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- PHYSICIAN ASSISTED SUICIDE IN THE USA AND SWITZERLAND - 12 Feb 2026
- 99% BOREDOM - 20 Jan 2026
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In the past year a friend of an acquaintance of mine travelled from California to Switzerland and obtained enough oral medications, prescribed by a physician, to complete a Physician Assisted Death (PAD), otherwise known as Physician Assisted Suicide (PAS). His diagnosis was early Alzheimer’s disease, and apparently his concern was that a long, drawn-out course of dementia was not the way he would choose to die. This tale was similar to the fate of Brazilian poet Antonio Cicero, who journeyed to Switzerland in 2024 to undergo the same process. Cicero had been diagnosed with Alzheimer’s disease. He traveled to Zurich, Switzerland and died on October 23, 2024, at the age of 79.
On October 5, 2015, California’s End of Life Option Act (EOLOA) became law, legalizing Physician Assisted Suicide (PAS). The law gives qualified patients with a prognosis of 6 months or less to live the ability to ask their physicians for a lethal prescription to end their lives. It grants physicians the right to choose not to participate.
In the United States, Physician Assisted Suicide (PAS) is legal in 13 states plus the District of Columbia:
- Oregon since 1997
- Washington since 2008
- Montana since 2009
- Vermont since 2013
- California since 2016
- Colorado since 2016
- Washington D.C. since 2017
- Hawaii since 2018
- New Jersey since 2019
- Maine since 2020
- New Mexico since 2021
- Delaware since 2025
- Illinois since 2026 (starting in September)
- New York since 2026
Green = States in which Physician Assisted Suicide is legal.
Tan = States in which Physician Assisted Suicide legislation is pending.
We’re all going to die someday, and there are a myriad of ways to perish, some more unpleasant than others. No one wants to die by drowning, by jumping out the window of a burning skyscraper, or in a crashing helicopter. No one wants an endgame of severe pain, or physical or mental wasting away. Slipping away under the cloud of a pleasant barbiturate sleep seems to have humane aspects to it. Empathy related to avoiding the awful ways to die led to the PAS movement. PAS is legal under certain circumstances in certain countries including Canada, Austria, Germany, Luxembourg, parts of Australia, the Netherlands, Portugal, Spain, Switzerland, and parts of the United States. Switzerland is the only country which permits assisted suicide for non-resident foreigners. Some have described this practice as suicide tourism. Unlike the circumstances in the United States, a patient in Switzerland is not required to have a terminal illness, but must have intact capacity to make decisions. About 25% of people in Switzerland who take advantage of assisted suicide do not have a terminal illness, but are simply old or “tired of life.”
Active euthanasia is illegal in Switzerland. Euthanasia is defined as “the practice of intentionally ending life to eliminate pain and suffering.” Euthanasia differs significantly from PAS in that euthanasia is the administration of lethal medications to a patient by a third party. Supplying the medications for dying (assisted suicide) is legal in Switzerland as long as the action which directly causes death is performed by the person who wishes to die. In Switzerland, every assisted suicide is followed by a mandatory investigation due to its classification as a non-natural death.
In the United States, access to PAS is restricted to people with a terminal illness with less than six months to live. Patients are required to be mentally capable, to get approval from multiple doctors, and to affirm their request multiple times. In the United States, dementia or pending dementia would not be a diagnosis qualifying for PAS, because dementia would not doom a patient to less than six months to live. Regarding a dementia patient qualifying for PAS in Switzerland, one must interpret the issue of whether a patient in cognitive decline is “mentally capable” to make the decision that they want to die.
Arguments against assisted dying include concerns about the lack of genuine consent. Some worry that vulnerable patients may be at risk of forced deaths if they are subjected to PAS without their genuine consent. There’s also concern of a “slippery slope,” regarding that once assisted suicide is initiated for the terminally ill, it may progress to other vulnerable and disabled people who will seek out PAS based on socioeconomic status.
In Oregon, 2,454 PAS deaths occurred from 2001 to 2022. In 2022, 431 people received prescriptions for lethal doses of medications under the provisions of the Oregon Death With Dignity Act (DWDA). In January 2023, the Oregon Health Authority received reports of 278 people dying through ingesting those medications. Eighty-five percent were aged 65 years or older, and 96% were white. The most common underlying illnesses were cancer (64%), heart disease (12%) and neurological disease (10%). Ninety-two percent died at home. In 2022 in Oregon the most frequently reported end-of-life critical issues were:
- decreasing ability to participate in activities that made their life enjoyable (89%)
- a loss of autonomy (86%)
- a loss of dignity (62%)
- burden on family/caregivers (46%)
- losing control of bodily functions (44%)
- inadequate pain control, or concern about it (31%)
- financial implications of treatment (6%)
Physicians are the gatekeepers to PAS. Does PAS have physician support? A 2019 survey of physicians in the United States found that 60% answered “yes” to the question “Should PAS be legalized in your state?” The public seems to favor the idea of PAS. A 2024 Gallup News poll found that Americans overwhelmingly supported medical aid in dying, and 71% of people “believed doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it.”
Physician Assisted Suicide programs that are legal in several U.S. states involve the prescription of oral medications in a dosage guaranteed to cease breathing and cause death. Typical medications prescribed include oral barbiturates such as secobarbital or pentobarbital.In most cases, the patient becomes unconscious after a few minutes, with dying occurring within about two hours. In some U.S. states where assisted suicide is legal, the drug combinations called “DDMA’” (diazepam, digoxin, morphine sulfate and amitriptyline) and “DDMP” (diazepam, digoxin, morphine sulfate and propranolol) have been used.
Why should an anesthesiologist weigh in on these matters? A general anesthetic has the power to end a patient’s life if that patient’s life is not supported by the anesthesia practitioner. I’ve previously weighed in on the issue and techniques of death by lethal injection which occur in death rows in prisons in several U.S. states. To my knowledge, no anesthesiologist will assist or execute a lethal injection as part of a death sentence. Anesthesiologists typically work with intravenous medications, not oral medications. Dr. Jack Kevorkian infamously created an intravenous death machine, which would inject lethal doses of Sodium pentothal, succinylcholine, and potassium chloride as a form of euthanasia. Dr. Kevorkian was imprisoned for his invention of the death machine sequence, and no anesthesiologist nor any United States physician is interested in causing euthanasia by lethal injection. Like all physicians, anesthesiologists are trained to support life and to save lives. The decision to help a patient end their own life is not a decision any physician makes lightly. In my home state of California, I’m not aware of any anesthesiologists who prescribe lethal doses of barbiturate pills for Physician Assisted Suicide. The most common specialists who will make the life-or-death decision in PAS will be primary care doctors such as internal medicine doctors, geriatricians, or family practice doctors.
What about the Hippocratic Oath? The Oath, established circa 400 B.C., states, “I will give no deadly medicine to any one if asked, nor suggest any such counsel.” Contrary to popular belief, the Hippocratic Oath is not required at graduation by most medical schools, nor does the Oath confer any legal obligation on doctors who choose to take it.
In 2022 the American Medical Association (AMA) opposed medical aid in dying, stating in their Code of Ethics Opinion 5.7 that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.”
It’s unlikely any Switzerland-like laws will ever be approved in the United States, allowing patients to request, obtain, and self-administer lethal doses of oral medications simply because the patient no longer wants to be alive. But the option of “suicide tourism” in Switzerland exists. Most Americans are unlikely to travel there to end their lives on their own terms. As a physician I’m not endorsing or recommending it, but the possibility of American patients ending their lives in Zurich exists. American physicians can begin the debate on how best to interface with the Swiss values on end-of-life care.
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