Assisted Dying in the Americas: Courts and Statutes

Last Updated: July 2026

Overview

The Americas legalized assisted dying through a route Europe mostly did not use: constitutional litigation. Colombia’s Constitutional Court decriminalized euthanasia in 1997, before any European parliament acted, and Ecuador’s court followed in 2024. Canada’s framework also began with a Supreme Court ruling, in Carter in 2015, rather than with legislation.

Scale separates Canada from everywhere else in the hemisphere. Canada recorded 16,499 assisted deaths in 2024, about 5.1 percent of all deaths in the country, a figure compiled here by Cardus, an organization critical of the programme, from federal reporting. Colombia, by contrast, recorded fewer than 700 procedures across eight years. The United States operates a narrower model in a minority of states, and most of Latin America prohibits the practice entirely.

This page describes the landscape and does not take a side. It is a maintained reference, revised as laws and circumstances change.

The Competing Frames

Autonomy and dignity in death. The frame that has won in court across the hemisphere, and the one on which Colombian, Ecuadorian and Canadian judgments rest. It treats the manner of one’s death as within the sphere of personal decision, and suffering without prospect of relief as a rights violation the state must permit an exit from. Its Latin American version is grounded in dignity clauses in national constitutions rather than in liberty interests, which is why the arguments read differently from the American ones.

Sanctity of life and medical ethics. Advanced by Catholic bishops’ conferences, evangelical organizations, and a substantial part of the medical profession. It divides into a religious claim about the wrongness of intentionally ending life and a professional claim about what medicine is for. The two are often bundled together in coverage, but doctors’ associations in Canada and Colombia have raised conscience and professional identity objections independent of theology.

Disability rights and structural coercion. The most consequential objection in Canada and the least reducible to left or right. Disability organizations, including some that support autonomy in other contexts, argue that offering assisted death to people whose suffering is driven by inadequate housing, home care or income support is not a free choice. United Nations special rapporteurs have raised the same concern about Canada. Supporters respond that the eligibility assessment exists to catch exactly this, and that denying the option to disabled people alone is itself discriminatory. Both sides invoke equality.

Palliative care as the alternative. Argued by hospice organizations across the region, holding that demand for assisted death reflects failures of pain management and end-of-life support. In Latin America, where palliative coverage is thin, this argument carries different weight than in Canada, where coverage is better but uneven. The empirical question of whether improved palliative care reduces requests is contested and the evidence is not conclusive in either direction.

Regulation versus prohibition. A practical frame that cuts across the moral ones. Several Latin American medical bodies have argued that unregulated terminal sedation already occurs and that formal law makes practice visible rather than creating it. Opponents contest the premise about how common that is.

The Policy Spectrum

Broad eligibility including non-terminal illness. Canada and Colombia. Canada’s second track covers people whose natural death is not reasonably foreseeable. Colombia’s Constitutional Court removed the terminal illness requirement in 2021, extending access to serious and incurable conditions causing intense suffering.

Euthanasia by statute with terminal or extreme-suffering criteria. Uruguay, which regulates administration by a health professional and does not permit patient self-administration.

Assisted suicide only, terminal illness only. The United States model. A prognosis of six months or less, self-administration required, waiting periods, and two physicians. No US jurisdiction permits a clinician to administer the medication.

Court-permitted without implementing legislation. Ecuador after 2024, where the ruling ordered regulations that the executive and legislature were directed to produce on a timetable.

Prohibited. Most of the hemisphere, including Brazil, Mexico, Argentina, Chile, Peru and the Caribbean states. Several permit withdrawal of treatment and palliative sedation under dignified death or living will laws, which is a distinct question frequently conflated with this one.

The Regional Map

Canada. The largest programme in the world by share of deaths and the most contested. Parliament delayed eligibility for people whose sole condition is mental illness until March 2027 through Bill C-62, the second such postponement. Track two deaths, where natural death is not foreseeable, numbered 732 in 2024, under 5 percent of the total but the category driving nearly all the controversy. Quebec operates additional provincial rules and has moved on advance requests ahead of federal law.

Colombia. The hemisphere’s oldest legal framework and one of its smallest in practice. The 1997 ruling sat unimplemented for eighteen years until the Court forced the health ministry to issue a protocol in 2015. Around 692 procedures were recorded between April 2015 and the end of 2023, according to a compilation by Australian Care Alliance, an organization opposed to the practice, with annual numbers rising steeply toward the end of that period. Congress has never passed a governing statute, which leaves the framework resting entirely on court orders and ministerial resolutions.

Ecuador. The Constitutional Court ruled seven to two in February 2024 in favour of Paola Roldán, a woman with amyotrophic lateral sclerosis, exempting doctors performing active euthanasia from the homicide provision. The court set deadlines for the health ministry, the ombudsman and the National Assembly to produce regulations and legislation. Roldán died of natural causes weeks later.

Uruguay. The exception to the courts-not-legislatures pattern. The Senate approved the Dignified Death Law by 20 votes to 11 in October 2025, after five years of legislative process and with support crossing party lines. It is the first euthanasia law in Latin America passed by a parliament rather than imposed by a court, which makes it the region’s most durable settlement to date.

United States. Expanding steadily but narrowly. Oregon’s 1997 law remains the template every subsequent state has followed with minor variation. Delaware’s law took effect in January 2026, and Illinois became the thirteenth jurisdiction to authorize the practice in December 2025, the first in the Midwest, effective September 2026. Montana’s position rests on a state supreme court ruling rather than a statute. Residency requirements have been dropped in Oregon and Vermont after litigation, allowing out-of-state patients.

Mexico and Brazil. Both prohibit assisted dying while permitting advance directives and withdrawal of life-sustaining treatment. Mexico City and several states have dignified death laws covering that narrower ground, and constitutional challenges have been filed without success so far.

The Caribbean and Central America. Uniformly prohibited, with little organized movement in either direction. Catholic and evangelical influence is strong and the issue rarely reaches legislative agendas.

Recent Changes

The hemisphere’s route to legalization has been judicial more often than legislative, and the consequences of that are visible. Colombia has had a legal right for nearly thirty years and no statute governing it, which produced an eighteen-year implementation gap and continuing disputes over eligibility, conscientious objection and institutional refusal. Ecuador is at the start of the same problem. Canada moved from court ruling to legislation within a year, which is why its framework is more detailed and also why its expansions have been fought in parliament rather than in clinics.

Uruguay’s 2025 law suggests a second route is opening. It passed with cross-party votes in a country with an unusually secular political culture, after the Chamber of Deputies had approved a version in 2022. Whether it is replicable in Chile or Argentina, where bills have been introduced without advancing, is unresolved.

In the United States, the pattern since 2020 has been legislative rather than ballot-initiative, which is a change from the Oregon and Washington era. Eligibility has not broadened: no state has moved beyond terminal illness with six-month prognosis, and the American debate has stayed narrower than the Canadian one throughout.

Active Debates

Canada. Two questions are live as of mid-2026. Whether the mental illness eligibility scheduled for March 2027 proceeds, with legislation introduced to make the pause permanent, and whether advance requests for people facing dementia are permitted federally as Quebec has already done provincially. The disability rights objection remains the strongest opposition argument and has not been resolved by either side’s evidence.

Colombia. Whether Congress will legislate. Every expansion so far has come from the Constitutional Court, and hospital-level refusal to provide the service continues without a statutory remedy.

Ecuador. Whether the National Assembly meets the court’s directive at all. Implementation has lagged the deadlines set in the ruling, which is the same failure mode Colombia experienced after 1997.

United States. Expansion to additional states continues, with New York reported as the most recent addition in early 2026. The contested edges are residency requirements, telehealth prescribing, and whether clinicians outside a patient’s state can participate.

Southern Cone. Chile’s bill has passed one chamber in the past without becoming law, and Argentina’s proposals have not advanced. Uruguay’s law is the reference point both sets of advocates now use.

This is a maintained reference page, last updated July 2026. It is revised as laws and circumstances change. Major developments are covered as dated posts in the News section and linked from here.

Discussion Questions

Is assisted dying legal where you live? If it is not, has it ever been debated?
Canada records one in twenty deaths as assisted. Does that number tell you the law is working or that something has gone wrong?
Colombia has had a legal right since 1997 and still has no law from its congress. What does that do to how the right functions?
Disability organizations argue that choosing death because of poor support is not really a choice. How would you answer that?
US laws all require the patient to take the medication themselves. Uruguay requires a doctor to administer it. Which design makes more sense to you?
Should a court be able to create this right, or does it need to come from elected legislators?
Imagine you are a doctor in a country that has just legalized this and your hospital refuses to participate. What are your options?
Canada has twice delayed allowing this for people whose only condition is mental illness. Why do you think that question is harder?
Would better palliative care reduce demand for assisted dying, or are they separate questions?
What safeguard would have to exist before you would be comfortable with a law like this?

Assisted Dying in the Americas: Courts, Statutes, and the Canadian Argument