New York's Medical Aid in Dying (MAID) Act gave dying patients more choice. Now it must give them more support.

When New York's Medical Aid in Dying (MAID) Act took effect in early August, allowing terminally ill, mentally capable adults to obtain medication they can choose to take to end their lives, much of the debate centered on the age-old question: is choosing the circumstances of one's death an act of freedom or a violation of something sacred?

As a death doula, hospice volunteer and public policy doctoral researcher, I understand why this question troubles people. For those who believe that life and death belong to God, MAID can feel like an act of defiance against divine will.

But after years of sitting with people who are dying, I’ve come to see the question differently.

For someone with a terminal illness, death is not a possibility. Death is already coming. The uncertainty is not whether it’ll happen, but when and under what circumstances. New York has now given some dying people another choice about how they meet that death, but choice alone is not good enough. The law includes safeguards such as physician determinations, a mental-health evaluation, informed consent, waiting periods and required discussions of alternatives,including hospice and palliative care. Yet those safeguards are largely designed to ensure that a patient is medically eligible, mentally capable and making an informed choice. They do not guarantee the sustained, nonmedical support that can help someone grapple with what that choice means.

To me, the question is whether we can help someone meet death with peace. That is where death doulas can play a distinct role.

Campaigners in the United Kingdom hold their placards outside Parliament before the vote on the Terminally Ill Adults (End of Life) Bill. (Krisztian Elek/SOPA Images/LightRocket via Getty Images)

In hospice and palliative care, I’ve often heard patients say, "I'm ready,” “I’m tired,” or “I just want it to end.” These words don’t necessarily mean that someone wants to hasten death. Often, they are expressing something more complicated: an acceptance that illness has commandeered their independence, comfort, and the future they expected to have. When a client of mine begins speaking this way, my job is not to tell them what to do, but to listen.

We talk about what gives their life meaning, relationships they want to repair, stories they want to preserve, fears they haven't voiced, and what they hope the end of their life will look like. Sometimes, these conversations are the bridge between a frightened mind and a peaceful one.

Terminal illness takes control of the body and dictates nearly every aspect of daily life. The ability to say what matters to you at the end and to have those wishes taken seriously can restore a measure of agency when much of it has been lost.

A death doula’s job is to help carry that agency through life and into death.

New York already recognizes the value of this kind of support at another profound transition: when life begins. Since 2024, Medicaid has covered doula services for pregnant, birthing, and postpartum New Yorkers. Birth doulas do not deliver babies or replace doctors and nurses. They help people navigate a life-altering experience with information, advocacy and emotional support.

Dying deserves that kind of care, too.

Similar to birth doulas, death doulas are non-medical professionals who complement healthcare teams and provide emotional, spiritual and practical support. New York should explore Medicaid reimbursement and state-supported pilot programs for qualified end-of-life doulas working alongside hospice and palliative-care teams, with clear training, ethical and scope-of-practice standards.

For those who believe MAID violates the will of a higher power, I offer a different question: Can respecting a person's final wishes be an expression of reverence for life rather than a rejection of it? Supporting someone in death does not require agreeing with every choice they make. It requires recognizing their humanity as they make it.

We have the ability to choose whether death is experienced in fear and confusion or love, preparation and peace.

Medical Aid in Dying will not be right for everyone and doesn’t have to be. But as New York recognizes greater choice at the end of life, we should make sure no one has to navigate that choice alone.