HB140 (The Ron Silverio/Heather Block End of Life Options Act) legalized assisted suicide in Delaware. It allows any physician or nurse practitioner in the state of Delaware to prescribe lethal drugs, in response to request from a Delaware resident with a prognosis less than 6 months, with the sole intent of causing death when taken by the patient. This prescription of drugs to help a patient take their own life is known as assisted suicide. Proponents of the practice prefer the term “medical aid in dying (MAID)” which is also used to refer to euthanasia (where lethal drugs are administered by a healthcare provider) or hospice (which is not controversial). The law also provides broad immunity from civil (malpractice) and criminal liability as well as prohibiting medical/nursing licensing boards and medical organizations such as hospitals from disciplining physicians and nurse practitioners who help patients commit suicide.

No, it only provides immunity to physicians and nurse practitioners. Anyone else (such as a family member) who helps a terminally ill patient end their life is still committing a crime in Delaware.

There is no scientific test to determine prognosis. To determine prognosis, physicians and nurses must mentally compare the patient in front of them with data on large groups of patients with similar diseases reported in the literature and cases they have seen personally. They also must consider the condition of the patient in front of them in terms of physical function, nutrition, and general ability to tolerate treatment. Finally, they may think about the patient’s social support and community resources. In doing this, they are subject to all the implicit and explicit biases of other human beings. The result is like what you will get asking an attorney if you will win or lose your court case or asking a mechanic if your car will make it to New York. The answer will not be perfect, but it will be better than a coin toss. However, predicting survival in hospice patients can be even more difficult. In a study of 468 patients enrolling in hospice, doctors accurately predicted survival time (defined as within 33% of actual survival), in only 20% of patients (British Medical Journal).

NO, this law only addresses prescribing medication with the sole intention of helping a patient end their life. It does not provide any additional options for management of symptoms. Studies of titrating pain medication in end-of-life patients to high doses needed to control pain show that this, rarely, if ever, hastens death. However, ethicists draw a sharp distinction between giving medication with the intention of causes death and having an unintended effect of causing death. As a result, using medications to achieve end of life pain control is already both an accepted and legal medical practice in all US states. The immunity from civil liability or discipline that is granted to physicians and nurse practitioners by HB 140, applies specifically and only, when helping patients commit suicide.

NO, unfortunately, there is a shortage of specialty trained palliative care professionals in Delaware. Many non-specialty trained physicians and nurse practitioners are not aware of best practices in treating end of life symptoms, including not only titration of medications for symptoms but palliative use of interventional procedures. Additionally, practical/workflow barriers to prescribing controlled substance and fear of liability have caused many non-palliative care practices to completely stop treating pain with the types of drugs typically required at the end of life. The CDC has acknowledged that efforts to address the opioid overdose deaths have inadvertently harmed some patients with pain (see: New CDC guidelines a ‘corrective’ for opioid prescriptions, specialist says — Harvard Gazette). Further, some palliative interventional procedures which are very effective such as celiac plexus nerve blocks for pancreatic pain may require patients to travel outside of the state to obtain. As a result, many Delawareans at the end of life are suffering from symptoms that could be eliminated with optimal care. HB 140 does nothing to help these patients access treatment but instead offers them suicide as an escape from inadequate symptom management. Additionally, there are well know disparities in pain treatment with African American patients more likely to have their symptoms inadequately managed.

The state of Oregon publishes an annual report on assisted suicide deaths. The most recent data available is from 2023. In that year 126 patients (34.3% of a total of 367 patients who died from assisted suicide in Oregon in 2023) cited pain as a concern. This is a slight increase compared to 599 patients (27.5% of 2,176 deaths from 1998-2021).

The most common reasons cited by patients in 2023 are loss of autonomy (91.6%), less able to engage in activities they enjoy (88.3%), loss of dignity (63.8%), and being a burden on family, friends and caregivers (43.3%). Financial implications of treatment were cited as a reason in 8.2% deaths from assisted suicide in Oregon in 2023. There is variation year to year in reasons cited in Oregon reports. However, in most years almost half of patients cite being a burden and the percentage citing financial concerns about treatment appears to be increasing overall. The reports for various years are available on the state of Oregon Health Authority website and first 25 years of data has been summarized in a peer reviewed publication (Oregon Death with Dignity Act access: 25 year analysis – PubMed).

NO, regulations which took effect on March 11, 2026, indicate Delaware will not be collecting data on reasons why Delaware patients choose assisted suicide and many other key features that Oregon uses to monitor this practice in their state. Current plans for an annual report by the state of Delaware are inadequate to monitor implementation of this law.  Delaware regulations are available at Delaware Regulations – Regulation.

There are no drugs approved by the US Food and Drug Administration (FDA) or any other regulatory agency for assisted suicide. While there are recommendations from practitioners on combinations of drugs to use, there is no consensus. Commonly used drug combinations include high doses of barbiturates, opioids, cardiotoxic drugs (such as digoxin) and anti-nausea drugs. In New Jersey, a combination of diazepam, digoxin, morphine and amitriptyline is most often used. It might seem that the safety of drugs would be less important when the intention is to cause death. However, despite lack of data collection, distressing side effects from these combinations such as vomiting, choking, gasping, and prolonged time to death have been reported. While in the US, it is extremely rare for assisted suicide practitioners to attend their patients’ deaths, in the Netherlands it is common practice for physicians prescribing assisted suicide drugs to be present when the patient takes the drugs. Physicians in the Netherlands attending assisted suicides have reported a need to convert from assisted suicide to euthanasia 18% of the time. (Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands | New England Journal of Medicine). This percentage is not dissimilar to a reported 14.8% complication rate reported in Oregon, but interpretation of US numbers is severely limited by missing data. The Canadian Association of MAID Assessors and Providers recognized this problem in 2019 white paper which recommended that “Clinicians should obtain consent from patients prior to the initiation of MAID for any therapies that may be required should a complication occur (e.g. conversion from oral self-administered to IV….).” Many of these issues and drugs used were reviewed by in a 2022 British Medical Bulletin article (Efficacy and safety of drugs used for ‘assisted dying’ – PMC).   In the US where euthanasia is illegal and physicians typically are not present for assisted suicides, there is a risk that patients may not experience the rapid, peaceful death many are seeking.

NO, it would be highly unusual for medical or nursing schools in the United States to provide any training in the use of these drugs for assisted suicide. Assisted suicide is illegal in most US states.

NO, any licensed physician or nurse practitioner is now allowed to add this to their practice without any training at all. This contrasts with Delaware laws requiring continuing medical education on safe opioid prescribing, child abuse recognition, and Alzheimer disease (all of which are typically part of medical school curriculums).

NO, despite defining who can be considered a mental health professional, the law contains no requirement for consulting any mental health professional. It leaves the decision to ask for consultation entirely to the discretion of physician or nurse practitioner prescribing drugs for suicide.

YES, patients with serious medical illness are more likely to have comorbid psychiatric disease than the general population. The incidence of major depression in terminally patients has been reported to range from 25% to 77% (BAPR_14_2_Apr01). Anxiety disorders are also very common. Unfortunately, psychiatric disease is often under-recognized and untreated in this population.  It is noteworthy that in addition to a shortage of palliative care clinicians, Delaware also has a shortage of mental health professionals. However, treatments for psychiatric disease which is comorbid with terminal illness is effective and improves quality of life (managing_depression.pdf).

NO, only 1% of 2454 patients undergoing assisted suicide in Oregon from 1998-2022 underwent psychiatric evaluation. Further, this percentage declined over time such that in 2021 only 0.5% underwent psychiatric evaluation (Oregon Death with Dignity Act access: 25 year analysis | BMJ Supportive & Palliative Care). In Canada, 6.7% of medical aid in dying patients had a mental health evaluation but this is still far lower than even the lowest estimates of serious mental illness in this population (umj-92-01-4.pdf). It seems likely that with treatment for comorbid psychiatric disease some of these patients would have chosen not to end their lives.

YES. Based on the experience in other states, the controversy will continue. HB 140, like other initial state laws contains what advocates for assisted suicide consider “barriers to access”. Soon after passing initial laws legalizing assisted suicide, advocacy for reducing barriers began in other states and there is no reason to think Delaware will be different in this regard. “Barriers” in HB 140 include a brief waiting period, requirements for 6-month prognosis, a requirement to be a Delaware resident, and prohibiting physician assistants from prescribing medications to aid patients in suicide. In California, New Mexico, Oregon, and Washington laws have been changed to either waive or reduce waiting periods for assisted suicide. Residency requirements in other state laws have been successfully challenged in court. Out of state residents are now able to commit suicide in Vermont and Oregon with the assistance of local providers. More types of practitioners have been added to the authorized list of prescribers in other states. There is already a bill pending in New Jersey seeking to expand assisted suicide/reduce “barriers” in that state. For an idea of what may be in store if HB 140 becomes law, I recommend that the What’s Next for MAID section of the following 2023 article by Attorney Pope (who is advocating in favor of assisted suicide/MAID): Your End-of-Life Options. However, it is not just lawyers and law makers who will push the envelope on this issue, physicians will also. An important example of this is the use of assisted suicide for “terminal” anorexia nervosa in Colorado which is nicely described in an article rebutting the concept: Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined | Journal of Eating Disorders | Full Text.

See STATES ABANDON INITIAL “SAFEGUARDS” TO EXPAND ASSISTED SUICIDE LAWS for additional information

Assisted suicide is only legal in 12 states (including Delaware) and the District of Columbia. It will become legal in New York in August 2026. In New York, Governor Hochul insisted the legislature add requirements for mental health evaluation, recording of the patient request and in person evaluations. While even the New York requirements do not adequately protect vulnerable patients, it is noteworthy that they offer far more protection than patients in Delaware receive under HB 140. In one of the 12 states referred to above, Montana, assisted suicide is legal only due to a legal loophole where the courts allow physicians to use the patient’s consent as an effective defense against being charged with a crime.

The American Medical Association opposes legalization of assisted suicide (H-270.965 Physician-Assisted Suicide | AMA H-140.966 Decisions Near the End of Life | AMA H-140.952 Physician Assisted Suicide | AMA).

The American College of Physicians also opposes legalization of assisted suicide. The American College of Physicians represents internal medicine physicians (doctors who provide nonsurgical care for adults, including many patients near the end of life). The position paper of the American College of Physicians summarizes many of the relevant ethical issues and is available at: Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper

YES. While individuals with disabilities have a wide variety of views, this question was carefully examined in a 2019 US government report from the National Council on Disability which concluded that these laws are in fact harmful. The full report can be found at https://www.ncd.gov/report/the-danger-of-assisted-suicide-laws/.

No, assisted suicide harms the most vulnerable members of society and is not consistent with progressive ideas. People from across the political spectrum recognize the harms of legalizing assisted suicide. For additional information on this question, please visit: PAMAS – Progressives Against Medical Assisted Suicide

Michael Vest, DO, FACP, FCCP, FCCM is the content editor of this website. He is a critical care physician at Christiana Care and Associate Professor of Medicine at Sidney Kimmel Medical College. In caring for patients near the end-of-life Dr. Vest frequently encounters patients and families with questions about the differences between with-holding or withdrawing life support, initiation of hospice care and deliberately causing a patient’s death. He also works daily with patients who have limited resources and struggle to obtain access to optimal medical care or implement recommendations from their physicians. These experiences led him to research the medical literature on medical aid in dying including assisted suicide. Created in collaboration with a multidisciplinary group of colleagues, this website seeks to share this information in an accessible way. Please send any suggestions, questions, or additional references via the contact us section of the website. Thank you again for taking the time to learn about this topic.

According to Delaware State Campaign Finance Reporting System (View Contributions) in 2022 alone, Compassion and Choices contributed over $15,000 to Delaware legislators’ campaigns. In 2024, they gave $1200 (maximum legal limit) to Governor Meyers’ campaign and in 2025, they contributed $600 (maximum legal limit) apiece to Senators Cruce and Seigfried. This only includes funds given directly by Compassion and Choice and does not include funds candidates may have received thru “bundling”. Bundling is a legal practice where a special interest group collects individual donation and presents them to candidate as bundle (i.e., “here in my 600 dollar check plus X number of checks from people who support our cause.”). Please note if searching the state website, I recommend searching for “Compassion” in the contributor box because the name of the organization is listed slightly differently by different campaigns (i.e., Compassion & Choices versus Compassion and Choice(s) etc.).

When the Senate passed HB140 by a single vote on April 17, 2025, two amendments to were offered to protect public safety. One would have required mental health evaluation of patients requesting assistance in committing suicide. The second would have required monitoring of compliance with the law. Both were defeated making clear that the legislators intended neither mental health evaluation nor monitoring of compliance with the law.

These can be found at Bill Detail – Delaware General Assembly

Please take the time to call or write and thank them for trying to protect vulnerable people from this dangerous bill.

Please take the time to call or write and tell them that you are disappointed. This issue will not be going away. We anticipate campaigns to expand eligibility over the next 5 years so it’s not a waste of time to express your disappointment. Also, please consider their vote as a factor in deciding who to vote for in the next election.

It is noteworthy that opposition to HB140 came from across the political spectrum. All the Republicans were joined by a number of Democrats in opposing this dangerous bill. Unfortunately, there were enough remaining Democrats, who choose to disregard advice from medical experts (including but not limited to the American Medical Association, Delaware Academy of Family Physicians, Delaware Chapter of the American College of Physicians, and Delaware Psychiatric Society), other experts, and disability rights groups in favor of the special interest group advocating for this dangerous and irresponsible bill, to allow it to pass.  However, it is also worth noting that Democratic leadership in both house and senate not only supported but pushed to pass this irresponsible bill.

Yes. Shortly after assisted suicide/medical aid in dying was legalized in Canada, an economic analysis published in the Canadian Medical Association Journal estimated that the government might save up to 138.8 million dollars annually due to not needing to provide other care (Cost analysis of medical assistance in dying in Canada). However, as Canada has expanded eligibility some experts predict even more savings.

Yes, heart, lungs, kidneys and livers have been harvested and transplanted successfully after donors died from medical aid in dying. (First successful cardiac allograft donation and transplantation after medical assistance in dying (MAiD) – The Journal of Heart and Lung Transplantation) (Organ Donation after Medical Assistance in Dying — Canada’s First Cases | New England Journal of Medicine and Lung donation after medical assistance in dying at home – American Journal of Transplantation).

The following representatives voted in favor of legalizing assisted suicide: Frank Burns, William Bush, William Carson, Mara Gorman, Krista Griffith, Kerri Evelyn Harris, Kendra Johnson, Larry Lambert, Sean Lynn, Sherae’a Moore, Eric Morrison, DeShanna Neal, Edward Osienski, Sophie Phillips, Cyndie Romer, Melanie Ross Levin, Kamela Smith, Claire Synder-Hall, Kimberly Williams, Madinah Wilson-Anton, and Melissa Minor-Brown.

The following representatives voted against legalizing assisted suicide: Stephanie Bolden, Nnamdi Chukwuocha, Richard Collins, Franklin Cooke, Timothy Dukes, Ronald Gray, Debra Heffernan, Kevin Hensley, Jeff Hilovsky, Valerie Jones-Giltner, Shannon Morris, Josue Ortega, Charles Postles, Daniel Short, Bryan Shupe, Jeffrey Spiegelman, and Lyndon Yearick.

The following were absent (which under the rules count the same as no in terms of passing the bill): Jesse Vanderwende, Stell Parker-Selby, Michael Smith.

The following senators voted in favor of legalizing assisted suicide: Daniel Cruce, Stephanie Hansen, Kyra Hoffner, Russell Huxtable, S Elizabeth Lockman, Trey Paradee, Marie Pinkney, Raymond Seigfried, David Sokola, Laura Sturgeon, and Bryan Townsend.

The following senators voted against legalizing assisted suicide: Eric Buckson, Gerald Hocker, Spiros Mantzavinos, Brian Pettyjohn, Nicole Poore, Bryant Richardson, John Walsh, and David Wilson.

The following senators were absent (counts as no vote by their rules): Darius Brown and Dave Lawson.