Breaking Down the Medical Aid in Dying Act

End-of-life decisions can involve difficult conversations about personal wishes and medical care. But, since the Medical Aid in Dying Act took effect in August, some New Yorkers now have another option to discuss with loved ones and care teams.

Under the new law, qualifying adults with a terminal illness can self-administer medication to end their lives. Here’s what you need to know about how the process works, the safeguards in place and how it may affect your estate and assets. 

Who Qualifies?

The Medical Aid in Dying Act applies only to a narrow group of adults. To qualify, a person must be at least 18 years old, live in New York, demonstrate adequate decision-making capacity and have a medically confirmed terminal illness expected to cause death within six months.

“It’s not assisted suicide,” says Wendy Hoey Sheinberg, an elder law attorney at Rivkin Radler. “These are not people who are electing to die. They are people who are going to die, and they are electing to do it in a way that gives them control as to when it happens.”

The law includes multiple safeguards. Both an attending physician and a consulting physician must determine that a patient meets the legal criteria, including having decision-making capacity and the ability to self-administer the medication. No physician, family member or other person may administer the medication on the patient’s behalf.

If the patient’s physician questions a patient’s decision-making capacity, a mental health evaluation is required before the process can continue. Patients must also indicate in their written request whether they have informed, plan to inform or have chosen not to inform their family of the decision.

“This is not something that someone can wake up and decide to do that day because they’re feeling pressure or vulnerable,” says Deidre Baker, an elder law attorney at Davidoff Hutcher & Citron. “The law includes lots of guardrails to make sure you’re doing this voluntarily and of your own free will.”

Separating Fact From Fiction

Before it was even enacted, Hoey Sheinberg kept hearing several misconceptions about the law. “There’s no lethal injection,” she says. “It’s not being forced on people. Hospice is not going away, medical aid in dying is not euthanasia. There are no death panels mandating that people utilize medical aid in dying.”

The law does not allow someone else, such as a healthcare proxy, power of attorney or guardian, to request medical aid in dying on a patient’s behalf. It also cannot be authorized in advance through a living will. “This is obviously a really personal decision that can only be made by the patient,” Baker says, “and, importantly, only while they have the capacity to do so.”

According to the act, the death certificate must list the patient’s underlying illness as the cause of death—not medical aid in dying—and life insurance or annuity coverage cannot be denied solely because someone chose this route, says Hoey Sheinberg. The law also requires unused medication to be disposed of safely. She anticipates that the law may eventually need to clarify how certain provisions will be implemented, including whether there will be a minimum residency requirement to qualify or restrictions on where patients may self-administer the medication, such as at vacation homes or rental properties.

Looking Ahead

As an elder law attorney, Baker encourages people to consider their end-of-life preferences well before a medical crisis or terminal diagnosis; she says those conversations are best had early. “The first time you’re considering it really shouldn’t be at the end of your life,” she says. “Part of our job is to educate people, so that they’re aware of what’s available.” She says that understanding the options and sharing your intentions with loved ones can go a long way in easing tough conversations and later decisions.

Attorneys can then review estate plans, update legal documents such as wills and powers of attorney, and ensure property and other assets are set for distribution according to your wishes, including to a spouse or children. 

Whether someone chooses medical aid in dying or not, Baker says the goal of end-of-life discussions remains the same: “To allow you to retain as much control and dignity as possible during a chapter of your life where you’re typically the most vulnerable.”