Until Oregon voters approved an aid-in-dying referendum in 1994, no jurisdiction in the United States had given legal approval to aid in dying. Moreover, fourteen years passed before a second state, Washington, legalised aid in dying. Since then, recognition has accelerated. Now, aid in dying is permitted in nine states and the District of Columbia, with nearly one in four Americans living in a jurisdiction that permits the practice. While a right to aid in dying has taken different paths—voter approval, legislative action, or judicial decision—all legalising US jurisdictions recognise the right in the same basic way: patients must be adults with decision-making capacity, must be terminally ill, and must self-administer the lethal dose of medication. This chapter discusses why the different jurisdictions have converged on the same legal framework for a right to aid in dying. In particular, there are key reasons for limiting a right to aid in dying to patients who are terminally ill (i.e., life-expectancy of six months or less). The chapter also discusses the implications of the common legal framework for future evolution of the right to aid in dying in the United States.

An Act Respecting End of Life Care came into force in the province of Québec, Canada on 10 December 2015.  This new law aimed to ensure that all adults with decisional capacity in Québec had access to the full range of health care options at the end of their lives including for the first time, medical assistance in dying (euthanasia). This chapter describes how the province’s medical regulator, the Collège des Médecins du Québec (CMQ), laid the groundwork for the passage of this law.  Although not necessarily setting out to play a role in law reform as such, the CMQ’s proposal to frame assisted dying as a therapeutic act enabled the legislator to introduce a bill which already had the support of the medical profession as well as a regulatory structure in place to guide practice.  This allowed the regulator to be more than a stakeholder in a process of law reform but a driver of reform itself.