Medical Aid-in-Dying and Estate Planning

Takeaways

• More than a quarter of Americans live where Medical Aid-in-Dying (MAID) is legal.
• Choosing MAID requires strict adherence to legal rules, and failing to follow them precisely can create serious problems for both the patient and their family’s estate plan.

Do you have the right to die?

A majority of U.S. adults say “yes” to this controversial question, and more jurisdictions are passing laws that allow terminally ill patients to voluntarily end their own lives.

More than one in four Americans live in a state where medical aid-in-dying (MAID) is legal. But there is arguably no other estate planning issue that so narrowly walks the line between morality and legality.

While MAID is legal in some areas, practices like euthanasia and assisted suicide generally are not, and conflating these terms can muddy the waters about what is and is not allowed.

And it is not just a matter of medical terminology. MAID is lawful only when every legal requirement is met. Failing to meet these strict criteria can result in questions about the person’s decision-making capacity, estate disputes, and even criminal charges when the right to “die with dignity” is exercised.

Anyone considering assisted dying has likely arrived at that place after deep soul-searching. Not giving equal consideration to its legal side, however, can turn a right into a crime and make what was intended to be a private and dignified act a public and messy one.

MAID Is Widely Available, But Misconceptions Are Widespread

Death With Dignity, a group that campaigns for legislation, says that the term originates from the original Oregon MAID law. It still prefers “death with dignity,” but other recognized terms are “physician-assisted death,” “aid in dying,” and “physician aid in dying.”

Euthanasia is illegal throughout the U.S., including in states that have passed MAID laws. Death With Dignity notes that terms like “mercy killing,” “active euthanasia,” and “suicide or assisted suicide” are misused by the media and misrepresent MAID laws and practices.

By the end of 2026, more than 30 percent of Americans will reside in states where doctors may legally prescribe a fatal medication to terminally ill patients.

The latest state to allow assisted dying is New York, where Governor Hochul signed the Medical Aid in Dying Act in February 2026 (effective August 5, 2026). New York joins the 12 other states, in addition to Washington D.C., where assisted dying is legal. More than a dozen other states will consider similar legislation in 2026.

Although MAID accounts for less than 1 percent of deaths in the U.S. jurisdictions that permit it, public support for assisted dying is strong.

A 2024 Gallup poll found that 71 percent of Americans believe doctors should be allowed to intervene to end the life of a patient “by some painless means” if the patient and their family request it. Two-thirds agree that doctors should “be allowed by law to assist the patient to commit suicide.”

Gallup refers to this first option as “euthanasia” and the second as “doctor-assisted suicide,” a term it uses interchangeably with “MAID” in its polling. Both are different from suicide, which only 22 percent of Americans find morally acceptable, while more than half of Americans consider MAID to be moral, Gallup found.

Policymakers and proponents have landed on “MAID” because, as the American Bar Association writes, the patients who seek out this treatment “don’t want to die.” Rather, they recognize they’re already dying and “merely want to control the precise time and manner of their impending death.”

Many do not make this choice in the end. A January 2026 report that evaluated nearly three decades of MAID data since Oregon implemented the first law in 1997 found that more than 20,000 eligible individuals have received MAID prescriptions, with 12,425 — or slightly more than 62 percent — going on to ingest them.

The report also found that:

• Men and women utilize MAID at nearly equal rates.
• Most (89 percent) are enrolled in hospice or palliative care services at the time of their deaths.
• Terminal cancer (67.6 percent) is the top diagnosis among MAID patients, followed by neurodegenerative diseases (11.2 percent) such as ALS or Huntington’s disease.
• Patients with cardiovascular disease are seeking MAID in growing numbers.

A separate 2022 study that aggregated 23 years of U.S. MAID data reveals that the median age of MAID death is 74. Most patients (88.6 percent) were white, nearly three-quarters (71.6 percent) had at least some college education, and most (90 percent) took the lethal medication dose at home.

The same researcher also looked at public knowledge about MAID in a 2025 study that found a notable lack of awareness about MAID’s legality.

Although polling shows broad public desire for this end-of-life option, more than half of U.S. adults (51.3 percent) surveyed didn’t know if MAID was legal in the U.S. and a nearly identical number (50.9 percent) did not know if it was legal in their state. However, 44 percent expressed interest in using MAID if they were terminally ill.

“People are dying in the hospital and are receiving aggressive discretionary treatments up until the day they die despite many people saying that this is not what they would want at end of life,” the researcher told the American Psychological Association.

How Assisted Dying Laws Work

Oregon was the first state to legalize assisted dying in 1994, and other states tend to follow its model, though there’s increasing variability.

In states that allow MAID, the law typically requires the patient to:

• Live in a state that has passed MAID legislation
• Be at least 18 years old
• Have six months or less to live
• Have their diagnosis confirmed by two providers
• Make multiple requests to their provider, including at least one written request witnessed by two qualified individuals (more on this below) who attest that the patient appears to be acting voluntarily and not under coercion
• Be capable of making and communicating health care decisions
• Personally request and self-administer the medicine
• Act voluntarily and without coercion or undue influence

Notable state differences exist, however. For example:

• Oregon, Vermont, and Montana do not have residency requirements.
• Hawaii requires a mental health evaluation for all MAID patients. Some states require it if the prescribing physician doubts a patient’s ability to provide informed consent. In these cases, a psychiatrist or psychologist must ensure the patient is not cognitively or psychologically impaired.
• New York requires a patient’s mental fitness to be confirmed by a psychologist or psychiatrist (not just any doctor). The patient’s request must also be audio or video recorded in addition to being witnessed by two people.
• A waiting period, ranging from one to 15 days, must occur between two separate oral requests. These waiting periods can be waived under limited circumstances, including when death is imminent. Some states, including California, Washington and Colorado, also allow for shorter waiting periods.

When all state MAID requirements have been met, the physician can then prescribe the lethal medication that the patient will self-administer.

Importantly, most MAID statutes specify that a death carried out in compliance with the law is not considered suicide for purposes of wills, contracts, or insurance policies. But that protection applies only when the statutory requirements are strictly followed.

Protecting Patients and Their Loved Ones When MAID Is Chosen

Anyone who has arrived at the decision to pursue MAID is making a profoundly personal choice within a specifically defined medical and legal framework.

But even when the decision itself is lawful and deliberate, failure to follow MAID statutes precisely can create serious legal consequences, not only for the patient, but also for the loved ones they leave behind.

Here are some common MAID-related legal risks and ways to mitigate them.

Late-Stage Estate Plan Changes Invite Scrutiny

MAID often compresses time. When estate planning documents are revised close to the end of life, those changes may later be examined through a litigation lens.

What can go wrong:

• Legal challenges questioning whether the individual had the mental capacity to update their documents
• Undue influence claims against an heir who was closely involved
• Medical records from the MAID approval process used as litigation evidence
• Disinheritance disputes triggered by unexpected revisions
• Closer examination of when estate planning documents were signed

How to reduce risk:

• Meet privately with estate counsel
• Separate MAID approval from major estate revisions when possible
• Document the reasoning behind significant changes or unequal distributions
• When appropriate, have a medical professional document that the individual understands what they are signing
• In states where they’re valid, consider a clause that discourages beneficiaries from challenging a will

Beneficiary Involvement Can Create Optics Problems

The person most involved in coordinating care or logistics may also be a primary beneficiary. That overlap can become a focal point after death.

What can go wrong:

• Allegations of coercion or pressure
• Claims of conflict of interest or self-dealing
• Executor or trustee removal petitions
• Delays in probate due to contested appointments
• A written MAID request witnessed by an ineligible person may not meet legal requirements

How to reduce risk:

• Maintain clear boundaries between caregiving, medical coordination, and estate planning
• Avoid having beneficiaries present during estate document execution
• Confirm that required witnesses are qualified and not:
  • A relative
  • Entitled to any portion of the patient’s estate
  • An owner, operator, or employee of the health care facility
  • The attending health care provider
• Separate fiduciary roles from logistical roles when feasible
• Consider appointing a neutral or professional fiduciary if conflict is likely

Accelerated Transfers and “Cleaning Up Affairs”

Some individuals choose to simplify their financial affairs before death by making gifts, retitling assets, or forgiving debts.

What can go wrong:

• Fraudulent transfer allegations
• Claims of lack of mental capacity at the time of transfer
• Medicaid lookback penalties
• Disputes if a surviving spouse asserts their legal right to a share of the estate
• Inconsistent beneficiary designations creating conflict

How to reduce risk:

• Avoid abrupt structural asset changes without legal review
• Carefully time and document significant transfers
• Confirm that beneficiary designations align with the overall estate plan
• Review potential public benefit consequences
• Consider whether major transfers are better handled through existing estate documents rather than last-minute revisions

Insurance and Contractual Implications

Most MAID statutes specify that a death carried out in compliance with the law is not considered suicide for purposes of wills, contracts, or insurance policies. That protection depends on strict adherence to legal requirements.

What can go wrong:

• Recently issued policies may be closely reviewed before paying a claim
• Beneficiaries may face delays while the insurer completes its investigation
• Policy language disputes, particularly in older contracts
• Accidental death benefits may be denied
• Beneficiary disputes triggered by payout timing or investigation

How to reduce risk:

• Review when the policy was issued and whether it’s still within the early review period
• Confirm beneficiary designations are current
• Understand how the jurisdiction handles death certification
• Don’t assume that compliance with state law guarantees automatic payment
• Communicate proactively with beneficiaries about expected timelines and possible insurer review

Criminal Exposure (Rare but Serious)

Criminal liability generally arises not from choosing MAID itself, but from failing to follow the law’s specific requirements.

What can go wrong:

• Improper assistance with self-administration of medication
• Ineligible individuals serving as witnesses
• Handling or transporting medication in ways not authorized by state law
• Acting beyond the authority granted under health care documents
• Allegations of coercion arising from family members’ involvement in the process

How to reduce risk:

• Work with experienced medical and legal professionals to ensure full compliance
• Ensure witnesses meet eligibility requirements
• Maintain clear boundaries between emotional support and clinical participation
• Follow the state’s requirements exactly, without shortcuts
• Ensure the patient’s requests and decisions are documented independently and voluntarily

Balancing End-of-Life Care and the Law

The right to die is increasingly recognized by state MAID laws. But exercising that right does not eliminate the responsibility to plan carefully beforehand. In some meaningful ways, it can raise the stakes.

End-of-life decisions — whether they involve MAID, hospice, palliative care, or other medical interventions — affect more than just you. Each option carries estate-planning, financial, and fiduciary implications that demand careful consideration before irreversible steps are taken.

Working with estate planning and elder law professionals can help you and your loved ones understand the consequences of those choices, coordinate medical and financial decision-making, and ensure that your legal documents reflect both your wishes and your family’s realities.