“Death with Dignity” laws are on the rise around the nation. Today, five states legally recognize assisted suicide in the face of terminal illness. They include Oregon, Washington, Montana, Vermont, and most recently, the most populous state, California.

It is estimated that in 2016 one in 10 Americans will live in jurisdictions in which it is legal for a physician to prescribe a lethal drug to a terminally ill patient who, under a variety of safeguards, may commit suicide. While only five states currently allow individuals to choose this option, more than 25 other states have introduced bills that discuss the legalization of some form of “right-to-die” measures.

The end-of-life option

California’s “End of Life Option Act” serves as a good touchstone in understanding the death-with-dignity landscape, particularly in regard to how far it has come and in what direction it may expand in the future.

The act, which became effective in January 2016, authorizes adults to request a drug for the purpose of ending their lives if they meet certain qualifications and their physicians determine that they suffer from a defined terminal disease. While the act creates an avenue for individuals to make right-to-die choices, its restrictions and qualifications create limits on who may avail themselves of this option.

In California, the act requires that the individual suffer from a “terminal disease,” which is defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within six months. The act goes on to require that the individual be a resident of California, be physically and mentally capable of self-administering the aid-in-dying drug, and that the application process for the medication include two verbal requests, a minimum of 15 days apart, and a written request, all addressed to the patient’s attending physician.

Excluded

California’s End of Life Option Act still excludes a large range of people who may want to be covered. This includes people with progressive debilitating diseases who don’t have a clear six-months-to-live prognosis as well as people with dementia, one of the fastest-growing health threats in the United States. There are similar restrictions in the other four states that currently allow this practice.

Moreover, there are medical conditions that are unpredictable, in terms of life expectancy as well as how, when, and in what order bodily functions are lost. Examples include progressive neurological diseases such as multiple sclerosis and ALS; patients with these conditions who want to avoid the most debilitating final stages might end their lives prematurely, afraid that their ability to self-administer the life-ending medication may become impossible.

Utah’s death-with-dignity bill proposed that an individual could seek life-ending medication if they were suffering from an “intractable and unbearable disease,” meaning a bodily disorder that cannot be cured or successfully palliated, and that caused suffering severe enough to cause a patient to prefer death. This bill was put on hold for further review; however, State Representative Rebecca Chavez-Houck plans to reintroduce the bill again in the 2016 session.