by Nicole Nuttall | Dec 17, 2025 | Announcements, Publications
My views on end-of-life care were formed by personal experiences. I watched my grandmother’s difficult decline in a nursing home over a number of years. My mother suffered through multiple strokes and dementia over nearly a decade. By the end of her life…
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.
Bill goes into effect on August 5, 2026
– 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
– Attending physician must:
– Consulting physician must:
– Mental health professional must:
– Patients must issue:
– There must be two witnesses to the written request
– There must be a 5 day waiting period between when the prescription is written and filled
New York Medical Aid in Dying Act, S138
– 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
– 2 separate physicians or Advanced Practice Registered Nurses (APRNs) must confirm that the patient:
– 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
– There is a 48 hour waiting period between the written request and the writing of the prescription
Bill goes into effect on September 12, 2026
– 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
– Attending physician must:
– Consulting physician must:
– Patients must issue:
– There must be two witnesses to the written request
End-of-Life Options for Terminally Ill Patients Act, S.B. 0009
– 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.
Baxter v. State, 224 P.3d 1211, 2009 MT 449, 354 Mont. 234 (2009)
– 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
– Attending physician required to inform patient of:
– Consulting physician must confirm terminal diagnosis and verify that the patient is:
– 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
– 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
– Patient must “”ingest”” covered medication
Death with Dignity Act of 2016, D.C. LAW 21-182 (2016)
– 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
– 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:
– 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
End-Of-Life Options Act, H.B. 47 (2021)
– 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
– 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
– 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:
– There is a 48 hour waiting period between the written request and the writing of the prescription
Medical Aid in Dying for the Terminally Ill Act, P.L. 2019, c. 59 (2019)
– 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
– 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:
– There is a 48 hour waiting period between the written request and the writing of the prescription
Death with Dignity Act, L.D. 1313 (H.P. 0948) (2019)
– 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
– Attending provider shall
– Attending provider shall inform the patient of the:
– 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
– 1 written request
– There is a 48 hour waiting period between the written request and the writing of the prescription
– Medication must be self-administered
Hi. Stat. § 327L (2018)
– 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.
– 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:
S.77, Act No. 39 (2013)
H.190, Act No. 10 (2023)
S.74, Act No. 97 (2022)
Patient Choices Vermont
– 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.
– 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:
– There is a 48 hour waiting period between the written request and the writing of the prescription
The Oregon Death With Dignity Act, OR S.B. 579 (2019)
Gideonse v. Brown, ECF No. 20
– 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
– Attending physician required to determine:
– Attending physician is required to confirm with the individual all of the following:
– 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:
– 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:
– 2 oral requests, with a 48 hour interval between each request
– 1 written request
End of Life, S.B. 380 (2021)
End of Life, A.B. 15 (2015)
End of Life Choices California
– 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
– Attending provider shall:
– Attending provider required to provide full, individual-centered disclosures to ensure that the individual is making an informed decision by discussing with the individual:
– 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:
– 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:
– Medication must be self-administered via ingestion
– 2 oral requests, with a 7 day interval between each request
– 1 written request
– 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
– 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
– 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:
Improving Access to the Death with Dignity Act, S.B. 5179 (2023) and H.B. 1281 (2023)