The American Clinicians Academy on Medical Aid in Dying Patient Referral System:
If you or your loved one have a terminal condition and are considering aid in dying, we will attempt to refer you to physicians who can consider your aid-in-dying request.  The requirements are that you:
*Live in a state where aid in dying is legal
*Have a terminal diagnosis with a less than six-month prognosis
*Have the capacity to make your own medical decisions.

Please be sure to ask your present doctors about considering your request for medical aid in dying. The Academy can provide your doctor with contact information for physicians who are experienced with medical aid in dying, who are willing to explain the process your doctors need to follow.┬áPlease share our contact information with your doctors: [email protected]

If you have approached 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 strongly encourage patients to begin hospice care as soon as they can, though this is not a requirement for eligibility for medical aid in dying. Hospices provide expert end-of-life care in your own home, and comfort to grieving family members. Many hospice doctors participate in medical aid in dying, as the first or second required physician. We recommend that you ask specifically about this during your intake interview with a hospice.

Submitting this form is your permission for us to share your information with potential aid-in-dying physicians.