THREE years ago John Radcliffe, a jovial retired lobbyist in Hawaii, was diagnosed with terminal stage four colon and liver cancer. He has since undergone 60 rounds of chemotherapy but doctors suspect he has just six more months to live. His illness often leaves him feeling exhausted but, undeterred, he has spent the past few years pushing to pass one last bill: Hawaii’s “Our Care, Our Choice Act”, which allows doctors to assist terminally ill patients who wish to die. Earlier this month, as Mr Radcliffe beamed behind him in a colourful lei, Hawaii’s governor signed the bill into law making Hawaii the seventh American jurisdiction to approve an assisted-dying law.

Like the laws in California, Washington, Vermont, Colorado and Washington, DC, Hawaii’s law is modelled on legislation in Oregon, which was the first state to allow assisted dying, in 1997. It permits an adult, who two doctors agree has less than six months to live and is mentally sound, to request lethal medication. The most commonly used drug is secobarbital, a barbiturate that induces sleep and eventually death by slowing the brain and nervous system. It is usually prescribed in the form of about 100 capsules that must be individually opened and mixed into liquid—a process advocates say averts accidental overdoses. The patient must take the medication themselves, without aid, but they can choose when and where to do so. Death with Dignity, an Oregon-based pressure group, estimates that 90% of the recipients of this service end their lives at home.

Legislatures in 24 other states are considering similar bills this year. Most will flounder. In 2017, 27 states debated assisted dying. None approved it. Still, the right-to-die movement seems likely to gather momentum. Between 1997 and 2008, Oregon was the only state that allowed doctors to let some patients hasten their deaths. In the decade since, six other jurisdictions have legalised assisted dying, either through legislation or ballot initiatives. Advocates are hopeful that Nevada, New Jersey and Massachusetts might soon follow.

A few factors make such laws likely to continue spreading. The first is public support. In 1947, when Gallup, a polling group, first began conducting surveys on the issue, 37% of Americans thought a “doctor should be allowed to end a terminally ill patient’s life by painless means” if requested by the patient. Since 1990, between 64% and 75% have expressed support for doctor-assisted dying (see chart). The remaining objections are concentrated among the religiously observant, though Gallup finds that a narrow majority of weekly churchgoers support assisted dying.