The Academy’s Patient-to-Doctor Referral System can help connect you to clinicians who can provide aid-in-dying care.
The Academy is a non-profit (501c3) and provides referrals without charge. We do gratefully accept donations so that we can continue this service for as many as are in need, as well as our research and clinician education about medical aid in dying.
Donations gratefully accepted
To become eligible for medical aid in dying, US laws require that you are an adult, live in a state where aid in dying is legal*, have been diagnosed with a terminal condition with less than six months left to live, and have the capacity to make your own medical decisions, as confirmed by medical doctors.
*(or can move to Vermont or Oregon, or establish residency in an aid-in-dying state)
Please be sure to ask your present doctors about your request. If they are not experienced with aid in dying, let them know that the Academy’s physicians will work with them on the details, from the law to the medications used. There is no charge for this, and they do not have to be a member of the Academy. Please share our contact information with your doctors: [email protected]
If you have contacted your doctors about medical aid in dying and continue to need a referral to a physician who will participate, please fill out our referral intake form below. We may have referrals to hospices, independent private practice MDs, or palliative care practices that provide aid-in-dying care.
Submitting this form grants the Academy your permission to share your information with potential aid-in-dying physicians and other related healthcare providers who may participate in your evaluation for and/or care related to medical aid in dying.
NOTE: Please pay attention to the details of the questions below, answer as completely as possible, and do not leave the required fields (marked with *) empty.
If the form was completed and submitted correctly, you will be taken to a CONFIRMATION PAGE.
If you complete this form and enter “Submit” and are NOT taken to the confirmation page, this indicates that you have left one or more *required fields blank and we will NOT receive your form. Please go back, fill in all the missing fields and then submit the form until you DO land on the confirmation page.
If you enter “Submit” and are not taken to the confirmation page, you have left fields blank and we will not receive your form. Please fill in the missing fields and then re-submit the form.