The Death Readiness Podcast

Episode: 31

Title: Why Medical Aid in Dying and Assisted Suicide are not the same thing

Host: Jill Mastroianni (Solo)

Published: September 9, 2025

Jill Mastroianni (00:00):

Charles turned 90 last week. He’s thoughtful, clear, and determined to keep his agency at the end of life. His question? What are my options if I want to die with dignity?

This Tuesday Triage is about medical aid in dying — not assisted suicide, though people often confuse the two. We’ll clear up what it really means, and what the law says for families like Charles.

Welcome to the Death Readiness Podcast. This is not your dad’s estate planning podcast. I’m Jill Mastroianni, former estate attorney, current realist, and your guide to wills, trusts, probate and the conversations no one wants to have. If your Google search history includes, “Do I need a trust?” “What exactly is probate?” and “Am I supposed to do something with mom’s Will?” you’re in the right place.

(00:58) My dad once told me that my mom had asked him to help her die. He had Googled it. That’s all he knew to do. He quickly found out it wasn’t legal in New York, where they lived. That’s a big thing to have to Google on your own. It’s a lot to carry, both mentally and emotionally. No matter how old you are, there are always painful things your parents will try to protect you from. 

But, unbeknownst to my dad, I was having the same questions, and I was also keeping them to myself. I remember when my mom was sick. Sometimes I couldn’t find her in the rooms in the house where I expected her to be. A few times I opened closed doors, bracing myself to find her dead by her own hand. I wouldn’t have been surprised. My mother was fiercely independent — she had agency.

(01:51) She’s the woman who, when I was determined to complete 300-meter repeats on the track after a snowstorm, didn’t just drop me off with a shovel. She grabbed her own shovel, cleared lane one alongside me, and yelled out my splits. I wanted to win a national championship that year — and I did — because she saw my determination and encouraged me to forge my path.

By her early sixties, my mom was slowly dying from progressive supranuclear palsy, or PSP — a rare degenerative brain disorder with no cure. Linda Ronstadt, due to her diagnosis, has brought some attention to it recently. My mom died on September 22, 2012. If she had a choice, I believe she might not have waited that long.

Things may be changing for New Yorkers. The Medical Aid in Dying Act, or “MAID,” has passed both the state Senate and Assembly and is now before Governor Hochul for her signature.

(02:54) Today’s question from Charles came by way of his daughter, Becky, who’s an avid listener of The Death Readiness Podcast. Becky discovered the show when she saw one of my yard signs while out walking in Nashville. That sign, and the yard it adorned, happened to belong to my law school roommate and one of my closest friends. I love that connection — and I especially love that Charles felt comfortable asking Becky this question, and that she passed it along to me.

Charles doesn’t want to rely on Google for something this important — and I don’t blame him. This is one of those topics we quietly Google, maybe in the middle of the night, and then tuck away on a shelf, hoping we never have to face it. 

But here, on this podcast, we take those hard questions off the shelf, dust them off, and turn on the light to figure out what’s really going on.

If this episode has you thinking about end of life and what would happen to your family if something happened to you, I can help you get organized and create a plan that truly reflects your goals.

(03:56) My Estate Planning Support Services are designed to make the process clear and manageable. Whether you’re just getting started, reviewing your existing plan, or trying to make sense of complex legal documents, I’ll help you:

• Gather, organize and review your personal, financial, and legal information

• Find and vet an attorney in your state 

• Prepare for and navigate meetings with that attorney

• Understand your estate plan in plain language, and

• And make sure everything is implemented and organized so your loved ones aren’t left guessing.

To learn more or get started, visit deathreadiness.com/services and I’ll include the link in the show notes. Together, we’ll make sure you and your family are ready for whatever comes next.

(04:39) In answering Charles’ question, let’s start with the basics: what is “medical aid in dying”?

It’s a medical practice that allows a terminally ill, mentally competent adult, someone with a prognosis of six months or less, to request a prescription from their physician that they can use to peacefully end their life.

Medical aid in dying legislation is complex. These laws cover more than just who’s eligible — they address things like life insurance and even how and where the medication can be taken. 

Right now, 11 states, plus Washington DC, have laws permitting medical aid in dying. Charles’ home state of Tennessee is not one of them. Tennessee does, however, have pending legislation. Senate Bill 0640 was referred to the Senate Judiciary Committee on February 12, 2025, but that’s the last action noted so far.

Tennessee isn’t alone — 18 states, including Tennessee and New York, have introduced medical aid in dying legislation in the most recent session. 

(05:48) But I don’t want to end the conversation there. Because while it’s not legal everywhere, it is legal in 11 states plus Washington, D.C., and those laws give us important insight into what’s possible — and what it could look like in the future.

Let’s talk about where medical aid in dying is currently permitted. In alphabetical order, the 11 states that do permit medical aid in dying are: California, Colorado, Delaware, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, and Washington state.

To give you a clearer picture of how these laws work in practice, let’s look at California. Their law is called the End of Life Option Act, and it’s currently in effect through January 1, 2031. There’s already a bill — Senate Bill 403 — that seeks to repeal that expiration date and make the law permanent.

(06:46) The End of Life Option Act a very detailed piece of legislation, outlining who qualifies, what safeguards are in place, and how the process works for both patients and physicians. I’ll include a link in the show notes for anyone who wants to read the full law, but for now I’ll highlight some of the key features so you can see how it works in one of the states where medical aid in dying is legal.

Here are the basics under California’s End of Life Option Act:

• Who qualifies? Any adult, 18 or older, who is a California resident, has the capacity to make medical decisions, and has been diagnosed with a terminal disease that is expected to result in death within six months.

• What is prescribed? The law refers to an “aid-in-dying drug.” This is a prescription medication chosen by the physician that the individual can choose to take to cause their death.

• Self-administration is key. The person themselves must make the conscious, physical act of taking the medication. It cannot be administered by anyone else — not a doctor, not a family member, not a caregiver.

• Residency matters. You have to prove you live in California, and the law spells out exactly how: a state driver’s license or ID, voter registration, proof of owning or renting property, or filing a California tax return.

(08:21) The individual has to be competent, terminally ill, and acting voluntarily. 

It’s important to understand that California’s medical aid in dying law requires mental capacity. That means this option is not available to someone with advanced dementia or Alzheimer’s disease.

Now that we understand the who, the what and the why of California’s End of Life Option Act, let’s understand how the process actually works. 

• The individual has to make two oral requests to their attending physician, spaced at least 48 hours apart.

• Then a third request must be made in writing.

• The written request has to be in a specific legal form and signed by the individual in front of two adult witnesses. 

• These witnesses must attest that: 

• The individual signed voluntarily in their presence, and that

• The individual appeared to be of sound mind and not under any duress, fraud, or undue influence.

(09:23) Before an aid-in-dying prescription can even be written, the attending physician must follow a series of very specific steps. And importantly, physician participation is voluntary — a physician can choose not to take part. If that happens, the patient would need to continue the process with another doctor who is willing to participate.

Additionally, the law requires the participating physician to explain the importance of:

• Having another person present when the medication is taken and

• Not ingesting the drug in a public place.

The California also puts important protections in place related to life insurance and liability for family and friends.

The law makes it clear that requesting or using medical aid in dying cannot impact life insurance, health insurance, or annuity policies. Death under the Act is legally recognized as a natural death from the underlying disease, not suicide. That means families don’t lose coverage, and policies remain intact.

(10:29) And, family and friends aren’t at risk. If someone is present when the medication is taken, they cannot be held civilly or criminally liable. They’re even allowed to help prepare the medication, like mixing it in a glass, as long as they don’t actually administer it. The act of ingesting must always be done by the individual themselves.

If this episode has you thinking about your family and what would happen if something happened to you, I can help. My Estate Planning Support Services make the process simple and manageable. I’ll help you get organized, find the right attorney in your state, and make sure your plan is clear and ready to implement.

Learn more at deathreadiness.com/services, that’s deathreadiness.com/services 

The link is in the show notes.

(11:20) Next, let’s talk about what the End of Life Option Act is and what it isn’t. 

You may have heard terms like assisted suicide or euthanasia used in conversations about medical aid in dying. I’m intentionally not using those terms.

Here’s why: California’s End of Life Option Act spells it out clearly in Section 443.18:

“Nothing in this part may be construed to authorize a physician or any other person to end an individual’s life by lethal injection, mercy killing, or active euthanasia. Actions taken in accordance with this part shall not, for any purposes, constitute suicide, assisted suicide, homicide, or elder abuse under the law.”

Let’s talk about the reasoning behind this distinction. To qualify for medical aid in dying, a person must already have a terminal illness with a prognosis of six months or less. The argument is that the individual is not choosing whether to die — their disease is already taking their life. What they are choosing is how they will face the dying process, with the option to avoid a prolonged or painful end.

(12:36) So when we talk about medical aid in dying, we’re not talking about suicide, euthanasia, or mercy killing. We’re talking about a narrow, carefully regulated medical option with the goal of providing individuals with terminal illnesses the ability to die on their own terms.

Thank you to Charles from Tennessee for asking today’s question. And happy 90th birthday to you, Charles!

If you found this episode helpful, please share it with someone you think could benefit from it.

This is Death Readiness, real, messy and yours to own. I’m Jill Mastroianni and I’m here to help you sort through it, especially when you don’t know where to start.

(13:19) Hi, I'm April, Jill's daughter. Thanks for listening to The Death Readiness Podcast.  While my mom is an attorney, she’s not your attorney.  The Death Readiness Podcast is for educational and entertainment purposes only.   It does not provide legal advice.  For legal guidance tailored to your unique situation, consult with a licensed attorney in your state.  To learn more about the services my mom offers, visit DeathReadiness.com.