Becoming eligible requires patients to meet several legal criteria. You must be an adult resident of a state where medical aid in dying is legal, have a medical diagnosis with a prognosis of six months or less, possess the mental capacity to make your medical decisions, and be physically able to self-administer the prescribed liquid medications, either by swallowing or by pushing them into your GI tract through a feeding tube or catheter (rectal or ostomy). Patients must voluntarily and independently request evaluation for this option from two participating providers. Suffering or having a verified plan is not required, and patients are never obligated to take the medications to die.

Verifying eligibility may take considerably longer than the mandated waiting period. If you think you may want this option at some point in your dying process, starting the process early can prevent unnecessary stress or urgency. Being deemed eligible does not require you to take the medications to die; it simply provides you with the option to do so. 

Hospice services offer expert symptom control and support for loved ones, no matter how your end-of-life proceeds. Aid in dying can become a non-viable option if you lose mental capacity or the ability to take the medications without assistance. Hospice care, which is covered 100% by Medicare and most insurances, ensures you and your family have attentive end-of-life care, no matter how you die.

Be sure to interview a few hospices before deciding. While most hospices provide “support” for patients considering or using medical aid in dying, the actual services and care provided can vary significantly.

It’s crucial to ask for details about what their providers and clinical staff can and cannot do regarding aid-in-dying. Can the hospice providers act as the attending/prescriber? Can they support non-oral routes, if needed? Are their staff allowed to prepare the medications and remain at the bedside while you take the medications? If they have referrals or work with outside providers, what are the potential costs? How does their Medicare-certified hospice work with external providers?

Some hospices do not allow their providers to participate in aid-in-dying at all, others allow them to act as prescribers or consultants, and some only permit them to act as consultants.

Some hospices permit their nurses to monitor patients, prepare these dangerous medications, manage non-oral routes, and remain at the bedside to provide essential support from ingestion through death, while others do not.

Note: Hospice eligibility does not guarantee eligibility for medical aid in dying. If you are deemed not yet eligible, you may ask your provider to continue to follow and provide guidance about what would indicate a need for reevaluation.

Consider your needs carefully, and ask for the details!

To initiate the process for medical aid in dying, patients must first make a direct request to a participating provider who agrees to serve as their “attending provider for medical aid in dying”. This attending/prescribing clinician will document the request in the medical chart, begin evaluations to determine if the patient meets all the legally required criteria, and provide counseling about all options for end-of-life care.

A “consulting” or confirming clinician must also review the patient’s records and confirm eligibility.

If there are questions about the patient’s capacity to make their own medical decisions, an additional capacity evaluation may be required by a mental health professional.

In some states, patients must complete a written request form witnessed by two others.

Patients who require translation will have to complete an additional form.

If the attending/prescribing provider agrees that the patient meets the legal criteria and has completed the other steps, they can take the second verbal request and complete the required counseling any time after the mandated waiting period. This completes the eligibility process, and the attending/prescriber may write the prescription for the medications, which can be held at the pharmacy until they are needed.

The attending/prescribing provider should continue to follow and provide guidance to patients about whether and when to proceed, and what to expect. The hospice team should also coordinate care with the attending/prescriber. If any questions or concerns arise, especially regarding the patient’s capacity or ability to safely self-ingest, the prescriber or their backup should be called.

Being deemed eligible does not obligate the patient to use the medications; it simply provides them with the option. Patients who are found ineligible may be reevaluated later if their condition changes.

Verifying eligibility may take considerably longer than the minimum waiting period, so it is advisable to start the process early to avoid unnecessary stress or urgency.

Note: Hospice eligibility does not guarantee eligibility for medical aid in dying. If you are deemed not yet eligible, you may ask your provider to continue to follow and provide guidance about what would indicate a need for reevaluation.

If permitted to participate, palliative care practices and other large medical organizations work with insurance and can provide aid-in-dying care, typically through office visits or sometimes via telehealth. However, they would have to rely on your hospice to provide bedside care. If permitted to participate, palliative care practices and other medical organizations work with insurance and can provide aid-in-dying care, typically through office visits or sometimes via telehealth. However, they would have to rely on your hospice, privately hired end-of-life doulas, or volunteers to provide bedside care.

If hospice allows its internal providers to act as attending prescribers, there should be no additional costs, because Medicare and federal law prohibit charging for this care. However, patients will still need to pay for the medicines (approximately $600 to $800), which hospices cannot cover. If a hospice does not allow this, they may be able to transfer the patients to a hospice that does, but this can add delays to the process.

Independent physicians can often work rapidly, manage non-oral routes, make home visits, and provide bedside care. Most charge a flat fee, but some may be willing to use a sliding scale for patients who genuinely need it. Some may also be able to bill insurance.

Consider your needs carefully.

The Academy can provide referrals at this link.

If you live in a facility, be sure to ask about their policies regarding medical aid in dying. Skilled nursing facilities are allowed to “opt out” and not permit aid-in-dying on premises. Other facilities, such as assisted living, must allow you to do what you choose in your own apartment or room, but policies can vary at different types of facilities.

If you cannot proceed with aid in dying in your current location, alternative plans, such as going to a friend or family member’s home for the day, are reasonable options. Short-term rentals (Airbnb) or hotels may also be an option, but they require prior permission from their owners, who should be notified that an expected death may occur, much like notifying them that a hospice patient will be staying on premises.

Some patients may decide to move to states where aid in dying is legal so they can have aid-in-dying as an option. Bear in mind that though residency requirements are typically minimal, the evaluation process and the self-administration of aid-in-dying medication must occur within that state’s borders. Transporting lethal medications across state lines is not legal and could potentially be considered “assisting a suicide” in states where aid-in-dying laws are not in place.

The process and the required move can be very stressful, especially as fragile patients continue to decline. Aid-in-dying can suddenly become unsafe or even impossible. Consider your needs and those of your loved ones very carefully before embarking on this highly complex project.

We have recommendations and referrals for patients who want to consider moving to a state where aid in dying is legal. (Oregon, Washington, California, Vermont, Colorado, New Mexico, Hawaii, etc.)

Please fill out our patient intake form.

While it’s always a good idea for you and your doctors to share your thoughts about your end-of-life hopes and fears, it’s not entirely practical to plan too far in advance for aid in dying, especially if your doctors are telling you that you currently don’t have a life-limiting disease or prognosis. Whatever you arrange with your current doctors is likely to change as your condition and care teams change. While you may be politically very supportive of aid in dying (thank you!), this may or may not translate into your reality. Palliative care may be an option if your symptoms are a burden. If and when you are closer to meeting the legally required criteria, we highly recommend you consider (and carefully choose) hospice care (see above). The Academy can provide referrals, if and when that time comes. In the meantime, please read our free patient guide.