since the 19th century, euthanasia has sparked intermittent debates and activism in europe and the americas. according to medical historian ezekiel emanuel, it was the availability of anesthesia that ushered in the modern era of euthanasia. in 1828, the first known anti-euthanasia law in the united states was passed in the state of new york, with many other localities and states following suit over a period of several years. after the civil war, voluntary euthanasia was promoted by advocates, including some doctors. support peaked around the start of the 20th century in the us and then grew again in the 1930s.