Most people who choose medical aid in dying (MAID) are hospice patients, and providers need a firm understanding of the legal and ethical considerations. 

More than 85% of individuals who choose MAID are hospice patients, according to a 2021 report by Compassion & Choices. Less than 1% of deaths that occurred in states with MAID policies were medically assisted, the report found.

MAID laws vary by jurisdiction but are generally designed to allow a patient with a life-limiting diagnosis nearing the last six months of life to choose a medically-assisted death. These laws have garnered controversial debate and have been subject to misperceptions.

Recognizing the nuances associated with MAID laws is key to helping patients and their families navigate these ethically complex decisions, said Yelena Zatulovsky, vice president of patient experience at AccentCare. A portfolio company of the private equity firm Advent International, the Dallas-headquartered company provides hospice, home health, personal and palliative care across 32 states and in the District of Columbia.

“Agencies need to have a policy that aligns with their mission, vision and values, but they can’t ignore the questions,” Zatulovsky told Hospice News. “The key is not dismissing the patient’s ask and potentially putting our own personal values or beliefs around this. It can be a very divisive topic, but it’s finding out the root cause of where this is coming from, like whether the concern [is] around a patient’s suffering. Not having these conversations with your staff is a disservice to them. Ultimately, it doesn’t matter what decision patients make, we’re going to support them as appropriate to law and agency policy. We still have an obligation to have those conversations. It is their end of life journey, after all. It comes back to ethical decision making.”

MAID laws and hospice

To date, medical aid in dying is authorized in 11 states and in Washington D.C., according to data from the end-of-life resource provider Compassion & Choices. Delaware became the most recent state to legalize MAID in 2025, with New York currently considering a Medical Aid in Dying Act.

Among the complexities surrounding MAID laws are the public misconceptions about these regulations, said Jeanne Chirico, president and CEO of Hospice and Palliative Care Association of New York State (HPCANYS). The misperceptions in some ways mirror and exacerbate those about what hospice care is and is not, Chirico indicated.

Staff need avenues for engagement and the ability to voice their questions and concerns about MAID laws, she said. Also important is ensuring hospice clinicians and interdisciplinary teams understand the role they play.

“It is a concern for providers of how they as organizations go out into the public and show that they aren’t killing people, they are supporting them through the end of life,” Chirico told Hospice News. “It’s dispelling any myths about MAID, like the patients have to self-administering, or that [hospice staff] are going to be asked to administer something, or that they have to be in a patient’s home when it happens. It’s offering education and perspectives about the legal things that get spelled out, [which] can offer decompression from the emotional value and try to desensitize the MAID conversation.”

The impacts of expanding MAID laws can be far-reaching for hospices, regardless of whether they provide care in states with these policies in place, said Jessica Empeño, national director for clinical engagement at Compassion & Choices.

Among the challenges is that two states, Oregon and Vermont, extend these regulations to allow MAID for eligible patients from any region across the country. This means that terminally ill individuals who qualify for MAID from these states are able to travel to other geographic areas to access a medically assisted death, should they have the financial means and physical ability to do so, Empeño explained.

Staying informed and educated about evolutions in MAID laws can be crucial when it comes to compliance and quality, according to Empeño. These laws have “strict” eligibility criteria, with different types of patient safety guidelines and protections.

“It’s important for hospice clinicians in particular to be aware of what it is and be able to have that conversation,” Empeño told Hospice News. “It’s not their job to know everything, but they should know how to find information and resources to state associations and administrators, as well as what the regulations say about medical aid in dying. It’s understanding how that works, the specific limitations, requirements and quality of care, and also that compliance has to be a part of everything they’re doing.”

Discussions about medically assisted deaths can allow for greater insight into some of the unmet patient needs, such as unmanageable symptoms and the sources of discomfort or distress, Empeño indicated. Even questions related to MAID can “open the door” to valuable conversations about what’s most important to patients and their families, which can improve goal-concordant care delivery, she stated.

Top of mind for hospice providers is focusing on patient-centered and directed care, and understanding the legal frameworks of MAID laws, Empeño said. Staff training is key, particularly when it comes to having more in-depth goals-of-care conversations about what families in these situations hope to experience at the end of life.

Strong education about the legal and ethical nuances is crucial, as is having protocols that help establish best practices related to supporting patients interested in a medically assisted death, according to Zatulovsky. Interdisciplinary hospice teams need to understand the complicated aspects of holding goals-of-care discussions about these options with patients and their families, Zatulovsky said.

“We have policies and protocols in place on how to have conversations related to MAID, and these have evolved a lot,” Zatulovsky said. “For questions related to medical aid in dying, it’s having a solid, very strong process so that our teams feel equipped and empowered to handle any kind of ethical dilemma. Ultimately, everything around these are nuanced cases — the complexities, the challenges, the discord, the stigmatization — is related to conversation. It’s about what their good death looks like.”