aid in dying. Arch Intern Med. 2009;169(5):489–492. doi:10.1001/archinternmed.2008.579.
10. Al Rabadi L, LeBlanc M, Bucy T, et al. Trends in medical aid in dying in Oregon and Washington. JAMA Netw Open. 2019;2(8):e198648. doi:10.1001/jamanetworkopen.2019.8648.
11. Loggers ET, Starks H, Shannon-Dudley M, Back AL, Appelbaum FR, Stewart FM. Implementing a Death with Dignity program at a comprehensive cancer center. N Engl J Med. 2013;368(15):1417–1424. doi:10.1056/NEJMsa1213398.
12. Wiebe E, Shaw J, Green S, et al. Reasons for requesting medical assistance in dying. Can Fam Physician. 2018;64(9):674–679.

Conflicts of Interest: None to report.
Author Affiliations: Mount Sinai New York, NY.
Version History: Originally edited by Sean Marks MD, first electronically published in December 2025.