Aid in Dying, Life Insurance, and Death Certificates: What the Laws Say

After a death under a medical aid in dying (MAID) law, families often worry about two practical things: what the death certificate says and whether life insurance will pay. The answers depend on the state, and we can only speak to three. We deliberately don’t generalize, because laws differ. If your loved one lived in another state, treat this as an illustration of what to look for.

What does the death certificate say?

New York. The law says the cause of death on the death certificate of a person who dies after taking medication under the law will be the underlying terminal illness or condition. The Department of Health says the death certificate cannot list medical aid in dying or the medications as the cause of death. The attending physician who wrote the prescription isn’t required to certify the death; the certificate is completed in the usual way, with the underlying illness as the cause. The department says that in cases where a medical examiner or coroner would normally be involved, such as an unattended death, standard protocols still apply.

Oregon. The Oregon Health Authority instructs physicians to record the underlying terminal disease as the cause of death and mark the manner of death as “natural,” and not to select suicide. It also asks certifiers to avoid certain terms on the certificate, to protect the confidentiality the law requires for participating patients and physicians. A certifier doesn’t have to be the prescribing physician.

Illinois. The Governor’s office said that the death certificates of people who take end-of-life medication under the law will attribute the cause of death to the underlying terminal disease. We couldn’t read the enacted text, so check the statute and the Illinois Department of Public Health for details.

In each case, the certificate you receive will show the illness, not the choice. Use of the law is reported separately to the state health department by the physician. For how to get certified copies, see getting death certificates.

Is it treated as suicide?

Under the laws we reviewed, no. New York’s statute says a patient who requests medication isn’t considered suicidal, that self-administering the medication isn’t suicide for any purpose, and that actions taken in accordance with the law aren’t to be construed for any purpose as suicide, assisted suicide, attempted suicide, euthanasia, mercy killing, or homicide. Oregon’s statute (ORS 127.880) likewise says that actions taken in accordance with the act are not, for any purpose, to be treated as suicide, assisted suicide, mercy killing, or homicide. Not everyone agrees with that description; see what is medical aid in dying.

What about life insurance?

New York. The Department of Health says health insurance benefits are unaffected by the availability of MAID, and life insurance payments cannot be denied to the families of people who exercise their rights under the law. The law provides that the sale, procurement, issuance, or rate of a life insurance or annuity policy, or health coverage, can’t be conditioned on or affected by a patient making or rescinding a request.

Oregon. The statute says the sale, procurement, or issuance of life, health, or accident insurance or annuity policies, or their rates, can’t be conditioned on or affected by making or rescinding a request, and that a qualified patient’s act of taking the medication has no effect on such a policy. (We read this section in a 2011 copy of the code, so confirm the current wording.)

Why this matters. Life insurance policies commonly exclude suicide during the first year or two. An industry newsletter from the Society of Actuaries discussing Oregon’s law points to the provision that these actions aren’t suicide as the basis for not applying that exclusion. We did not review other states’ insurance provisions or policy language, so check the specific policy.

What about wills, contracts, and other agreements?

New York’s law says no provision in a contract, agreement, or will that would affect whether a person may make or rescind a request or take any other action under the law is valid, and that no obligation under a contract or will is conditioned on or affected by those actions. Oregon’s statute has a similar section on the construction of wills, contracts, and statutes (ORS 127.870), which we did not read in full.

Who pays for the medication?

Federal funds can’t. The Assisted Suicide Funding Restriction Act bars federal funds, including Medicare and Medicaid, from paying for items or services for the purpose of causing or assisting in causing death. New York’s Department of Health says its Medicaid program doesn’t cover the prescription. See who qualifies and what’s the process.

What should I do?

If you’re a beneficiary or executor:

1. Order several certified death certificates. Insurers, banks, and agencies need them. See getting death certificates
2. File the life insurance claim as usual, with the certificate and the insurer’s forms. See life insurance and final expense insurance
3. If an insurer questions the claim, ask for the reason in writing, point to your state’s law, and contact your state’s insurance regulator and an attorney
4. Keep records of everything, including the policy and correspondence
5. Remember the family’s privacy. You choose what to share with others

If you’re planning ahead, ask an attorney or your insurer how your state’s law and your policies interact, and keep your documents where your executor can find them.

These rules vary by state and change, and we reviewed only New York, Oregon, and Illinois (in part). This is general information, not legal advice; an attorney or your state’s insurance regulator can tell you what applies.