Medical Aid in Dying in New York: A Changing Medical and Legal Landscape for Terminally Ill New Yorkers and Healthcare Professionals
7.29.2026
Medical aid in dying will soon become a legally permitted medical option for terminally ill patients in New York. On Feb. 6, Gov. Kathy Hochul signed the Medical Aid in Dying (MAID) Act. The new law legalizes the prescribing of a lethal dose of medication by New York State physicians for the purpose of hastening death at the request of a qualifying terminally ill adult patient who is a New York resident and possesses decisional capacity.[1] The law takes effect 180 days after signing, on Aug. 5.[2]
The chapter amendments, which Gov. Hochul required before signing the bill, introduced several additional patient protections and clarifications to address concerns raised during the legislative process. These amendments include the requirements that all oral requests for the bill be recorded by audio or video device and permanently stored in the patient’s medical record; a mandatory mental health evaluation by a qualified professional to confirm decisional capacity; a five-day waiting period between the writing and filling of the prescription (with a narrow exception if the attending physician determines the patient may die before the period expires); a strict residency requirement limited to New York residents only; an in-person initial physician consultation unless such would cause extraordinary hardship to the patient; and strengthened opt-out rights for individual clinicians and healthcare facilities – including home hospice programs – that hold religious, moral, or ethical objections to participating in MAID.[3]
These changes were designed to provide greater assurance that any decision by a patient to pursue medical aid in dying is made voluntarily, with full information, free from coercion or undue influence, while also respecting the conscience rights of providers and institutions; allowing sufficient time for the New York State Department of Health to develop necessary regulations; and commensurate time for healthcare facilities to prepare staff training and internal policies.
With this enactment, New York becomes the 13th state and the 14th jurisdiction overall (including the District of Columbia) to legalize medical aid in dying.[4] The successful passage of the law concludes more than a decade of intense legislative debate and public discussion that began when the first medical aid in dying bill was introduced in the New York State Legislature in 2016. In 2024, the New York State Bar Association weighed in on the issue with the creation of the Task Force on Medical Aid in Dying. The task force engaged in a comprehensive deliberative process that included a public hearing and issued a 2024 report recommending that NYSBA support the pending New York MAID bill and proposing changes and additions to strengthen patient protections in the bill.[5]
The bill’s approval signals a notable evolution in societal attitudes toward end-of-life care, including broader acceptance of patient autonomy in healthcare decision-making, and majority support among the public and physicians alike that adults with capacity facing the final stages of a terminal illness should have the legal option to request physician assistance in ending their life if their suffering becomes intolerable despite the best available palliative care.[6]
This article will provide a comprehensive overview of New York’s newly enacted Medical Aid in Dying Act and will highlight the law’s key eligibility criteria and detailed procedural requirements. It will also discuss the foundational legal and ethical underpinnings of medical aid in dying; provide a broader historical and national context for New York’s law; and examine the practical implications for terminally ill patients, their families, healthcare providers, facilities, and the attorneys who advise them. Particular attention is paid to how the law attempts to strike a careful balance between robust patient autonomy and multiple layers of safeguards, as well as to the ongoing challenges of addressing longstanding inequities in access to high-quality palliative and end-of-life care across New York’s diverse urban, suburban, rural, and institutional settings, including correctional care facilities and nursing facilities. Understanding these elements will be essential for patients considering their options, providers navigating compliance, facilities developing policies, and attorneys guiding clients through this new legal landscape.
Legal and Ethical Considerations in Medical Aid in Dying
Medical aid in dying is a medical practice that permits a terminally ill adult patient who retains full decisional capacity to request a prescription for life-ending medication from a qualified and willing physician.[7] The patient may rescind the request at any time and in any manner, providing multiple opportunities to change course if circumstances or wishes evolve.[8]
Legally, MAID builds upon New York’s long-standing recognition of patient autonomy. For more than a century, adults with capacity in New York have had the right to make their own medical decisions, including the right to refuse or withdraw life-sustaining treatment.[9] This right can be exercised directly by the patient while they have capacity or after a determination of incapacity through a previously executed health care proxy, living will, Medical Orders for Life-Sustaining Treatment form, or other advance directive.
However, New York’s MAID statute is intentionally narrower in one important respect: only the patient directly through their own actions may request and authorize medical aid in dying. No surrogate decision-maker – whether a healthcare agent, family member, or court-appointed guardian – is permitted to make the request on behalf of an incapacitated individual. This limitation distinguishes MAID from other end-of-life decisions and underscores the law’s emphasis on current, personal voluntariness and informed consent.[10] The law also protects the right of a patient to rescind their request for MAID assistance at any time and that they must be informed that they can do so by their attending physician.[11]
Ethically, MAID directly engages the four cornerstone principles of modern bioethics: respect for autonomy, beneficence (acting in the patient’s best interests), non-maleficence (the duty to do no harm), and justice (fair distribution of benefits and burdens).[12] Supporters argue that, for a dying patient whose suffering cannot be adequately relieved even with excellent palliative care, honoring a clear and voluntary request for MAID represents the highest expression of respect for human dignity and self-determination. Opponents, including some physicians and faith-based organizations, maintain that providing the means to intentionally end life violates the traditional medical imperative to preserve life and may create subtle pressures on vulnerable patients or undermine societal protections for those who might feel burdened by continued existence. Public opinion polls conducted in recent years, including a 2024 New York survey showing support levels above 72%, indicate that an increasing and substantial majority of both the general public and practicing physicians now favor making MAID available as an option to qualifying terminally ill patients.[13]
The End-of-Life Care Continuum: Palliative Care, Hospice and MAID
It is essential to distinguish medical aid in dying from palliative care and hospice, both of which are long-accepted, legally protected, and ethically supported components of comprehensive end-of-life medicine and care. The New York Public Health Law defines palliative care broadly as interdisciplinary treatment focused on preventing or relieving pain and suffering while enhancing the patient’s quality of life; importantly, it may be provided concurrently with curative or life-prolonging therapies rather than as a mutually exclusive alternative.[14] Hospice is a specialized subset of palliative care for patients with a prognosis of six months or less to live who choose to forgo further aggressive interventions aimed at cure or prolongation of life.[15] Both palliative and hospice care are covered by Medicare and other public and private payers, with hospice a fully covered Medicare Part A benefit for beneficiaries with a terminal illness and a life expectancy of six months or less.[16] It is also important to note that although many people assume that palliative care and chronic disease management or disease-modifying therapies are mutually exclusive, they are not. Palliative care may be provided concurrently with life-prolonging care or as the main focus of care.[17]
In palliative and hospice settings, the clinician’s primary goal is comfort and symptom control. The patient maintains full decision-making authority over every aspect of the process, including the continuing right to change their mind and rescind the request at any time. Medications may be administered to relieve pain, anxiety, dyspnea, or other distressing symptoms, or treatment withheld or withdrawn that is adding to the patient’s treatment burden, even if this carries a secondary risk of hastening death, provided the clinician’s intent is solely to alleviate suffering. This approach is widely justified ethically and legally under the doctrine of double effect, which holds that an action with both good and potentially harmful effects is ethically permissible if the good effect is intended and the harmful effect is merely foreseen.[18] In sharp contrast, under MAID the physician issues a prescription with the explicit purpose of enabling the patient to end their own life at a time of their choosing. This fundamental difference helps explain why MAID remains more controversial than traditional palliative and hospice care.
Legal Timeline and Context
The modern American framework for medical aid in dying was pioneered by Oregon, which in 1994 became the first state to legalize the practice through voter approval of the Death with Dignity Act.[19] Oregon’s statute established the core elements that other American jurisdictions have followed in legalizing medical aid in dying: the patient must be an adult with decisional capacity who has been diagnosed with a terminal illness expected to result in death within six months, and who must initiate the request for medical assistance on their own and not through a surrogate decision maker. The terminally ill patient must be acting voluntarily and without coercion and must be able to self-administer the medication. Further, no clinician is required to assist a patient requesting medical aid in dying and clinicians who do agree to participate are granted good faith legal immunity from liability.[20]
Washington followed Oregon’s lead with a voter-approved law in 2008. Montana’s Supreme Court recognized a limited constitutional right to MAID in 2009. Vermont became the first state to enact MAID through the legislative process in 2013. In the years since, additional states have adopted and refined the model, sometimes shortening waiting periods, expanding the types of qualified providers, or adjusting residency rules, while preserving the fundamental eligibility safeguards.[21]
A pivotal early influence on national discourse was Rochester, New York physician Dr. Timothy Quill’s 1991 article in the New England Journal of Medicine. In it, Quill described his compassionate decision to assist a terminally ill patient who had repeatedly requested help after concluding that available palliative options would not prevent a painful and prolonged death. His candid account helped shift public and professional conversation toward viewing MAID as a thoughtful, individualized response to unbearable suffering rather than an act of abandonment.[22]
Oregon’s law faced years of legal challenges at both state and federal levels. The principal federal obstacle was resolved by the U.S. Supreme Court in Gonzales v. Oregon (2006), which held that the federal Controlled Substances Act did not prohibit physicians from prescribing medications under a valid state MAID law.[23] Earlier rulings in Washington v. Glucksberg and Vacco v. Quill (1997) clarified that there is no federal constitutional right to assisted dying, leaving the policy choice to individual states and their legislatures.[24] New York’s Court of Appeals reached a parallel conclusion in Myers v. Schneiderman (2017), holding that any legalization of MAID would need to come through the legislative process rather than judicial interpretation of the state constitution.[25]
New York’s Medical Aid in Dying Act
New York’s statute closely tracks the Oregon model while incorporating several additional safeguards introduced through the chapter amendment process. To qualify for MAID, a patient must meet the following qualifications:
- Be a New York resident.[26]
- Be at least 18 years of age.[27]
- Have a terminal illness or condition with a prognosis of six months or less to live whether or not treatment is provided.[28]
- Possess decision-making capacity.[29]
- Be physically capable of self-administering the medication.[30]
The request process is intentionally rigorous and multi-step to help to ensure informed and voluntary decision-making. The patient must submit a written request substantially following the “Request for Medication to End My Life” form contained in the law, which must be signed in the presence of two independent witnesses who cannot be relatives or be anyone who stands to benefit financially from the patient’s death.[31] In addition, the patient must make an oral request that is recorded by audio or video device and permanently retained in their medical record.[32] Two physicians (the attending physician and a consulting physician) must independently confirm the terminal diagnosis, prognosis, decisional capacity, and voluntariness of the request.[33] The initial evaluation must occur in person unless the attending physician determines that an in-person visit would impose extraordinary hardship on the patient.[34] One of the more significant new requirements is the mandatory mental health evaluation.[35] All patients seeking MAID must undergo an assessment by a licensed psychologist, psychiatrist, or neurologist to verify that they have the capacity to make an informed and voluntary decision.
The attending physician bears responsibility for ensuring that the patient receives comprehensive, understandable information about the risks and probable outcomes of taking the medication, feasible alternatives including palliative care and hospice, and the patient’s ongoing right to rescind the request at any time.[36]
Culturally appropriate and health-literate educational materials must be provided, and the physician must offer referrals to other appropriate treatment options.[37] Further, there are protections in the law to overcome language and other communication barriers to accessing MAID, including the requirement that the patient’s written request for MAID must be in the same language as used by the patient in conversations or consultations with the attending or consulting physician, unless an interpreter’s declaration is attached stating that its contents were interpreted into the patient’s language or were otherwise communicated to patients with speech, hearing or vision disabilities.[38]
Additional procedural safeguards include a mandatory five-day waiting period between the writing of the prescription and its filling (subject to a limited exception if the patient is expected to die sooner), requirements for the safe disposal of any unused medication, and a clear prohibition on anyone other than the patient administering the medication.[39]
Importantly, the law contains strong conscience protections. No physician, other health care provider or facility is obligated to participate in MAID. A physician who declines to provide the service must nevertheless refer or transfer the patient to a willing provider upon request. Healthcare facilities, including home hospice programs, may adopt policies opting out of MAID based on sincerely held religious beliefs or moral convictions, provided they disclose their policy to patients and make reasonable efforts to facilitate a transfer to a willing provider or facility.[40]
Further, the law grants physicians and other healthcare providers broad immunity from civil, criminal, and professional liability for good-faith compliance with or refusal to participate in a patient’s request for MAID.[41] However, knowing violations of the statute are expressly defined as professional misconduct under the Education Law.[42] Further, the law does not bar civil, administrative, criminal, disciplinary or contractual liability for conduct in violation of the law.[43]
Additionally, to ensure that life insurance benefits are not jeopardized, the law also requires that the death certificate of a patient who dies after self-administering MAID medication note the cause of death of their death as their underlying terminal condition.[44]
The law also requires safe disposal of unused MAID medication in accordance with regulations to be issued by DOH.[45] This is a crucial public safety measure because many patients fill but do not take the MAID medication and because the prescription consists of a highly toxic compound of sedatives (to induce unconsciousness) and cardiac medications (to induce deadly arrhythmias) that could be deadly to others if mistakenly ingested.[46]
Mandatory Mental Health Evaluation
The mandatory mental health evaluation in New York’s law for all patients requesting MAID assistance is notable as a first of its kind requirement in a state MAID law. This provision adds a meaningful layer of protection by requiring that a mental health professional reach an independent conclusion whether the patient requesting MAID has decision-making capacity.[47] Mental health professionals are tasked with assessing the four standard elements of decisional capacity; the ability to understand relevant information about the condition, prognosis, and options; to appreciate how that information applies to the patient’s own situation; to reason through the risks, benefits, and alternatives; and to clearly communicate a consistent choice.
Beyond simply serving as a second opinion to the physician’s original determination, mental health professionals have expertise in assessing the impact of psychological symptoms (e.g., depression, delusions) on the individual’s decision-making capacity.[48] The assessment should also consider the patient’s biopsychosocial background, cultural and religious values, any reversible causes of impaired cognition (such as delirium, untreated depression, medication side effects, or metabolic disturbances), and potential communication barriers (hearing or vision impairment, language differences, or use of medical jargon).[49]
Structured, validated tools such as the Aid to Capacity Evaluation can promote greater consistency and objectivity.[50] During implementation, important practical questions will need to be resolved, including whether evaluations may be conducted via secure telehealth platforms, who will cover the associated costs (especially if insurance does not reimburse them), and how to ensure an adequate supply of qualified evaluators who are comfortable with end-of-life discussions.[51] Further, some individuals seeking MAID require augmentative and alternative communication tools;[52] mental health professionals should adjust their evaluations as appropriate to accommodate these supports while ensuring the validity of the assessment.
MAID Studies and Practical Considerations
Data from nearly three decades of experience in other U.S. jurisdictions that have legalized MAID provides helpful guidance for New York.[53] Across these states, utilization has remained relatively modest – typically well under 1% of all deaths – even as public awareness has gradually increased.[54]
In Oregon, for example, recent annual reports required by law to be issued about patient utilization of MAID indicate that, while the number of prescriptions has risen modestly over time, the percentage of total deaths involving MAID remains low, with many patients who receive a prescription ultimately choosing not to use it.[55] In Oregon and other states with MAID laws, approximately one-third or more of patients who receive a prescription ultimately decide not to use the medication, often viewing it as an “insurance policy” that provides the patient with peace of mind knowing that it is available to be used.[56]
Further, trends across all states with MAID laws clearly demonstrate that people who opt for MAID tend to be disproportionately white and to have a higher socioeconomic status than the general population. In all states studied, there has been limited utilization of MAID by “traditionally vulnerable populations based on age, race/ethnicity, level of educational attainment, or insurance status.”[57]
Researchers have noted that systemic barriers seen throughout our healthcare system may also contribute to limited access to MAID for marginalized populations, including racial and ethnic minority groups.[58] These barriers include limited individual patient financial resources to cover the cost of MAID-related services and medication (it is not a covered benefit under most health insurance policies), low numbers of physicians willing to be MAID prescribers, and limited use of hospice by disadvantaged populations, which is the primary starting point for patients who request MAID.[59] In New York and most other states with MAID laws, there are no state mandates requiring that health insurance policies cover MAID clinical services or medication costs.[60] Further, the federal Assisted Suicide Funding Restriction Act prohibits the use of federal funds, including Medicare, to cover any of the costs of MAID.[61]
Out-of-pocket costs for patients to pay for physician services and medication can be considerable, with a study of MAID usage in Colorado reporting a cost of $700 for clinical services and medication and anecdotal reports of it costing much more.[62] At least one state has attempted to close the equity gap by using state funds to cover the cost of MAID for office visits and medication for low-income residents.[63]
Equity Concerns in Palliative and End-of-Life Care
Despite the law’s procedural safeguards, New York continues to grapple with significant disparities in access to high-quality palliative and hospice services. The state consistently ranks at the bottom nationally in hospice utilization rates among Medicare recipients, with notably lower utilization among Black, Hispanic and other minority populations (each around 37% to 38%) as compared to white populations (around 51%).[64] These gaps are often more pronounced in nursing homes, rural counties, low-income communities, and especially within the correctional system, where formal hospice programs remain scarce and patients frequently face additional barriers such as restricted family visitation and tightly controlled pain management.[65]
While the MAID law includes multiple procedural protections intended to prevent coercion, it does not include funding to address barriers to access for patients who lack the financial resources to cover the cost of MAID or to raise awareness among marginalized groups about MAID, such as through culturally competent programs or multilingual resources. Without such outreach efforts and parallel investments to strengthen palliative and hospice infrastructure throughout the state, some observers worry that MAID could inadvertently become a default or “last resort” option for patients in under-resourced settings rather than a fully autonomous choice grounded in genuine preference.[66]
Further, an added protection for patients under New York’s law—the requirement, not seen in other state MAID laws, that a mental health professional must perform a patient capacity evaluation on MAID requests—could also act as an additional barrier for patients.[67] Patients will now need to consult with another medical professional, in addition to the attending and consulting physicians, and will also have an extra out-of-pocket expense.
State regulations and future policy efforts should therefore give serious attention to these equity considerations to help ensure that all New Yorkers – regardless of background or location – have meaningful access to comprehensive, high-quality end-of-life care options.
Department of Health Regulations
As required by the new MAID law, in June 2026 DOH proposed regulations for implementation of MAID in New York. There is a 60-day public comment period, with final regulations expected to be issued prior to the start date for MAID in New York on Aug. 5.[68]
A proposed DOH regulation, part 1008, establishes reporting requirements for physicians who offer MAID as part of their practice.[69] Physicians who prescribe medications under the MAID law must provide detailed information to DOH within five days of issuing the prescription, including patient information, licensing and names of the attending and consulting physician and mental health professional, information on the MAID medications prescribed, including strength and dosage form, and the patient’s care setting. The regulation further provides that medication prescribed for medical aid in dying shall carry the designation “MAID” as well as a notation that it shall not be filled until five days after the prescription was written. Information collected by DOH will be used to determine utilization and compliance with the law and compiled into a report delivered annually to the state Legislature and posted on DOH’s website.[70]
In a proposed Section 35.7, DOH prescribes a process for the correction of the cause of death on a New York State death certificate if it does not note that the death of a patient who used MAID was due to their underlying terminal illness or condition.[71] Upon notice from DOH, the medical provider responsible for creation of the death certificate must correct it.[72]
DOH also gives interpretive guidance on several key legal requirements in the law. First, it offers illustrative examples of financial conflicts of interest under the law that would disqualify an individual from acting as witness to a patient’s written request for MAID or from being a language interpreter. Examples provided are individuals who would inherit under the patient’s will, distributees if the patient were to die intestate, or a beneficiary under a patient life insurance policy.[73] Next, it directs that the safe disposal of unused MAID medications be done in accordance with existing rules for disposal of unused narcotics.[74] Finally, it adds needed clarity to the meaning of what constitutes patient self-administration of medication under the law, responding to access concerns from MAID proponents that patients who otherwise qualified for MAID but had physical impairments limiting their ability to physically self-administer or to orally ingest medication would be left out. DOH advised that patient self-administration includes the use of “tool or assistive device to help them self-administer the medication, but the patient must perform a final, physical act to self-administer the medication” and that “the medication may not be administered by a person other than the patient.”[75]
Implementation Challenges
States that have legalized MAID earlier often experienced initial delays in utilization due to clinician uncertainty about legal requirements, confusion about clinical protocols, limited pharmacy participation, and lack of education opportunities for physicians and other healthcare professionals to learn about MAID.[76] The training gap has been an issue not just for physicians but for nurse practitioners, physician assistants, social workers, pharmacists, mental health providers and other professionals who often play key roles in the implementation of MAID at the bedside.[77]
Additional challenges seen in other states have included identifying pharmacies willing to stock and dispense MAID medications, which are not standard in stock, addressing potential out-of-pocket costs for patients in the absence of insurance coverage, and ensuring safe disposal of any unused medication.[78]
New York has attempted to minimize these issues by providing a full six-month implementation period before the law becomes effective and by encouraging proactive educational efforts. Professional organizations and MAID advocacy groups are already developing clinical checklists, training modules, and real-time consultation support to help physicians, pharmacists, and facilities prepare.[79]
Also, given that New York is the first state to enact a MAID law requiring an evaluation by a mental health professional of a patient’s capacity to make an informed decision, it would be helpful for regulators in the future to provide explicit guidelines and requirements for the capacity evaluation. A template could be developed and disseminated to providers to standardize these reports. Mandatory domains of assessment (e.g., development, functional performance, intelligence, psychiatric symptoms) and appropriate tests should be identified.[80] In straightforward MAID applications by individuals without cognitive limitations or confounding conditions, a thorough clinical interview and measure of capacity could be sufficient to complete the evaluation.[81] However, if there are comorbid neurologic, cognitive, or complex psychiatric disorders, then more in-depth testing may be needed. If information about cognition or executive functioning is necessary, this reduces the number of available providers, as only specific professionals (i.e., neuropsychologists) are qualified to administer these tests. Additionally, if performance-based measures are required, then telehealth evaluations may not be allowed, further reducing access to services.[82]
New York’s MAID law requires that the DOH collect data and issue an annual report of MAID utilization and compliance to be sent to the New York State Legislature and posted on its website for public review.[83] These reports should provide valuable demographic information on MAID usage and accessibility to New Yorkers, including whether trends found in other states of reduced participation by marginalized populations also occur in New York and whether changes are needed to the law to increase its availability to all New Yorkers. Useful systematic data to collect would be information on MAID utilization broken down by race, ethnicity, socioeconomic status, geography, or incarceration status.
Conclusion
New York’s Medical Aid in Dying Act marks a significant and carefully crafted expansion of end-of-life options for terminally ill residents. By building upon the established Oregon model while incorporating additional safeguards – such as recorded oral requests, mandatory mental health evaluations, waiting periods, residency limitations, and strong conscience protections – the law aims to promote patient autonomy and dignity while seeking to minimize the potential for error, coercion, or abuse.[84] It should be noted that the law, however, does not address risks of structural coercion.
For terminally ill patients who retain the capacity to make their own decisions, the statute may offer the possibility of greater control, preserved dignity, and reduced suffering during the final months of life. For physicians, other clinicians, and healthcare facilities, it respects the right of conscientious objection while imposing a duty to provide appropriate referrals when participation is declined.
Successful rollout will hinge on several factors: the timely issuance of clear and practical regulations by DOH: Well-designed and disseminated education and training for physicians, pharmacists, social workers; and other healthcare professionals; readiness across healthcare institutions; and sustained efforts to address longstanding inequities in palliative and hospice care. The requirement of annual public reports on MAID usage will play a critical role in identifying emerging patterns in utilization and inform the Legislature whether amendments to the law are necessary over time.
As New York embarks on this new era of health care, attorneys will play a crucial supporting role in advising individual clients on MAID-related decisions, including counseling healthcare organizations on policy development, compliance and design of workforce education and training, assisting with documentation and referrals, and helping shape future legislative or regulatory refinements. Continuing dialogue among patients, families, providers, advocates, and policymakers; comprehensive workforce education and training of physicians and all healthcare professionals who may participate in MAID; as well as robust patient outreach efforts to reach less privileged populations, will be essential to ensuring that the law fulfills its promise of compassionate, equitable, and truly patient-centered care.[85],[86]
This article appears in Health Law Journal, the publication of the Health Law Section. For more information, please visit nysba.org/health.
Edward McArdle is a clinical assistant professor of bioethics and humanities at SUNY Upstate Medical Center and a certified ethics consultant (HEC-C) for two hospitals in Syracuse, New York. He is also an adjunct professor at Cornell Law School, where he teaches classes on ethical and legal dilemmas in healthcare. Prior to joining SUNY in 2019, McArdle served as an assistant attorney general in the Syracuse regional office of the state attorney general.
Mary Beth Quaranta Morrissey is a nationally recognized healthcare attorney and health, psychological, and social work researcher and serves on the United Nations NGO Committee on Ageing and Hastings Center for Bioethics Board. She is the founder of the Collaborative for Palliative Care and directs its Interdisciplinary Aging, Public Health, and Palliative Care Certificate program. She is a past associate professor and director of the PhD program in social welfare policy at Yeshiva University’s School of Social Work. Morrissey is a past chair of the Health Law Section as well as NYSBA’s Task Force on Opioid Addiction and co-chairs NYSBA’s Task Force on the New York State Medical Indemnity Fund.
Adrienne Borschuk is an assistant professor of bioethics and humanities at SUNY Upstate Medical Center. She began her career as a pediatric psychologist for medically complex children and their families. In her current role as a clinical ethics consultant, she works to improve communication, relationships, and outcomes in the healthcare setting.
Epiphany G. Ramirez is a third-year law student at Cornell Law School and will join the healthcare practice group at Nixon Peabody LLP post-graduation.
Endnotes:
[1] Governor Kathy Hochul, Press Release: Governor Hochul Signs Medical Aid in Dying Act into New York State Law, Feb. 6, 2026, https://www.governor.ny.gov/news/governor-hochul-signs-medical-aid-dying-act-new-york-state-law (hereinafter “Governor Hochul Press Release”).
[2] N.Y. Public Health Law §§ 2899-d–2899-r (PHL).
[3] PHL §§ 2899-d–2899-r.
[4] New York Becomes 13th State & 14th Jurisdiction to Authorize MAID, Compassion & Choices, Feb. 6, 2026, https://compassionandchoices.org/news/ny-governor-signs-medical-aid-in-dying-law/.
[5] See N.Y. St. Bar Ass’n, Report and Recommendations of the New York State Bar Association Task Force on Medical Aid in Dying, 5–6 (2024) (“NYSBA Task Force Report”) (Authors Morrissey (chair) and McArdle (member) were appointed to the NYSBA Task Force).
[6] Id. at 15–20.
[7] Although terms other than medical aid in dying have been used in the past to describe legalization of the right of terminally ill patients to request a lethal medication from a clinician, MAID is the term used in New York and in most jurisdictions in the United States. For purposes of clarity and to avoid confusion, the term MAID will be used throughout this article to describe the practice.
[8] PHL § 2899-g.
[9] Schloendorff v. Soc’y of N.Y. Hosp., 211 N.Y. 125 (1914).
[10] PHL § 2899-e.
[11] PHL § 2899-f(1)(i).
[12] Tom L. Beauchamp & James F. Childress, Principles of Biomedical Ethics (8th ed. 2019).
[13] New Poll from YouGov Confirms Majority Support Death with Dignity, Death With Dignity, Feb. 8, 2024, https://deathwithdignity.org/news/2024/02/new-poll-confirms.ny.support-dwd/.
[14] PHL § 2997-c.
[15] Feather A. Davis, Medicare hospice benefit: early program experiences, 9(4) Health Care Financing Rev. 99, 99–111 (Summer 1988), https://pmc.ncbi.nlm.nih.gov/articles/PMC4192888/.
[16] 42 U.S.C. §§ 1302, 1395hh; 42 C.F.R. pt. 418.
[17] Jennifer S. Temel et al., Early Palliative Care for Patients with Metastatic Non–Small Cell Lung Cancer, 363 New England J. of Med. 733 (2010), https://doi.org/10.1056/NEJMoa1000678.
[18] Beauchamp & Childress, supra note 12.
[19] Oregon Revised Statutes §§ 127.800–127.995.
[20] Id.
[21] See States with Authorized Medical Aid in Dying, Death with Dignity (May 4, 2026), https://deathwithdignity.org/states/.
[22] Timothy E. Quill, Death and Dignity: A Case of Individualized Decision Making, 324 New England J. of Med. 691 (1991), https://doi.org/10.1056/nejm199103073241010.
[23] 546 U.S. 243 (2006).
[24] 521 U.S. 702 (1997); 521 U.S. 793 (1997).
[25] 30 N.Y.3d 1, 62 N.Y.S.3d 838 (2017).
[26] PHL § 2899-d(13).
[27] PHL § 2899-d(1), (13).
[28] PHL § 2899-d(17).
[29] PHL §§ 2899-f(1)(a), 2899-d(3).
[30] PHL § 2899-f(4), (1)(h)(i).
[31] PHL § 2899-e (3)(b).
[32] PHL § 2899-e(1)–(3).
[33] PHL §§ 2899-f(1)(a) (attending physician), 2899-h (consulting physician).
[34] PHL § 2899-f(1).
[35] PHL § 2899-i.
[36] PHL § 2899-f.
[37] PHL § 2899-f(1)(f)–(g).
[38] PHL § 2899-k(2).
[39] PHL §§ 2899-f(3)–(4), 2899-o.
[40] PHL § 2899-m.
[41] PHL §§ 2899-l(1), 2899-r.
[42] PHL § 2899-l; N.Y. Education Law § 6530(51).
[43] Id.
[44] PHL § 2899-p.
[45] PHL § 2899-o.
[46] Patrick Macmillan et al., The Pharmacology of Aid in Dying: From Database Analyses to Evidence-Based Best Practices, 28 J. Palliative Med. 492 (2025), https://doi.org/10.1089/jpm.2024.0379.
[47] PHL § 2899-i.
[48] Paul S. Applebaum, Assessment of Patients’ Competence to Consent to Treatment, 357 New England J. of Med. 1834 (2007), https://doi.org/10.1056/NEJMcp074045.
[49] Id.
[50] Edward Etchells et al., Assessment of patient capacity to consent to treatment, 14(1) J. of General Internal Med. 27 (Jan. 1999), https://doi.org/10.1046/j.1525-1497.1999.00277.x.
[51] Paul S. Appelbaum & Thomas Grisso, Assessing Patients’ Capacities to Consent to Treatment, 319 New England J. of Med. 1635 (1988), https://doi.org/10.1056/nejm198812223192504.
[52] Examples of augmentative and alternate communication tools include the Picture Exchange Communication System, enabling devices, or speech generating systems.
[53] NYSBA Task Force Report, supra note 5, at 10–11; app. A.
[54] Elissa Kozlov et al., Knowledge of and Preferences for Medical Aid in Dying, Discussion, 8 JAMA Network Open (2025), https://doi.org/10.1001/jamanetworkopen.2024.61495.
[55] Oregon Death with Dignity Act 2025 Data Summary, Oregon Health Auth. Ctr. for Health Stats. , (rev. June 17, 2026), https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year28.pdf.
[56] Kozlov et al., supra note 53; Jonathan Treem, Medical Aid in Dying: Ethical and Practical Issues 14 J. of the Advanced Practitioner in Oncology 207 (April 2023), https://doi.org/10.6004/jadpro.2023.14.3.5.
[57] Luai Al Rabadi, Trends in Medical Aid in Dying in Oregon and Washington, 2 JAMA Network Open (2019), https://doi.org/10.1001/jamanetworkopen.2019.8648; Kozlov et al., supra note 53.
[58] Id.
[59] Id. (barriers to access include patient financial constraints, insurance concerns, disproportionately fewer members of racial and ethnic groups receive hospice care, and low numbers of physicians willing to be MAID prescribers are barriers to access to MAID); see also NYSBA Task Force Report, supra note 5, at 23 (more than 87% of people who utilized MAID received hospice services at death).
[60] Hibah Khaja, Medical Aid in Dying: Navigating Evolving Laws, Institutional Policies, and Professional Ethical Guidelines, Clinical Advisor Sept. 17, 2025, https://www.clinicaladvisor.com/features/medical-aid-in-dying-guidelines/; V Shankaran, RJ LaFrance & SD Ramse,. Insurance Coverage and Aid-in-Dying Medication Costs—Reply, 3(8) JAMA Oncology 1138 (Aug. 2017), https://doi.org/10.1001/jamaoncol.2017.0406 (there is some limited anecdotal evidence that a few plans will cover the cost of clinical services and some of the cost of MAID medications).
[61] 42 U.S.C. §§ 14401–14408.
[62] Melanie Mandell et al., Medical Aid in Dying in the State of Colorado: Perspectives, Data, and Lessons Learned in the First Years of a Uniquely Centralized Program, 28 J. of Palliative Med. 869 (2025), https://doi.org/10.1089/jpm.2024.0322.
[63] California Code of Regs., tit. 12, § 520.2.
[64] NHPCO Facts and Figures (2024 ed.), Nat’l Hospice and Palliative Care Org., Sept. 2024, https://allianceforcareathome.org/wp-content/uploads/2024/09/Facts-Figures-2024_FINAL.pdf (New York-specific data of hospice utilization).
[65] Connie S. Cole et al., Palliative Care in Nursing Homes; A Qualitative Study on Referral Criteria and Implications for Research and Practice, 72(8) J. of the Am. Geriatric Soc’y 2590 (Aug. 2024), https://doi.org/10.1111/jgs.18938; Shaowei Wan et al., Local Area Hospice Capacity and Rural Disparities in Hospice Use Among Older Adults with Metastatic Breast Cancer, 26(2) J. of Palliative Med. 182 (Sept. 2022), https://doi.org/10.1089/jpm.2022.0227; Melissa Wachterman & Benjamin D. Sommers, Dying Poor in the US – Disparities in End-of-Life Care, 1(12) JAMA Health Forum (Dec. 2020), https://doi.org/10.1001/jamahealthforum.2020.1533; Mushero N, Moore A, and Williams B. End-of-Life and Hospice Care for People Who Are Incarcerated, JAMA, (June 24, 2026), doi:10.1001/jama.2026.6222, https://jamanetwork.com/journals/jama/fullarticle/2850726.
[66] Kozlov, supra note 53 (notes limited enrollment in hospice of individuals from racial and ethnic minority groups, thereby limiting their access to information about MAID and the “lack of resources devoted to dissemination efforts, cultural taboos and shame surrounding end-of-life discussions”); see also Ramona Coelho et al., The Realities of Medical Assistance in Dying in Canada, 21(5) Palliative and Supportive Care 871 (2023) (criticizes structural coercion under Canada’s MAID law that places “the lives of marginalized and vulnerable Canadians at risk” and points to examples where patients were offered MAID as an alternative to waiting for medical treatment).
[67] PHL §§ 2899-i.
[68] L. 2026, ch 1, § 1, see also NYS Register, Vol. XLVIII, Issue 22, June 3, 2026, DOS, Div. of Administrative Rules, at 20-22.
[69] Id., at 20-21, proposed 10 N.Y.C.R.R. 1008.
[70] Id., at 21.
[71] Id., at 21, proposed 10 N.Y.C.R.R. 35.7.
[72] Id.
[73] Id., at Regulatory Impact Statement, at 21.
[74] Id.
[75] Id.; see also, Non-Cral Self-Administration: A Guide for Bedside Clinicians Managing the Procedure, Academy of Aid-in-Dying Medicine, https://www.aadm.org/courses/non-oral (last visited May 7, 2026) (discusses methods other than oral ingestion for self-administration of MAID medications, including rectal administration and percutaneous endoscopic gastronomy (PEG) tube administration by the patient).
[76] Mara Buchbinder et al., Health Care Providers Experiences with Implementing Medical Aid-in-Dying in Vermont: A Qualitative Study, 34 J. of Gen. Internal Med. 636 (2019), https://doi.org/10.1007/s11606-018-4811-1 (study of the difficulties of health care providers in Vermont with implementing its medical-aid-in-dying law).
[77] Gina A Bravo et al., Social Workers’ Experiences With Medical Assistance in Dying: Survey Findings from Quebec, Canada, 62(5) Social Work in Health Care 193, 200 (2023), https://doi.org/10.1080/00981389.2023.2210624 (“the small body of literature addressing the educational needs of healthcare professionals in this area [MAiD] of practice has focused on physicians.”); Jamie K. Fujioka et al. Implementation of Medical Assistance in Dying: A Scoping Review of Health Care Providers’ Perpectives, 55(6) J. of Pain and Symptom Mgmt. 1564, 1572 (2018), https://doi.org/10.1016/j.jpainsymman.2018.02.011 (“this scoping review is one of the first attempts to consolidate evidence exploring the roles and challenges of diverse health care professionals in the implementation of MAiD” and discusses lack of knowledge about work of “nurses, mental health providers, pharmacists, social workers, and medical examiners [who] are integral in the execution of MAiD in tandem with physicians.”); see also Sarah LeBlanc et al., Development of Learning Objectives for a Medical Assistance in Dying Program for Family Medical Residency, 22(167) BMC Med. Educ. 1, 5 (Mar. 2022), https://doi.org/10.1186/s12909-022-03204-1 (concludes that “little is known about the most effective strategies for providing MAiD education.”).
[78] Mikaela Lefrak, On Delivery With Vermont’s Only Pharmacist for Aid in Dying Prescriptions, Vermont Public Radio, April 14, 2023, https://www.vermontpublic.org/local-news/2023-04-14/on-delivery-with-vermonts-only-pharmacist-for-aid-in-dying-prescriptions; see also Nancy Kusmaul et al., Medical Aid in Dying: How Might U.S. Policy Prevent Suffering at the End of Life?, 36(5) J. of Aging and Soc. Policy 857 (2024), https://doi.org/10.1080/08959420.2023.2226306.
[79] Resources from Compassion & Choices and New York professional organizations.
[80] Examples of types of capacity assessment tests used by mental health professionals to determine a patient’s capacity to make an informed decision include the Wechsler Adult Intelligence Scale, Adaptive Behavior Assessment System, and Structured Clinical Interview for DSM-5.
[81] Victor Ajluni, Enhancing decision-making capacity assessments in primary care: A practical guide for family physicians, 26 J. of Gen. Fam. Med. 379 (2025)https://doi.org/10.1002/jgf2.70013.
[82] Erik Hessen et al., Core competencies in clinical neuropsychology training across the world, 32(4) The Clinical Neuropsychologist 642 (2018), https://doi.org/10.1080/13854046.2017.1413210; see also, Jason Karlawish, Measuring decision-making capacity in cognitively impaired individuals, 16(1) Neurosignals 91 (Dec. 2008), https://doi.org/10.1159/000109763.
[83] PHL § 2899-q.
[84] PHL §§ 2899-e–2899-f.
[85] After this article was submitted for publication, press reports alerted the authors to two federal lawsuits filed simultaneously in New York and Illinois by disability advocacy organizations and individual patient advocates challenging each state’s recently enacted MAID law. Brooklyn Center for Independence of the Disabled et al. v. Hon. Kathy Hochul, New York Governor et al., Case 1:26-cv-03492 (E.D.N.Y. June 11, 2026); Ebony Payne et al. v. Hon. Jay Robert Pritzker, Illinois Governor et al., Case 1:26-cv-06886 (N.D.IL. June 11, 2026). In the New York lawsuit, plaintiffs, eight disability rights groups and two individuals with disabilities, allege that New York’s law violates federal law, including the Americans with Disabilities Act, and is unconstitutional under the Equal Protection and Due Process clauses of the Fourteenth Amendment of the U.S. Constitution and corollary Equal Protection and Due Process provisions in the New York State Constitution. They seek a preliminary and permanent injunction enjoining enforcement of the law. Similar claims, also seeking injunctive relief, are made in the Illinois litigation. As of final publication, both lawsuits are still pending resolution.
[86] In July 2026, Catholic healthcare institutions and religious orders filed a federal action challenging the MAID Act and its interaction with the Palliative Care Information Act. Carmelite Sisters for the Aged and Infirm, Inc. et al. v. Letitia James, New York Attorney General, et al., Case 1:26-cv-1396-AMN-CBF (N.D.N.Y. July 17, 2026). The plaintiffs allege that New York’s statutory opt-outs are too narrow because providers may still be required to inform, counsel, evaluate, refer, or otherwise facilitate access to MAID. The complaint asserts claims under the First Amendment, federal conscience and funding statutes, the Americans with Disabilities Act and the Equal Protection Clause. The litigation remains pending, and no court has ruled on the merits of those claims.
