The Academy’s Patient-to-Doctor Referral System can help connect you to clinicians who can provide aid-in-dying care. We will send you an email within 24-48 hours and may need further information, so please check your emails often. If you haven’t heard back from us, please send an email to [email protected]

The Academy is a non-profit (501c3) and provides referrals without charge. We do gratefully accept donations to 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

Please be sure to ask your present doctors about your request. If they are willing but 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 proceed with filling out our referral intake form below.

We will work diligently to refer you to providers as quickly as possible, but unfortunately, an urgent need for aid-in-dying care is typically very hard to arrange. Doctors must carefully review your medical records and confirm your eligibility, so please be prepared to help them gain access promptly. Also, we highly recommend you consider being admitted to or stay in close touch with hospice for expert symptom control and so that they can provide contingent end-of-life care, should dying become not possible.  

The Academy provides referrals for patients whose intake form indicates they will likely meet the legal requirements for aid-in-dying. Generally, to become legally eligible for medical aid in dying, you must be an adult, live in a state where aid-in-dying is legal (or you can move to Vermont or Oregon, or establish residency in an aid-in-dying state) , 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. There are waiting periods between verbal requests, and some states require a written request. Additionally, you must have the ability to self-ingest (orally or via feeding tube, ostomy, or rectal catheter)

Eligibility does not require proof of suffering nor exact planning for self-ingestion. Once you have completed all the required steps and are eligible for medical aid in dying, you can proceed and take the medications to die if you choose to, but you are never required to. For further details, please see our guide for patients and their loved ones.

We may have referrals to hospices, independent private practice MDs, or palliative care practices that provide aid-in-dying care. The details and cost of this care can vary. For an explanation of the models of care, please see Potential Fees and Expenses for Medical Aid in Dying.

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 very close attention to the details of the questions below, answer as completely as possible, and fill in the required fields (marked with *).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.

~Thank you. We are happy to help. Donations gratefully accepted