We support individuals and families navigating end-of-life choices with autonomy and care

Bob Macauley is a pediatric palliative care physician, clinical ethicist, and Episcopal priest. After spending fifteen years on the faculty at the University of Vermont—where he directed the ethics and pediatric palliative care programs—he and his family moved to Oregon in 2017, where he is now the Cambia Health Foundation Endowed Chair in Pediatric Palliative Care at Oregon Health & Science University. He is the author of Ethics in Palliative Care: A complete guide (Oxford University Press, 2018) as well as the memoir Because I Knew You: How some remarkable sick kids healed a doctor’s soul (Chehalem Pres, 2025).

Father Don earned a Bachelor of Arts in Philosophy from Niagara University and has instructed many people across the country on scripture, including religious education teachers and Catholic high school administrators, reaching diverse religious backgrounds through various adult formation programs.

In addition to his religious vocation, Father Don has a distinguished medical background. He graduated from the University of Buffalo School of Medicine, where he completed residency training in Internal Medicine, followed by a specialization in Infectious Diseases at the University of Maryland Medical School. He served as an Associate Professor of Medicine at the University of Buffalo, and chaired the foundational Introduction to Clinical Practice course. He has also been a pioneer of integrating health and spirituality, speaking widely on the holistic relationship of body, mind, emotion, and spirit in health, and championing the therapeutic use of guided imagery in healing. He is also a respected instructor of Catholic Medical Ethics, working to clarify misconceptions, particularly those related to the Church’s teaching on end-of-life choices. He remains active in professional consultation, advising patients and physicians in clinical settings, nursing homes, and hospice care.

Dr. Paul Menzel has published widely on moral questions in health policy, voluntarily stopping eating and drinking (VSED), and advance directives for dementia. He taught philosophy at Pacific Lutheran University from 1971-2012, having been educated at Wooster, Yale, and Vanderbilt. He taught widely in cross-disciplinary curricula and published notably in health care ethics, including books on moral questions in health care economics and the tension between treatment and prevention in setting priorities. He also served the university in various administrative positions, including Provost. His recent work has been on compassionate approaches to enable those who wish not to live into severe dementia to hasten death to avoid it.

Jason J. Smith is the Founder and Chief Legal Strategist of Smith Legacy Law, LLC. Jason is admitted to practice in New York and Connecticut and focuses his practice on estate planning, asset protection, estate administration, trust administration and probate litigation. He also counsels clients on assets protection strategies, including the preparation of prenuptial agreements. His estate administration and trust administration practice dovetails with his trusts and estates litigation practice, where he advises clients in contested wills, probate proceedings, trust construction cases, contested accounting proceedings, kinship hearings and conservatorships and guardianship matters. He represents and advises a diverse range of clients, including those in the lesbian, gay, bisexual and trans gender (LGBT) community.

Jason served as the Chair of the Completed Life Initiative Board from its founding in 2019 until December, 2025. Now as a CLI Board member, he remains an integral asset to the Board, providing guidance based on his six years as Chair and from his personal experiences with family members.

Jason received his J.D. from Yale University Law School, and his B.S. magna cum laude, from New York University. While in law school Jason served as managing editor of the Yale Journal of Law & Technology. Prior to law school, Jason worked as a business and technology consultant for PricewaterhouseCoopers and Razorfish and also operated his own web design firm.

Nicole Nuttall serves as Chair of the Board of Directors of the Completed Life Initiative. Originally from Oklahoma, Nicole began her career in New York City, where she pursued photography and film before establishing a successful photography business in Fairfield, Connecticut.

Nicole believes that the ability to determine when one’s life feels complete—and to do so with dignity, autonomy, and compassion—is a fundamental human right. Her perspective is shaped by deeply personal experiences: as a young adult, she witnessed her grandmother’s decline in a nursing home; later, she supported her mother through nine years of serious illness following multiple strokes and vascular dementia; and she watched her father confront metastatic prostate cancer with courage before his death. These profound family experiences underscored for Nicole the importance of preserving personal agency at the end of life. Motivated by this commitment to self-determination and compassionate choice, Nicole helped Faith Sommerfield found the Completed Life Initiative in 2019, and she was grateful to be among those by Faith’s side when she died in 2022 in Basel, Switzerland.

New York

 Bill goes into effect on August 5, 2026 

MAID Eligibility Requirements

– At least 18 years old

– Terminal illness with prognosis of six months or less

– Resident of New York

– Mental capacity

– Capable of self-administering the MAID medication

MAID Process

– Attending physician must:

• – Determine whether the patient has a terminal illness
• – Determine whether the patient has decision-making capacity
• – Confirm that the patient is acting voluntarily and is not being coerced
• – Inform the patient of the diagnosis, prognosis, and probable risks and result of ingesting the medication
• – Inform the patient of other care options
• – Inform the patient that they may choose to withdraw the request at any time or decide not to ingest the medication at all
• – Store the patient’s recorded oral request in their medical record
• – Refer the patient to a consulting physician and a licensed mental health professional
• – Inform the patient on the recommended safekeeping, self-administration, and disposal procedures of the medication

– Consulting physician must:

• – Confirm that the patient has a terminal disease with a prognosis of 6 months or less to live
• – Confirm that the patient is making an informed decision
• – Confirm that the patient has decision-making capacity
• – Confirm that the patient is acting voluntarily and is not being coerced

– Mental health professional must:

• – Report in writing that the patient has decision-making capacity to make an informed decision

– Patients must issue:

• – One oral request that is video-recorded or audio-recorded and that is not witnessed by anyone who would benefit financially from the death of the patient
• – One written request

– There must be two witnesses to the written request

• – Both witnesses must attest that the patient has decision-making capacity, is acting voluntarily, and is not being coerced 
• – Neither witness can be related to the patient, be their healthcare proxy, have power of attorney, or benefit financially from the death of the patient

– There must be a 5 day waiting period between when the prescription is written and filled

SOURCES

New York Medical Aid in Dying Act, S138

Governor Hochul Signs MAID Act into New York State Law

Delaware

MAID Eligibility Requirements

– At least 18 years old

– Terminal illness with prognosis of 6 months or less

– Terminal disease verified by 2 physicians or APRNs

– Resident of Delaware

– Has decision-making capacity

– Capable of self-administering the MAID medication

MAID Process

– 2 separate physicians or Advanced Practice Registered Nurses (APRNs) must confirm that the patient:

• – has a terminal illness
• – has a prognosis of 6 months or less
• – is making an informed decision
• – has decision-making capacity
• – is acting voluntarily

– Required to be informed of other care options

– Required to be informed that they may choose not to ingest multiple times throughout the process

– 2 oral requests, with a 15 day interval between each request

– 1 written request

• – 2 witnesses to written request must attest that, to the best of their knowledge and belief, the individual is mentally capable, acting voluntarily, and not being coerced to sign the request
• – Identity of witnesses must meet statuory requirements

– There is a 48 hour waiting period between the written request and the writing of the prescription

SOURCES

H.B. No. 140 (2025)

Illinois

 Bill goes into effect on September 12, 2026 

MAID Eligibility Requirements

– At least 18 years old

– Terminal illness with prognosis of six months or less

– Resident of Illinois

– Mental capacity

– Capable of self-administering the MAID medication

MAID Process

– Attending physician must:

• – Determine whether the patient has a terminal illness
• – Determine whether the patient has mental capacity to make informed decisions
• – Confirm that the patient is acting voluntarily and is not being coerced
• – Inform the patient of the diagnosis, prognosis, and probable risks and result of ingesting the medication
• – Inform the patient of other care options
• – Inform the patient that they may choose to withdraw the request at any time or decide not to ingest the medication at all
• – Refer the patient to a consulting physician
• – Refer the patient to a licensed mental health professional if there is concern that the patient may not be mentally capable
• – Inform the patient on the recommended safekeeping, self-administration, and disposal procedures of the medication

– Consulting physician must:

• – Confirm that the patient has a terminal disease with a prognosis of 6 months or less to live
• – Confirm that the patient has mental capacity to make informed decisions
• – Confirm that the patient is acting voluntarily and is not being coerced
• – Refer the patient to a licensed mental health professional if there is concern that the patient may not be mentally capable

– Patients must issue:

• – Two oral requests, with the second oral request being made at least five days after the first oral request (unless the physician determines that the patient is likely to die within five days after the first request)
• – One written request after the first oral request

– There must be two witnesses to the written request

• – Both witnesses must attest that the patient has mental capacity, is acting voluntarily, and is not being coerced 
• – At least one witness must not be related to the patient or be entitled to any portion of the patient’s estate upon death

SOURCES

End-of-Life Options for Terminally Ill Patients Act, S.B. 0009

Montana

MAID Eligibility Requirements

– At least 18 years old

– Resident of Montana

– Diagnosed with a terminal illness and has a prognosis of six months or less to live

– Capable of self-administering the MAID medication and making an informed decision

While there is no law specifically addressing MAID, the Montana Supreme Court held in Baxter v. Montana that there is nothing prohibiting a physician from providing a terminally ill, mentally competent adult patient with aid in dying.

SOURCES

Baxter v. State, 224 P.3d 1211, 2009 MT 449, 354 Mont. 234 (2009)

Washington, D.C.

MAID Process

– At least 18 years old

– Terminal illness with prognosis of death within 6 months

– Terminal prognosis verified by 2 doctors

– Capable of making and communicating health care decisions

– Resident of Washington D.C.

– Capable of self-administering the MAID medication

MAID Eligibility Requirements

– Attending physician required to inform patient of:

• – medical diagnosis
• – prognosis
• – potential risks of taking covered medication
• – probable result of taking covered medication
• – feasible alternatives, including comfort care, hospice care, and pain control
• – the availablity of supportive counseling
• – the opportunity to rescind a request at any time and in any manner

– Consulting physician must confirm terminal diagnosis and verify that the patient is:

• – capable
• – acting voluntarily
• – has made an informed decision

– If the attending physician or consulting physician opines that a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient to counseling

• – No medication shall be prescribed until the patient recieves counseling and the psychiatrist/psychologist determines they are not suffering from a psychiatric or psychological disorder or depressoin causing impaired judgment

– Attending physician must offer the patient an opportunity to rescind request

– 2 oral requests to attending physician, with a 15 day interval between each request

– 1 written request to attending physician

• – must be made before 2nd oral request
• – must be made at least 48 hours before medication is prescribed/dispensed
• – must be witnessed by 2 individuals who, in the presence of the patient, attest to the best of their knowledge and belief that the patient is: capable, acting voluntarily, and not being unduly influenced to sign the request
• – identity of witnesses must meet statuory requirements

– Patient must “”ingest”” covered medication

SOURCES

Death with Dignity Act of 2016, D.C. LAW 21-182 (2016)

DC Health Annual Reports

End of Life Options DC

New Mexico

MAID Eligibility Requirements

– At least 18 years old

– Terminal illness with prognosis of 6 months or less

– Terminal prognosis verified by 2 doctors

– Resident of New Mexico

– Capable of self-administering the MAID medication

MAID Process

– Required to be informed of other care options

– Required to be informed that they may choose not to ingest

– At least one physician or qualified osteopathic physician has determined that the individual has decision-making capacity

– 1 written request

– 2 witnesses to written request who:

• – know the patient,
• – sign the request in their presence,
• – attest that the patient is of sound mind, and not under duress, fraud, or undue influence

– There is a 48 hour waiting period between the written request and the writing of the prescription, unless the prescriber can reasonably see that the patient would die during the waiting period

SOURCES

End-Of-Life Options Act, H.B. 47 (2021)

New Jersey

MAID Eligibility Requirements

– At least 18 years old

– Terminal illness with prognosis of 6 months or less

– Terminal prognosis verified by 2 doctors

– Resident of New Jersey

– Capable of self-administering the MAID medication

MAID Process

– Required to be informed of other care options

– Required to be informed that they may choose not to ingest

– Physician shall refer patient to a mental health care professional to determine whether the patient is capable

– 2 oral requests

• – Interval: Fifteen (15) days between the oral requests

– 1 written request

– 2 witnesses to written request who, in the patient’s presence, attest that to the best of their knowledge and belief that the patient is:

• – capable,
• – acting voluntarily to sign the request

– There is a 48 hour waiting period between the written request and the writing of the prescription

SOURCES

Medical Aid in Dying for the Terminally Ill Act, P.L. 2019, c. 59 (2019)

New Jersey Death with Dignity

Maine

MAID Eligibility Requirements

– At least 18 years old

– Terminal illness with prognosis of 6 months or less

– Terminal prognosis verified by 2 doctors

– Resident of Maine

– Capable of self-administering the MAID medication

MAID Process

– Required to be informed of other care options

– Required to be informed that they may choose not to ingest

– The attending and consulting physicians are required to assess the patient for depression or other mental health condition that impairs judgment. If the attending or consulting physician, in the physician’s professional opinion, believes such a condition exists, the patient must be evaluated and treated by a state-licensed psychiatrist, psychologist, clinical social worker or clinical professional counselor

– 2 oral requests, with a 15 day interval between each request

– 1 written request

– 2 witnesses to written request who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is:

• – competent,
• – acting voluntarily,
• – not being coerced to sign the request

– There is a 48 hour waiting period between the written request and the writing of the prescription

SOURCES

Death with Dignity Act, L.D. 1313 (H.P. 0948) (2019)

Maine Death with Dignity

Hawai’i

MAID Eligibility Requirements

– At least 18 years old

– Terminal illness with prognosis of 6 months or less

– Terminal disease verified by 2 doctors

– Resident of Hawai’i

– Patient has voluntarily expresesd their wish to die

– Capable of self-administering the MAID medication

– Has decision-making capacity

MAID Process

– Attending provider shall

• – Make the initial determination of whether a patient has a terminal disease, is capable of medical decision-making, and has made the request for the prescription voluntarily;
• – Require that the patient demonstrate residency
• – Require that the patient is capable and acting voluntarily;
• – Refer the patient for counseling;
• – Recommend that the patient notify next of kin;
• – Counsel the patient about the importance of having another person present when the qualified patient self-administers the prescription and of not self-administering the prescription in a public place;
• – Inform the patient that a qualified patient may rescind the request at any time and in any manner, and offer the qualified patient an opportunity to rescind the request at the time of the qualified patient’s second oral request;
• – Verify, immediately prior to writing the prescription, that the qualified patient is making an informed decision;
• – Fulfill the medical record documentation requirements;
• – Ensure that all appropriate steps are carried out in accordance with this chapter prior to writing a prescription for medication
• – Follow prescribing requirements

– Attending provider shall inform the patient of the:

• – Patient’s medical diagnosis;
• – Patient’s prognosis;
• – Potential risks associated with taking the medication to be prescribed;
• – Probable result of taking the medication to be prescribed;
• – Possibility that the individual may choose not to obtain the medication or may obtain the medication but may decide not to use it; and
• – Feasible alternatives or additional treatment opportunities, including but not limited to comfort care, hospice care, and pain control

– Consulting provider shall confirm, in writing, the attending provider’s diagnosis that the patient is suffering from a terminal disease and the attending provider’s prognosis, and verify that the patient is capable, is acting voluntarily, and has made an informed decision

– Counselor shall determine that the patient is capable, and does not appear to be suffering from undertreatment or nontreatment of depression or other conditions which may interfere with the patient’s ability to make an informed decision

– 2 oral requests

• – must be 5 days between oral requests
• – the five day waiting period can be waived if patient’s attending provider attests that the patient will, within a reasonable medical judgment, die within five days after making the initial oral request

– 1 written request

• – 2 witnesses to written request must attest that to the best of their knowledge and belief the qualified patient is of sound mind, acting voluntarily, and is not being coerced to sign the request
• – identity of witnesses must meet statuory requirements

– There is a 48 hour waiting period between the written request and the writing of the prescription

– Medication must be self-administered

SOURCES

H.B. No. 2739 H.D. 1 (2018)

Hi. Stat. § 327L (2018)

Burden Lifters, LLC

Vermont

MAID Eligibility Requirements

– At least 18 years old

– Has decision-making capacity

– Has a diagnosis of a terminal illness with prognosis of 6 months or less, verified by 2 separate clinicians

– Capable of self-administering the MAID medication

*Eligible patients don’t have to be in-state residents of Vermont. Out-of-state residents are welcome.

MAID Process

– Required to be informed of other care options

– Required to be informed that they may choose not to ingest

– The physician and the second physician should record and file in the patient medical record that the patient was capable, was acting voluntarily and had made an informed decision

– 2 oral requests, with a 15 day interval between each request, made in the physical presence of the physician or, if the doctor thinks it’s appropriate, by telemedicine. Any telemedicine calls have to take place within Vermont borders.

– 1 written request

– 2 witnesses to written request who, in the presence of the patient, affirm that the patient:

• – appears to understand the nature of the document,
• – is free of duress, or undue influence at the time the request was signed

SOURCES

S.77, Act No. 39 (2013)

H.190, Act No. 10 (2023)

S.74, Act No. 97 (2022)

Patient Choices Vermont

Oregon

MAID Eligibility Requirements

– At least 18 years old

– Has decision-making capacity

– Has a diagnosis of a terminal illness with prognosis of 6 months or less, verified by 2 separate clinicians

– Capable of self-administering the MAID medication

*Eligible patients don’t have to be in-state residents of Oregon. Out-of-state residents are welcome.

MAID Process

– Required to be informed of other care options

– Required to be informed that they may choose not to ingest

– Attending Physician responsibilities include referring the patient to a consulting physician for medical confirmation of the diagnosis and for a determination that the patient is capable and acting voluntarily

– 2 oral requests, with a 15 day interval between each request

– 1 written request

– 2 witnesses to written request who, in the presence of the patient, attest to the best of their knowledge and belief that the patient is:

• – capable,
• – acting voluntarily,
• – not being coerced to sign the request

– There is a 48 hour waiting period between the written request and the writing of the prescription

SOURCES

The Oregon Death With Dignity Act, OR S.B. 579 (2019)

Gideonse v. Brown, ECF No. 20

End of Life Choices Oregon

California

MAID Eligibility Requirements

– At least 18 years old

– Terminal disease that will result in death within six months

– Capacity to make medical decisions

– Voluntary expression of choice, documented pursuant to statutory requirements

– Resident of California

– Physical and mental ability to self-administer the MAID medication

MAID Process

– Attending physician required to determine:

• – the individual’s capacity to make medical decisions
• – if there are indications of mental disorder
• – whether individual has a terminal disease
• – whether the individual made the request voluntarily
• – whether the individual is a “qualified individual” under the statute

– Attending physician is required to confirm with the individual all of the following:

• – their medical diagnosis and prognosis
• – potential risks of ingesting the aid-in-dying drug
• – the probable result of ingesting the aid-in-dying drug
• – the possibility that they may obtain the aid-in-dying drug but not take it
• – feasible alternatives or dditioanl treatment options, including but not limtied to, comfort care, hospice care, palliative care, and pain control

– Attending physician must refer to a consulting physician

– Attending physician must confirm that the request does not arise from coercion or undue influence

– Attending physician must counsel the individual on the importants of all of the following:

• – having another person present during ingestion
• – not ingesting the drug in a public place
• – notifying next of kin of their request for an aid-in-dying drug
• – participation in hospice
• – maintaining the drug in a safe and secure location

– Physician shall refer the individual for mental health specialist assessment if there are indications of a mental disorder

– Attending physician must inform the individual that they can withdraw or rescind a request at any time, and must directly offer the patient an opportunity to rescind request

– Immediately before writing a prescription, the attending physician must verify that the individual is making an informed decision

– Consulting phsysician must:

• – examine the individual
• – medically confirm diagnosis and prognosis
• – .determine that the individual has capacity to make medical decisions, is acting voluntarily, and has made an informed decsion
• – refer to a mental health specialist if their are indiciations of a mental disorder, and
• – determine that the individual has that the individual has complied with the law

– 2 oral requests, with a 48 hour interval between each request

– 1 written request

• – must be witnessed by 2 individuals who, in the presence of the individual, attest to the best of their knowledge and belief that the individual: is personally known to them or has provided proof of identity, voluntarily signed the request, is of sound mind, is not under duress, fraud, or undue influence, and is not an individual for whom they are the attending physician, consulting physician, or mental health specialist
• – identity of witnesses must meet statuory requirements

SOURCES

End of Life, S.B. 380 (2021)

End of Life, A.B. 15 (2015)

End of Life Choices California

Colorado

MAID Eligibility Requirements

– At least 18 years old

– Terminal illness with a prognosis of six months or less

– Resident of Colorado

– Mental capacity

– Voluntarily expression of the wish to receive a prescription for medical aid-in-dying medication

– Capable of self-administering the MAID medication

MAID Process

– Attending provider shall:

• – determine that the individual has a terminal illness, has a prognosis of six months or less, is mentally capable, is making an informed decision, and has made the request voluntarily
• – request that the individual demonstrate Colorado residency
• – provide care that conforms to established medical standards and accepted medical guidelines;
• – refer the individual to a consulting provider for medical confirmation of the diagnosis and prognosis and for a determination of whether the individual is mentally capable, making an informed decision, and acting voluntarily
• – confirm that the individual’s request does not arise from coercion or undue influence
• – inform the individual that they may rescind the request at any time
• – verify, immediately prior to writing the prescription, that the individual is making an informed decision
• – ensure that all appropriate steps are carried out before writing a prescription for medical aid-in-dying medication

– Attending provider required to provide full, individual-centered disclosures to ensure that the individual is making an informed decision by discussing with the individual:

• – their medical diagnosis and prognosis of six months or less
• – the feasible alternatives or additional treatment opportunities, including comfort care, palliative care, hospice care, and pain control
• – the potential risks associated with taking the medication to be prescribed
• – the probable result of taking the medication to be prescribed
• – the possibility that the individual can obtain the medication but choose not to use it

– Attending provider shall refer individual to a licensed mental health professional if they observe signs that the individual may not be capable of making an informed decision

– Attending provider must educate the individual about the importance of:

• – having another person present when the individual self-administers the medication
• – not taking the medication in a public place
• – safe-keeping and proper disposal of unused medication
• – notifying the individual’s next of kin or any person who plays a significant role in the individual’s life, which may include a person not legally related to the individual, of the request for medical aid-in-dying medication

– Attending provider must offer the patient an opportunity to rescind request

– Statutory requirements concerning the process of dispensing the medication

– Consulting provider must examine the individual and the individual’s relevant medical records and confirm, in writing, to the attending provider that the individual:

• – has a terminal illness
• – has a prognosis of six months or less
• – is making an informed decision
• – is mentally capable, or provide documentation that the consulting provider has referred the individual for further evaluation
• – has requested a prescription for medical aid-in-dying medication

– Medication must be self-administered via ingestion

– 2 oral requests, with a 7 day interval between each request

• – Note: the waiting period may be waived if the attending provider has determined that the individual will, within reasonable medical judgment, die within forty-eight hours after making the initial oral request

– 1 written request

• – 2 witnesses to written request must attest that, to the best of their knowledge and belief, the individual is mentally capable, acting voluntarily, and not being coerced to sign the request
• – Identity of witnesses must meet statuory requirements

SOURCES

Senate Bill 24-068

End of Life Options Colorado

Washington

MAID Eligibility Requirements

– At least 18 years old

– Terminal illness with prognosis of 6 months or less

– Terminal diagnosis and mental capacity verified by 2 licensed healthcare providers

– Resident of Washington

– Mentally capable of making informed decisions

– Capable of self-administering the MAID medication

MAID Process

– Attending and/or consulting clinicians may refer patient for psych evaluation if patient may be suffering from psychiatric or psychological disorder or depression causing impaired judgement

– 2 oral requests

• – Interval: 7 days between oral requests

– 1 written request

– 2 witnesses to written request who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is:

• – competent,
• – acting voluntarily,
• – not being coerced to sign the request

SOURCES

Improving Access to the Death with Dignity Act, S.B. 5179 (2023) and H.B. 1281 (2023)

End of Life Washington