New York Enacts Medical Aid in Dying

New York is now the 14th U.S. jurisdiction to authorize Medical Aid in Dying (MAiD), concluding a decade of legislative effort. With 100 million Americans now living in states with such laws, the enactment marks a significant shift in end-of-life care, reflecting a broader four-decade transition toward systemic reform in American medicine. 

As a national bellwether state, New York’s law raises new and salient complexities that could inadvertently infringe upon the very autonomy it seeks to protect. 

MAiD Across the United States

The New York law (SB138) follows the standard Oregon model, requiring a competent adult resident with a terminal illness and a six-month prognosis (see table below for U.S. comparisons.) It also introduces unique complexities that were influenced by New York’s specific political climate, namely, where strong opposition to the Catholic Church led the executive branch to demand additional layers of verification before the bill’s passage. 

Comparison of Current MAiD Frameworks in the U.S.

Jurisdiction	Legal Basis	Death Forseaable	Oral Requests	Mental Health Eval	Waiting Period	Residency	Provider Types
New York	Statute (2026)	≤ 6 Months	1 Recorded (A/V)	Discretionary	5 Days	Required	MD, DO
Delaware	Statute (2025)	≤ 6 Months	2 Verbal	Discretionary	15 Days	Required	Discretionary
Illinois	Statute (2025)	≤ 6 Months	2 Verbal	Discretionary	5 Days	Required	Discretionary
New Mexico	Statute (2021)	≤ 6 Months	None (1 Written)	Discretionary	48 Hours*	Required	MD, DO, APRN, PA
Maine	Statute (2019)	≤ 6 Months	2 Verbal	Discretionary	15 Days	Required	MD, DO
New Jersey	Statute (2019)	≤ 6 Months	2 Verbal	Discretionary	15 Days	Required	MD, DO
Hawaii	Statute (2018)	≤ 6 Months	2 Verbal	Mandatory	5 Days	Required	MD, DO, APRN
Colorado	Statute (2016)	≤ 6 Months	2 Verbal	Discretionary	7 Days*	Required	MD, DO, APRN
Washington, D.C.	Statute (2016)	≤ 6 Months	2 Verbal	Discretionary	15 Days	Required	MD, DO
California	Statute (2015)	≤ 6 Months	2 Verbal	Discretionary	48 Hours	Required	MD, DO
Vermont	Statute (2013)	≤ 6 Months	2 Verbal	Discretionary	15 Days	Removed	MD, DO, ARNP
Montana	Court (2009)	≤ 6 Months	2 Verbal (Clinical)	Discretionary	None	None	Discretionary
Washington	Statute (2008)	≤ 6 Months	2 Verbal	Discretionary	7 Days	Required	MD, DO, ARNP, PA
Oregon	Statute (1997)	≤ 6 Months	2 Verbal	Discretionary	15 Days	Removed	MD, DO

Broadly, the U.S. MAiD approach emerged from state legislation. Montana remains unique, allowing MAiD via a 2009 State Supreme Court ruling (Baxter v. Montana), rather than a legislative statute, functioning virtually the same as other states yet emerging with legislative distinction. 

The MAiD movement began with the established right to refuse treatment in the 1970s and accelerated with Oregon’s first MAiD law nearly 40 years ago. 

Provisions of NY’s Law 

The most novel provision required by the New York law is for a recorded oral request via audio or video from the patient, as a supplement to the written consent and the physician’s notations in the medical records. This requirement was a heavily negotiated safeguard intended to provide a verifiable record of voluntariness. However, in an era of artificial intelligence, it is not clear that audio or video can be reliably distinguished from a “deepfake.” Research reveals no pilot studies or rigorous evaluations of how patients are likely to experience this mandate, including whether it may undermine the dignity of the private clinical encounter, which could cause ethical endangerments to the vulnerability of patients. 

Verbal consent is a valuable tool when written consent is physically impossible. However, requiring a digital recording may alienate vulnerable patients, such as those with advanced Amyotrophic Lateral Sclerosis (ALS), who may find the prospect of a final video or audio recording insurmountable, as up to 95 percent of people with ALS become unable to meet their communication needs using natural speech.

New York’s law also expressly prohibits anyone other than the patient from administering the medication, overlooking the fact that many patients, suffering from ALS and other terminal diseases, eventually lose the motor dexterity required to self-administer. 

Following the lead of most U.S. jurisdictions, New York’s MAiD requires a referral to a mental health professional if the attending physician believes the patient lacks decision-making capacity. This referral-based system relies on the clinician’s ability to distinguish between end-of-life choices and clinical depression. 

New York’s requirement follows a typical, although increasingly contested, state-law feature regarding residency. Recent constitutional challenges under the Privileges and Immunities Clause led Oregon and Vermont to remove their residency requirements to avoid discriminating against out-of-state citizens. New York’s adherence to this rule suggests a focus on domestic regulation over national access. 

MAiD Trends 

New York’s five-day waiting period is among the shortest in the nation. This follows a trend toward shortening the original 15-day model to accommodate patients whose death is imminent or who suffer from rapidly progressing conditions. Several states, including Delaware’s new law, require 15 days, while California and New Mexico’s waiting periods are as short as 48 hours, and allow doctors to waive the requirement if death is imminent. Montana’s judicial approach has no waiting period. A shorter window arguably makes MAiD more accessible and autonomous to patients who might otherwise lose capacity, in advanced cases of dementia, for example, during a protracted waiting period. 

Several states have broadened MAiD to allow provision by physician assistants and advanced practice nurses. New York joins Illinois and other states that limit it to doctors, further infringing on the right to autonomy and accessibility. 

Data from 23 years of MAiD implementation in the U.S. provide a clear profile of the typical patient: The median age is 74, the population is predominantly white and well-educated, and nearly 90 percent are enrolled in hospice at the time of death. Most patients (74 percent) have a primary diagnosis in oncology, followed by neurological conditions. With New York’s diverse population, these data may not be sufficient for anticipating the needs of prioritizing patient autonomy in a heterogeneous environment. 

Visibility and Uptake 

Despite the visibility of these laws, public knowledge is outpaced by fragmented implementation. A 2024 national survey found that more than 50 percent of U.S. adults are unaware of the legality of MAiD in their own state. Yet there seems to be substantial demand, as 44 percent of Americans would consider MAiD if diagnosed with a terminal illness. 

However, survey statistics can be misleading. Some reports demonstrate that utilization is rare, accounting for less than 1 percent of total annual deaths in states where it is legal. While the Center for Palliative Care estimates 12-14 million Americans need palliative services annually, only a small fraction of those with terminal illnesses are eligible for or seek MAiD. It is estimated that one-third of patients who obtain a prescription never use it, suggesting that for many, the prescription serves as a tool to have control over their process of dying.

MAiD Ahead 

As state-based models of MAiD proceed across the U.S., data is needed on the fragmented provisions that accompany their enactments. The New York law includes reporting requirements under Section 2899-p, but these alone are insufficient to truly determine if these guardrails will advance or hinder autonomy, skew the demographic profile of participants, or potentially place undue burden on those with neurological decline. 

If the recorded oral request becomes the standard, the national movement for death with dignity may be redefined as “death with documentation,” risking alienation of particularly vulnerable patients who find the prospect of a final recording intrusive, undignified, or simply impossible. The potential for comparative research is an advantage of the state-level heterogeneity, and it may shed light on whether New York’s unique requirement of oral request inspires other states to reevaluate or embrace MAiD.