Voters in the state of Washington this week approved a ballot-initiative that legalizes medically assisted suicide. It is now the second state in the union, along with neighboring Oregon, to approve such a measure.

The measure is different than previous versions that failed in years past. It stipulates that physicians not be allowed to administer a lethal dose of medication to patients who are incapable of injecting themselves. The measure also requires a patient to orally request the injection twice at least 15 days apart, and submit a written request witnessed by two people, at least one of whom cannot be affiliated with the patient. Two doctors must also confirm the patient is terminally ill and has less than six months to live.

The ballot initiative passed with roughly 58% of the vote. Similar laws have previously been rejected in California, Michigan and Maine. A total of 340 people have taken advantage of physician-assisted suicide in Oregon since that state legalized the practice in 1997.