Maine became the latest state to legalize physician-assisted suicide Wednesday as Gov. Janet Mills (D) signed LD 1313 into law.

Mills had previously said that she was undecided on the issue of physician-assisted suicide, and was unsure if she would sign the bill into law.

Maine is now the ninth state to make it legal for a doctor to prescribe a terminally-ill patient a lethal dose of medication. Earlier this year, New Jersey legalized assisted suicide.

Mills said to reporters June 12 that the decision to sign the bill into law was the hardest she had made in her political career, and that she hopes assisted suicide does not become the norm in her state.

“It is my hope that this law, while respecting the right to personal liberty, will be used sparingly,” she said prior to signing the bill.

She added that she hopes Mainers “will respect the life of every citizen, with the utmost concern for their spiritual and physical well-being, and that as a society we will be as vigorous in providing full comfort, hospice and palliative care to all persons, no matter their status, location or financial ability as we are in respecting their right to make this ultimate decision over their own fate and of their own free will.”

To receive the life-ending medication, a patient must undergo two waiting periods, request the medication once in a written request and twice orally, undergo a psychological evaluation, and be approved by a second physician. The law also criminalizes coercing someone into assisted suicide, or forging a note requesting suicide.

The law was narrowly passed by the state legislatures June 4, and sent to the governor’s mansion. Mills had 10 days from June 4 to decide whether or not she was going to sign the law. Members of both political parties voted for and against the bill, which was passed by a single vote in the state’s House of Representatives.

In addition to LD 1313, Mills signed Executive Order No. 9, which requires the state’s Department of Health and Human Services to report all instances of physician-assisted suicide over the next years. Specifically, DHHS will examine the data for any trends regarding socio demographic status, location within the state, and medical conditions, to ensure that the “personal liberty and autonomy of all Maine people is protected.”  

While the bill is set to go into effect 90 days after the legislative session ends, the existence of Executive Order 9, which goes into effect immediately, means that assisted suicide will likely not be available in Maine until 2020. This is because lawmakers must approve the collection methods and norms required by the executive order.

The battle to legalize physican-assisted suicide in Maine was drawn out for about a decade. There were seven previous bills submitted to legalize the practice, all of which failed. In 2012, there was a statewide referrendum to legalize assisted suicide, which also failed.