Read almost any medical aid-in-dying statute in the United States and you will find the same two locks on the same door. The person has to be dying on a schedule, and the person has to still be there to say so. Oregon's law, the oldest of them, was enacted on October 27, 1997 and allows terminally ill people to end their lives by voluntary self-administration of prescribed medication, according to the Oregon Health Authority's own account of the Act. The state's 2025 data summary, published this April, shows what that produces in practice: 400 people reported to have died in 2025 after ingesting the medication, 637 prescriptions written by 155 physicians, cancer the most common diagnosis at 61 percent, neurological disease 14 percent, heart disease 11 percent. Eighty-eight percent were 65 or older. Dementia does not appear as a qualifying route, because a person deep in dementia can meet neither lock.
That is the gap Ronald L. Hirsch went after in an essay for The Fulcrum published at the start of May, under the title "Beyond Terminal: Why Advance Directives for Death with Dignity Must Be Expanded to Protect the Right to Choose Life or Death." Hirsch, a lawyer and author, argues that the standard qualifying condition, a terminal diagnosis within six months, is (in the version of the essay reprinted by The Daily World on May 6) "far too narrow," and that people should be able to write binding directives now, while of sound mind, covering irreversible suffering, dementia, and non-terminal catastrophe later. His framing is not clinical but proprietary in the older sense: "There are few things more personal or private than one's physical and mental health." He counts eight countries and 19 states as already permitting assisted dying in some form; tallies vary by how you count, and FindLaw's state-by-state guide put it at 13 states and the District of Columbia as of August 2026, while noting that euthanasia, meaning administration by another person, remains illegal everywhere in the country.
This is an opinion piece. It is worth saying that plainly, because the essay contains no new data, no cohort, no survey of families, and no legal test case. It is a citizen's argument about where a line should sit. What makes it newsworthy for households living with a diagnosis is that the line has just moved in one direction and not the other. New York became the newest state to legalise aid in dying when Governor Kathy Hochul signed S.138/A.136 on February 6, 2026, a law her office described as affirming "the right for the terminally ill to peacefully and comfortably end their lives with dignity and compassion." The New York State Department of Health announced the law took effect on August 5, 2026. It applies to terminally ill residents with less than six months to live. A person with moderate Alzheimer's disease who may live for years, and who may by then be unable to make the request, is outside it, as they are outside Oregon's.
The question Hirsch raises is not hypothetical elsewhere. In the Netherlands, where the legal architecture is different and a written advance request can carry weight, the Regional Euthanasia Review Committees reported a rise in dementia-related cases in their 2025 annual report, published in March 2026: 499 notifications involving dementia, against 427 the year before, out of 10,341 notifications in total, as summarised by the Dutch right-to-die association NVVE. The committees' own figures page is careful about the hardest category. A small number of patients in recent years, it says, were in an advanced stage of dementia, no longer decisionally competent regarding their request and no longer able to communicate meaningfully about it. Those are the cases that test an advance directive to destruction, and the Dutch system treats them as rare and separately scrutinised rather than routine.
For a family here and now, none of this changes what is available on a Tuesday afternoon. It changes the vocabulary of the argument they may find themselves in. The practical objection to dementia directives is not squeamishness; it is that the person who wrote the document and the person who would be affected by it can look, to everyone in the room, like two different people, one of whom may seem content. The practical argument for them is that waiting for a six-month prognosis in a disease that can run a decade is, for some people, a promise that will never come due. Both of those are real. An essay cannot settle them, and this one does not claim to. What it does is name the group that current statutes were not drafted with in mind, and ask legislators to say out loud whether that exclusion was a decision or an oversight.