Countries where euthanasia is legal — meaning a physician may actively end a patient’s life at their voluntary request — now number at least nine: the Netherlands, Belgium, Luxembourg, Spain, Colombia, Canada, New Zealand, Ecuador, and Australia. All of them require the patient to be suffering from a serious medical condition, to ask voluntarily, and to have the mental capacity to understand the decision. Beyond that shared floor, the rules diverge sharply, especially over whether the illness must be terminal, whether minors can qualify, and whether foreigners can access the procedure at all.
The Nine Countries at a Glance
The Netherlands was first. Its Termination of Life on Request and Assisted Suicide Act took effect in 2002, and while euthanasia technically remains a criminal offense, physicians who follow six statutory due care criteria are exempt from prosecution.1Government of the Netherlands. Is Euthanasia Allowed in the Netherlands
Belgium legalized the practice the same year under its Law of 28 May 2002. A 2014 amendment removed the age limit entirely, making Belgium the only country that permits euthanasia for minors regardless of age.2Library of Congress. Regulation of Assisted Dying
Luxembourg followed in 2009. Its law defines euthanasia as a medical act by which a physician intentionally ends a patient’s life at their explicit and freely given request, and it imposes no nationality or residency requirement.3The Government of the Grand Duchy of Luxembourg. Euthanasia: Assisted Suicide
Spain legalized euthanasia through Organic Law 3/2021, which took effect in June 2021 and made the procedure a covered service within the national health system.
Colombia was the first country in Latin America to decriminalize the practice, through a 1997 Constitutional Court ruling that shielded physicians who ended the lives of terminally ill patients giving informed consent.4Corte Constitucional de Colombia. Sentencia C-239/97 A 2021 ruling dropped the terminal-illness requirement, opening access to anyone with a serious, incurable condition causing intense suffering.
Canada legalized medical assistance in dying (MAID) in 2016 and expanded it in 2021 to cover people whose natural death is not reasonably foreseeable.5Department of Justice Canada. Canada’s Medical Assistance in Dying Law
New Zealand’s End of Life Choice Act 2019 took effect in November 2021 after a public referendum, and it is one of the more restrictive laws: applicants must have a terminal illness likely to end their life within six months.6New Zealand Legislation. End of Life Choice Act 2019
Ecuador’s constitutional court decriminalized euthanasia in early 2024, holding that a physician who ends the life of a seriously and chronically ill patient at that patient’s request can no longer face homicide charges.
Australia has phased in voluntary assisted dying state by state since Victoria became the first in 2017. All Australian states and the Australian Capital Territory now permit the practice; only the Northern Territory lacks an operational law.7Healthdirect Australia. Voluntary Assisted Dying Because each state legislated separately, the eligibility rules, waiting periods, and safeguards vary depending on where the patient lives.
One more country belongs on the map with an asterisk. Portugal passed Law 22/2023 in May 2023, but the law is not yet operational. The Portuguese Constitutional Court ruled in April 2025 that parliament must amend the statute to sharpen the line between assisted suicide and euthanasia, and implementation remains suspended pending that action.
Who Qualifies: The Shared Requirements
Almost every country with a euthanasia law requires the same three things. First, the patient must be suffering unbearably from a serious or incurable medical condition. Second, the request must be entirely voluntary and free from outside pressure. Third, the patient must have the mental capacity to understand their diagnosis, prognosis, and the irreversible nature of the decision.
Two independent medical assessments are also universal. The attending physician confirms the diagnosis and explores alternatives including palliative care, and a second independent physician examines the patient and agrees that the legal criteria are met.1Government of the Netherlands. Is Euthanasia Allowed in the Netherlands In Canada, if neither assessor has expertise in the patient’s condition, they must consult someone who does.5Department of Justice Canada. Canada’s Medical Assistance in Dying Law
Terminal Illness or Chronic Suffering?
This is the sharpest dividing line in the field, and it determines whether someone with a debilitating but non-fatal condition can qualify at all.
New Zealand takes the strict approach. The illness must be terminal and likely to end the patient’s life within six months.6New Zealand Legislation. End of Life Choice Act 2019 The Netherlands, Belgium, Canada, and Colombia go the other way. Each permits access for chronic conditions that cause unbearable suffering even when death is not imminent. Canada’s 2021 expansion made this explicit by opening MAID to people whose natural death is not reasonably foreseeable, and Colombia’s 2021 ruling did the same by removing the terminal-illness limit.5Department of Justice Canada. Canada’s Medical Assistance in Dying Law
Age Rules and Minors
Most countries limit euthanasia to adults aged 18 and older. That is the rule in the Netherlands, Luxembourg, Canada, New Zealand, Spain, and Ecuador. Luxembourg also bars anyone under guardianship or legal protection from making a request, even through a guardian.8Guichet.lu. Euthanasia and Assisted Suicide
Belgium is the sole country with no age floor. A child of any age can request euthanasia, but the safeguards are far more demanding: a child psychiatrist or psychologist must certify that the minor understands the decision, the condition must be terminal and cause unrelievable physical suffering, and the legal representatives must consent.2Library of Congress. Regulation of Assisted Dying Cases involving minors remain extremely rare in practice.
Colombia sits in the middle. Its framework recognizes that adolescents aged 12 to 17 may have decision-making capacity, with parental involvement built into the process. Access for younger children exists only in exceptional cases under strict safeguards.
Can Foreigners Qualify?
Residency rules are how most countries prevent people from traveling solely to access the procedure, and the rules matter to anyone considering the option from abroad.
Canada requires eligibility for publicly funded health services, which in practice means Canadian citizenship, permanent residency, or meeting a province’s minimum residency period. Visitors are generally not eligible.9Health Canada. Medical Assistance in Dying: Overview New Zealand limits access to citizens and permanent residents.6New Zealand Legislation. End of Life Choice Act 2019 Spain requires Spanish nationality or at least 12 months of residence. Colombia requires either nationality or a valid visa with health system coverage.
Luxembourg is the outlier: no nationality or residency requirement at all. The practical barrier is the doctor-patient relationship, since the physician must have treated the patient for a sufficiently long and continuous period.8Guichet.lu. Euthanasia and Assisted Suicide The Netherlands and Belgium have no formal residency requirement in their statutes either, but the same practical need for an established medical relationship creates a de facto barrier for foreigners.
Mental Illness as the Sole Condition
Whether psychiatric suffering alone can qualify is the most contested question in this area, and countries have landed in very different places.
The Netherlands has permitted euthanasia for patients with psychiatric disorders since the 1990s, provided the same due care criteria are met. In practice these cases are rare, heavily scrutinized, and typically involve patients who have spent years exhausting every available treatment. Belgium similarly allows it, though its one-month waiting period always applies because the patient’s death is not foreseeable.
Canada was on track to extend MAID to people whose sole underlying condition is mental illness, but the federal government has delayed the expansion multiple times. The current exclusion runs through March 17, 2027.5Department of Justice Canada. Canada’s Medical Assistance in Dying Law
Spain, New Zealand, Luxembourg, and every U.S. state with an assisted dying law limit access to physical medical conditions and do not permit the practice for mental illness alone.
Dementia and Advance Directives
A common question is whether someone diagnosed with early-stage dementia can arrange euthanasia in advance, to be carried out after they lose the ability to communicate their wishes. The answer depends entirely on the country.
The Netherlands allows it. A patient who is still mentally competent can draft a written advance directive describing the circumstances in which they would want euthanasia, such as reaching an advanced stage of dementia. If the patient later becomes unable to express their will, that directive can substitute for an oral request.1Government of the Netherlands. Is Euthanasia Allowed in the Netherlands There is no required format, but the patient should discuss it with their physician and be as specific as possible. Even then, the physician must still satisfy all six due care criteria, including a judgment that the suffering is unbearable — a difficult determination in a patient who can no longer communicate.
Most other countries take the opposite approach. Belgium, Canada, Luxembourg, New Zealand, and Portugal’s stalled law all require decision-making capacity at the time of the request, which effectively rules out euthanasia for someone who has already lost that capacity.
A Note on the United States
The United States does not appear on the list because active euthanasia, where a physician administers the lethal medication, is illegal in every state. Federal law reinforces the prohibition: the Assisted Suicide Funding Restriction Act of 1997 bars any federal health care funds from being used to cause or assist in causing a patient’s death, covering Medicare, Medicaid, and all federally operated facilities.10Office of the Law Revision Counsel. 42 USC Ch. 138: Assisted Suicide Funding Restriction
What is legal in a growing number of states is a narrower practice, usually called medical aid in dying, in which a doctor prescribes lethal medication that the patient must take themselves. As of 2026, 13 states and the District of Columbia authorize this: Oregon (first in 1994), Washington, Vermont, California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Delaware, Illinois, New York, and Montana, whose authorization comes from a 2009 state supreme court decision rather than legislation. The laws explicitly declare that actions taken under them do not constitute suicide, assisted suicide, or homicide. Anyone comparing the U.S. to the countries above should keep that distinction in mind: prescribing is not the same as administering, and eligibility in the U.S. states is generally limited to terminally ill adults with a prognosis of six months or less.