Medical Aid in Dying in America: Where We Stand in 2026

At the end of life, the question isn't simply whether we have choices—but whether we have the freedom to make them.

There was a time when the phrase medical aid in dying was barely part of the American conversation. Today, it is becoming increasingly difficult to ignore.

As of August 2026, medical aid in dying (MAiD) is authorized in 14 U.S. jurisdictions, with New York becoming the most recent on August 5. Illinois is scheduled to join that group in September. Together, these developments represent a significant shift in how Americans are thinking about autonomy, suffering, and what it means to have a dignified death. But the map is still remarkably uneven. Where you live can determine whether you have an option available to you at the end of your life that someone with an identical diagnosis may have just a few hundred miles away. And I believe we need to talk about that.

What is medical aid in dying?

Medical aid in dying is a carefully regulated end-of-life option for mentally capable adults who have a terminal illness and meet specific legal requirements. While laws vary by jurisdiction, the laws generally require a person to be an adult, have a terminal diagnosis with a prognosis of six months or less, demonstrate decision-making capacity, make multiple voluntary requests, and be physically capable of self-administering the medication. The distinction between MAiD and euthanasia is important.

With medical aid in dying, the patient—not the physician—takes the medication.

The physician's role is to evaluate eligibility and, where appropriate, prescribe the medication. The decision about whether and when to take it remains with the patient. And that distinction matters enormously. A prescription can be filled and never used. A person can change their mind. A person can die naturally before ever taking the medication.

For many people, simply knowing that the option exists provides an enormous sense of control during a time when so much else may feel uncontrollable.

The map is changing

Oregon became the first state to authorize medical aid in dying through its Death with Dignity Act, which voters approved in 1994. For years, it stood largely alone. Then the movement slowly spread. Today, authorized MAiD jurisdictions include Oregon, Washington, Vermont, California, Colorado, Hawaii, New Jersey, Maine, New Mexico, Delaware, Illinois, New York, Washington, D.C., and Montana through a court ruling rather than a statute. The laws and procedures are not identical, and the practical availability of MAiD differs from one jurisdiction to another.

New York's arrival is particularly significant.

After a decade of legislative efforts, Governor Kathy Hochul signed the state's Medical Aid in Dying Act in February 2026. It took effect August 5. The New York Department of Health now recognizes MAiD as an available option for eligible terminally ill New Yorkers. That is a remarkable change. But it also illustrates something important: passing a law is not the same thing as creating easy access.

Patients still have to find participating physicians. Health systems and individual clinicians may decline to participate. Religious healthcare institutions may have their own policies. And legal challenges are already underway in New York. So the conversation is evolving from "Should this be legal?" to the much more complicated question of "What does meaningful access actually look like?"

The questions aren't going away

Opposition to MAiD is real, and it deserves to be heard. Some religious traditions believe that intentionally hastening death is morally wrong. Some disability-rights advocates worry that people with disabilities could be pressured—subtly or overtly—to view their lives as burdensome or less valuable.

Others question whether a six-month prognosis is sufficiently precise, whether safeguards adequately protect vulnerable people, and whether society is doing enough to provide excellent hospice, palliative care, mental-health support, home care, and caregiver assistance before offering another end-of-life option. These are serious questions and they should not be dismissed. But neither should the experiences of terminally ill people who are asking for another choice. The existence of MAiD should never mean that a person is offered medication instead of appropriate pain management, hospice, palliative care, emotional support, or human companionship.

Choice requires alternatives.

• If someone chooses MAiD because they cannot obtain adequate care, that is not a success of our healthcare system.

• If someone chooses MAiD after receiving excellent hospice and palliative care because they simply do not want the final stage of their terminal illness to unfold in a particular way, that is a different conversation.

We need to be capable of having both conversations.

What about Maryland?

This is where the issue becomes personal for me. Maryland has considered medical aid in dying legislation repeatedly. In 2025, lawmakers introduced the Honorable Elijah E. Cummings and Honorable Shane E. Pendergrass End-of-Life Option Act, Senate Bill 926 and House Bill 1328. The legislation would have permitted qualifying terminally ill adults to request medical aid in dying under a series of safeguards, including a terminal prognosis of six months or less and requirements concerning capacity, physician involvement, and mental-health evaluation. The legislation did not become law. That means a Maryland resident with a terminal illness may live within driving distance of a state where MAiD is available and still have no legal option in their own state. For someone who has spent years thinking about death and dying, that geographic disparity is difficult to ignore.

We routinely tell people that they should make their own decisions about the care they want—or don't want—at the end of life. We encourage advance directives. We honor DNR orders. We allow people to refuse chemotherapy, dialysis, ventilation, feeding tubes, and other life-prolonging interventions. We recognize that a mentally capable person has the right to say, "This treatment is no longer consistent with what I want."

So the question becomes:

Should that autonomy extend one step further for a mentally capable, terminally ill adult who wants the option of choosing the timing and circumstances of their death?

Reasonable people can disagree about the answer. But I believe we owe people the opportunity to have the conversation.

MAiD is not about giving up on life

This is perhaps the biggest misconception I encounter. Wanting control over the circumstances of one's death is not necessarily the same thing as wanting to die.

In fact, some people who pursue MAiD never take the medication. They simply find comfort in knowing that it is there. That distinction is profound.

Imagine being told that you have an incurable disease and probably six months to live. Imagine knowing that your body will increasingly fail you, that your independence may disappear, and that treatments may no longer be able to change the outcome.

Now imagine being told:

"There is a legally available option. You don't have to use it. But if your suffering becomes unacceptable to you, and you continue to meet the requirements, you will not have to face those final moments entirely on someone else's terms." For some people, that knowledge is terrifying. For others, it is liberating.

Both responses deserve respect.

The conversation I hope we can have

As a death doula, I don't believe my role is to tell someone how they should die.

My role is to help people understand their choices, explore their values, ask difficult questions, communicate with their families and healthcare providers, and prepare as thoughtfully as possible for the end of life. That includes supporting someone who wants every possible treatment. It includes supporting someone who chooses hospice. It includes supporting someone who wants to stop treatment. And I believe it should include being able to have an informed, compassionate conversation about medical aid in dying.

We don't have to agree on MAiD to agree that dying people deserve dignity, and we don't have to support someone's decision to recognize their right to make deeply personal decisions about their own body. And we don't have to eliminate our concerns about vulnerability, disability, religion, healthcare inequity, or coercion in order to continue examining whether our laws adequately respect individual autonomy. In fact, those concerns are precisely why the conversation needs to continue.

Where do we go from here?

The United States is moving—slowly, unevenly, and sometimes reluctantly—toward a broader conversation about how much autonomy people should have at the end of life. New York's new law is evidence of that movement. Illinois will soon add another jurisdiction. Other states continue to debate legislation. And Maryland remains part of that conversation.

For me, the issue ultimately comes down to a simple principle:

No one should be forced to choose between suffering and death because their state legislature has decided that they are not entitled to the same end-of-life options available to people across a state line.

That doesn't mean MAiD should be unregulated. It doesn't mean every person with a terminal diagnosis should qualify. It doesn't mean hospice and palliative care are somehow less important. And it certainly doesn't mean that choosing to live as long as possible is anything less than a completely valid and deeply personal choice.

It means that perhaps we can trust competent adults, facing the reality of their own terminal illness, to have a voice in how their final chapter unfolds.

Death is something every one of us will experience.

Perhaps it is time we become more comfortable talking about how we want that experience to look—and whether, when the time comes, we should have a meaningful choice in it. That conversation is already happening across America and I believe Maryland should be part of it.