Every person will face decisions at the end of life. Yet too often, our healthcare system and our broader culture avoid honest conversations about dying until choices are constrained, suffering is heightened, and patients lose control over care that should reflect their values, priorities, and dignity.
Medical aid in dying must be understood within this broader context. It is not a replacement for hospice, palliative care, pain management, or disease-directed treatment. Rather, it is one option within a full spectrum of end-of-life care, including comfort care, the refusal or withdrawal of life-sustaining treatment, and hospice care. Together, these options support patient-directed decision-making at the end of life. When people are empowered with accurate information and meaningful options, they are better able to engage in thoughtful conversations with their clinicians and loved ones and to make decisions aligned with what matters most to them.
Lawmakers today are not starting from theory. Nearly three decades of experience, beginning in Oregon and now spanning 13 states and Washington, D.C., provide a robust, evidence-based foundation for medical aid in dying policy. Research, patient experiences, and clinical data consistently demonstrate that medical aid in dying protects patients, upholds individual autonomy, and strengthens end-of-life care overall. Importantly, its availability has helped normalize earlier and more honest discussions about dying. These conversations improve hospice utilization, pain management, and alignment between care delivered and patient wishes, whether or not the option is ultimately used.
Medical aid in dying allows terminally ill, mentally capable adults with a prognosis of six months or less to request a prescription for medication they may choose to self-ingest to bring about a peaceful death. While most authorized states limit access to residents, three jurisdictions, Montana, Oregon and Vermont, allow non-residents to access medical aid in dying. As a result, all individuals technically have access to this option, but only if they are able to travel, temporarily relocate, or permanently change their state of residence near the end of life.
For many terminally ill people, this reality creates significant hardship. Relocating or interrupting continuity of care in the final months of life can mean leaving trusted clinicians, separating from loved ones, navigating unfamiliar healthcare systems, and bearing logistical, financial, and emotional burdens at an already vulnerable time. No one nearing the end of life should be forced to uproot themselves or die away from their community in order to access an option that reflects their values and priorities.
As experience has grown, lawmakers in authorized jurisdictions have refined these laws to remove unnecessary barriers while maintaining strong safeguards. During the 2024–2025 legislative session, Delaware and Illinois became the 12th and 13th jurisdictions to authorize medical aid in dying, and in February 2026, New York became the 14th. These actions reflect a shared understanding that end-of-life care policy should be responsive to clinical realities and grounded in compassion, evidence, and respect for patient autonomy.
States that have not authorized medical aid in dying effectively deny many terminally ill individuals meaningful access to this option, leaving them to endure suffering they may find unacceptable or to seek care far from home. Policymakers have the opportunity to address this inequity by adopting thoughtful, evidence-based legislation that ensures people can receive comprehensive end-of-life care within their own communities, supported by the clinicians and loved ones they trust.
This policy resource is offered in the spirit of partnership. It provides up-to-date, data-driven information; addresses common questions and concerns; and reflects lessons learned from decades of implementation. Our hope is that it supports lawmakers in advancing policies that not only authorize medical aid in dying, but also contributes to a broader cultural shift that encourages open dialogue about death and dying, affirms patient autonomy, and improves end-of-life care for everyone. Ensuring that medical aid in dying is available as an option, alongside hospice, palliative care, and other established practices, is part of the gold standard of patient-directed end-of-life care.
Thank you for your leadership on this deeply human issue, one that transcends partisanship and reflects compassion, dignity, and respect for individual choice. Compassion & Choices stands ready to support your efforts to expand access to comprehensive end-of-life care and to ensure that individuals can make decisions consistent with their values.
If you have questions or would like additional information, please contact Bernadette Nunley, Chief Legal Advocacy Officer, at policy@compassionandchoices.org. We look forward to working with you to advance patient-centered end-of-life policy.
Sincerely,
Kevin Díaz
President and CEO
Compassion & Choices
