Hospice and Medical Aid in Dying: How They Work Together and Where They Don't

Hospice and medical aid in dying (MAID) are often mentioned together, but they are not the same thing, and they don’t always fit together neatly. This guide explains how they relate and what to ask.

Why do they overlap?

Both are aimed at people with a terminal illness and a limited life expectancy, typically about six months or less. For hospice, that’s the Medicare eligibility standard; see hospice eligibility. For MAID, it’s the usual legal standard; see who qualifies. The overlap in practice is large: in Oregon’s 2025 report, 92% of the people who died after taking the medication were enrolled in hospice, and most died at home.

That doesn’t mean hospice is how people get MAID. Hospice is a comprehensive care service (nursing, symptom control, social work, spiritual care, and support for the family; see what is hospice). MAID is a separate legal process that involves a prescribing physician, a consulting physician, and other steps. Some people have both, some have only one, and many have neither.

What do hospices actually do about MAID?

It varies, and there’s little public information. Participation by clinicians and organizations is voluntary under the laws. New York’s Department of Health says providers are not required to participate and that one who chooses not to must arrange to transfer a patient who asks to a new provider.

Research suggests hospices’ positions are diverse and often unpublished:

• A 2025 study that looked at hospice websites in legalizing jurisdictions found that only 5.4% contained a public policy on participation in MAID. Among the policies that were posted, content was highly variable: 69.2% described providing patients with information about local MAID laws, and 20.6% had a protocol outlining how a patient initiates MAID. The authors concluded that the lack of available policies likely affects patients’ choice of hospice
• A small survey of hospice clinicians (100 people, a convenience sample, so not representative) found that, among those at hospices that permit at least some participation, the most common pattern was never being present at a patient’s self-administration (49%), followed by consistently being in the room (24%). The authors note that concerns about liability have led some organizations to restrict where in a home clinicians may be, sometimes called “leave-the-room” policies

Taken together, one hospice may talk with you openly about MAID and have staff who may be present, another may provide information only, and another may decline any involvement, even while continuing to care for you.

What does the law say about hospice and MAID?

• Medicare and other federal funds can’t pay for MAID. The Assisted Suicide Funding Restriction Act of 1997 bars federal funds from paying for health care items or services for the purpose of causing or assisting in causing death. CMS says this doesn’t apply to items or services given to relieve pain or discomfort, even if they may increase the risk of death, as long as they aren’t also given to cause death. So the Medicare hospice benefit covers hospice care but not the aid-in-dying prescription
• A hospice may decide its own policy. In New York, a health care facility that prohibits MAID on its premises must have a formally adopted written policy that is available on request
• State rules differ. We didn’t survey each state’s rules on hospice involvement, so ask your state health department or hospice

What should I ask a hospice?

If MAID may matter to you or someone you love, ask each hospice you’re considering, and ask for the answers in writing:

1. Do you have a written policy on medical aid in dying? May I see it?
2. Will staff discuss it, answer questions, or provide information about my state’s law?
3. If I pursue it with another clinician, will you keep caring for me? Will the care team stay involved?
4. May any staff be present when I take the medication, and what may they do?
5. If you don’t take part, will you help me connect with someone who does, and will you transfer my care if I ask?
6. How do you handle the paperwork, including DNR orders, so that my wishes are respected?

New York’s Department of Health recommends that a patient who plans to use MAID have DNR and DNI (do not intubate) orders, issued through a physician’s MOLST form, so that emergency responders know not to attempt resuscitation. See DNR and POLST forms.

What if my hospice doesn’t take part?

• You may be able to switch hospices. Medicare’s manual says a hospice patient can transfer to a new hospice without affecting the hospice benefit. See choosing a hospice provider
• A prescribing physician doesn’t have to be affiliated with the hospice. Your own physician, a palliative care specialist, or another participating clinician may be involved, though finding one may take effort, and not every community has one
• Ask your state health department what resources exist; New York, for example, says it won’t keep a central registry of participating providers

What do professional groups say?

The American Academy of Hospice and Palliative Medicine takes a position of “studied neutrality” on whether physician-assisted dying should be legal, and also says it has concerns about folding it into routine medical practice, including palliative care. The Academy acknowledges that “morally conscientious individuals adhere to a broad range of positions,” including among its own members. That variation is part of why hospices differ. See what is medical aid in dying for the wider debate.

What matters most

Whatever you decide about MAID, hospice can help with pain, breathlessness, anxiety, and other symptoms, and with support for the family. If you’re considering hospice, ask about its policies early, so that you aren’t surprised later, and choose the one that fits what matters to you. See hospice vs. palliative care.

If you are struggling with hopelessness or thoughts of harming yourself outside a legal medical process, please call or text 988, or call 911 in an emergency.

Hospice policies and state laws differ and change. This is general information, not medical or legal advice; your care team and your state’s health department can tell you what applies to you.