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INSPIRATION FOR ARTICLE

When my mother died in 2018, I became one of many people 
throughout human history irrevocably impacted by grief, and a reverent 
student of its power to disrupt, transform, and heal. When the COVID 
pandemic began, I supported people in the throes of grief and worked 
with people at the end of life. I heard patients and families inquire about 
medical aid in dying during my second-year practicum in oncology 
social work. I wrote my final research paper on the topic for Dr. Hara’s 
policy course because I wanted to better serve patients and their loved 
ones. Although I have my own views on the topic, it was important to 
me to write this article with a social work lens, and with respect for 
multiple perspectives and lived experiences. It is my hope that readers 
see the humanity of multiple perspectives when reading it. Thank you to 
the primary editing team who made this publication a reality: Angelyn, 
Chloe, and ClaraGrace. Thank you also to the Editors-in-Chief Brenna 
and MacKenzie. I dedicate this article to my beautiful mother, Cherylyn 
Smith, for bringing me into this world and for teaching me so much 
when she left it.

Originally from California, I am focusing on Integrated Practice and 
Programming at CSSW. I work as a Research Assistant at the Center 
for Prolonged Grief, where I interview survivors of the 2001 World Trade 
Center attack about their grief experiences. My goal is to work as a 
medical social worker and provide psychotherapy to bereaved people 
and communities.

STEPHANIE
VERONICA SMITH



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SOCIAL WORK AND THE NEW YORK STATE MEDICAL AID IN DYING ACT

ABSTRACT

Medical Aid in Dying (MAiD) is garnering increasing attention throughout 
the world. Since 1998, 14 states and Washington D.C. have MAiD laws 
in the United States. For the eighth time in as many years, the New 
York State legislature has introduced MAiD legislation, and the Medical 
Aid in Dying Act is currently in committee in both the Assembly and the 
Senate. Although this legislation has failed in New York State in the past, 
it is increasingly supported by New York voters (Granquist, 2024). The 
MAiD debates in New York state, along with data from U.S. jurisdictions 
with MAiD laws, highlight important considerations about end-of-life 
choices and how they intersect with social work values. Social workers 
can gain valuable insight into supporting people at the end of life, 
engage in self-reflection on their own beliefs and biases related to end-
of-life choices, encourage self-reflection of medical professionals, and 
advocate for equity in healthcare within medical institutions and through 
social welfare policy (Schroepfer et al., 2022). This discourse can benefit 
patients interacting with the health care system regardless of MAiD’s 
outcome in New York State.

STEPHANIE VERONICA SMITH

A s of April 2024, the Medical Aid in Dying (MAiD) Act is in 
committee in both the State Assembly and Senate (A995/
S2445) in New York State (N.Y. Legis. Assemb, 2023). It 
proposes the legalization of a process by which terminally 

ill people can access medication that will end their life. The MAiD Act 
specifies that this option is only available to people diagnosed with a 
terminal illness, which is defined as a physician determining they will live 
six months or less due to their illness. Multiple safeguards are defined in 
the legislation to prevent coercion from medical institutions and people 
who might benefit financially or otherwise from a person’s death. For 
example, MAiD outlines the process by which terminally ill patients 
can request medication: patients must make both an oral and written 
request to a physician, the physician will then examine the patient to 
confirm whether they are terminally ill and have the capacity to make 
the decision, and a consulting physician must confirm. Though it is not 
a requirement, if physicians have concerns about any patient’s capacity 
to make the decision, they are recommended to refer the patient to 
a licensed psychiatrist or psychologist to assess the patient’s mental 
health and capacity (N.Y. Legis. Assemb, 2023).  

There are also guidelines governing how physicians engage in 
consultations with potential MAiD patients. These include a requirement 
for physicians to provide education about the patient’s treatment 
options and alternatives to MAiD such as hospice and palliative care. If 
prescribed the medication, there are strict guidelines that a patient must 
administer the medication to themselves and ingest it, and it must not 
be taken in a public space. Patients can also revoke their request for 
the medication at any time or simply elect to not take the medication 
even if they receive it. Physicians also have the right to choose not to 
incorporate MAiD in their practice or refer any patient who is interested 
in MAiD to another physician (N.Y. Legis. Assemb, 2023).



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The MAiD Act aims to ethically expand the options for people at 
the end of life when they are terminally ill so they can die with 
choice and dignity. Although it is not explicitly stated in the Act, 
MAiD also attempts to address the problem of society’s limited 
conceptualization of autonomy at the end of life, especially as it 
relates to suicide. As a result, part of what is being addressed is a 
societal exploration of what is ethically permissible when choosing 
to end one’s life. The MAiD Act aims to address these problems 
through collaboration with patients, healthcare providers, and 
policymakers in New York State (N.Y. Legis. Assemb, 2023). 
Although social workers are not explicitly mentioned in the 
MAiD Act, the policy impacts the role of social workers and their 
engagement with people they serve. Whether or not MAiD passes 
in New York, the related discourse is crucial for social workers 
to understand. This paper will explore the nuances of the MAiD 
debate and its interaction with social work values. It will also 
provide information about the spectrum of end-of-life options 
currently available to New York residents, how social workers can 
prepare individually and within their workplaces for end-of-life 
conversations, and advocacy possibilities for a just and equitable 
healthcare system.

MAID CONSIDERATIONS 
THE DISCOURSE ABOUT MAID AND SUICIDE

A major MAiD debate involves its relationship to suicide. Some 
people classify MAiD under the umbrella term “Physician-Assisted 
Suicide,” which includes practices like euthanasia that are completed 
by physicians rather than the patient (Schroepfer et al., 2022, p.820). 
Proponents of the Act generally argue that MAiD is distinct from suicide. 
On a practical level, characterizing a death by MAiD as suicide can 
prevent life insurance beneficiaries from receiving claims (Parker et al., 
2004), meaning that a patient’s end-of-life wishes may not be honored. 
Conflating MAiD with suicide also means that prescribing physicians 
might be vulnerable to legal ramifications including felony charges. 
Although suicide is no longer considered illegal in any state, there are 

state laws, including in New York, that outlaw aiding suicide. New York 
Penal Law deems “a person guilty of promoting a suicide attempt when 
he intentionally causes or aids another person to attempt suicide” and 
classifies it as a class E felony with a 2-to-5-year sentence in prison 
(Promoting a Suicide Attempt, 2014). By distinguishing MAiD from 
suicide in legal documentation, a patient’s end-of-life wishes are more 
likely to be honored, and there will be less liability for physicians and 
healthcare institutions if they choose to engage in MAiD. 

Beyond practical considerations, framing MAiD deaths as suicides 
reflects deep sociohistorical ties to Western nations' perspectives 
on suicide. The legal codification of suicide enforced government 
control over what constituted sin, crime, and property rights. While 
there are efforts by mental health professionals to avoid stigmatizing 
language such as “committing suicide” in modern times, the language 
of “commit” is rooted in the idea that ending one’s life is a crime with 
legal consequences. Historically, this included government forfeiture 
of property to the detriment of non-elite families and communities 
(Chang, 2018). Social stigma was generally a horrific byproduct for the 
people most impacted by a suicide death, and this legacy persists for 
many people. Attempts to conflate MAiD with suicide–and potentially 
punish the patients, communities, and physicians who prescribe MAiD 
medications–perpetuates stigma for people suffering from a terminal 
illness who seek options at the end of their lives. 

OPPOSITION TO MAID

New York State legislators who voted against MAiD prevailed in 
past legislative sessions. It most recently failed in 2022 despite 
polls indicating voter support. According to a 2021 poll of New York 
voters, 58% supported MAiD, 37% opposed, and 5% were unsure 
(Marist College, 2021). Opponents of MAiD, primarily disability rights 
organizations such as the Center for Disability Rights in New York 
(CDRNYS) and Not Dead Yet, advocate against MAiD and argue it 
should be categorized as suicide. CDRNYS calls the bill an “existential 

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threat to disabled New Yorkers,” claiming that the government will 
“abdicate its responsibility” to equal protection related to suicide 
prevention services for people living with disabilities if it is passed 
(CDRNYS, 2022). Not Dead Yet echoes these concerns, stating that 
people living with disabilities will experience increasing levels of 
coercion to end their lives rather than seek life-saving care, especially 
those of low socio-economic status who cannot afford expensive 
medical treatment (Not Dead Yet, 2022). The New York State Catholic 
Conference joins these organizations, claiming that “ambiguous” 
aspects of the bill weaken accountability for healthcare professionals, 
diminish protections for people living with disabilities, and create 
further risks for those choosing to live with a terminal diagnosis despite 
treatment possibilities available to them (New York State Catholic 
Conference, 2024).

Organizations such as CDRNYS distrust the safeguards put in place to 
ensure coercion is not active in MAiD. Experts from the United Nations 
(UN) join them in warning about a global slippery slope toward eugenic-
influenced pressures and ableist assumptions in medical practices 
that may eventually engulf low-income, terminally ill people along with 
other people living with disabilities. These warnings were issued in 
2021 as a response to Canada’s decision to expand MAiD to people 
with disabilities in addition to people with “grievous and irremediable 
conditions” (Quinn et al., 2021, p.1). Even before the expansion of 
Canadian MAiD laws, a 2019 UN report that investigated MAiD practices 
in Canada determined that “there is no protocol in place to demonstrate 
that persons with disabilities deemed eligible for assistive dying have 
been provided with viable alternatives” (Devandas-Aguilar, 2019, p. 13). 
There were also reports from people living with disabilities in institutions 
regarding pressure to seek MAiD. 

U.S. disability rights organizations echo similar concerns to those from 
Canadian activists. CDRNYS (2022) states that the current language of 
the New York MAiD legislation deems people living with disabilities and 
conditions which could be life-threatening without treatment, such as 

diabetes, eligible for MAiD even if treatment options exist. They argue 
that people who cannot afford expensive treatments may experience 
financial pressure to pursue MAiD. As such, many disability rights 
advocates do not welcome an expansion of end-of-life options to 
include MAiD (CDRNYS, 2022).

While it is not yet possible to know how MAiD will impact New York, 
statistics from other states with similar laws provide insight. Kozlov et 
al. (2022) analyzed 23 years of aggregated data across 14 states and 
Washington D.C. The data determined that patients who died by MAiD 
“tend to be older, white, educated, and diagnosed with cancer across 
all jurisdictions where MAiD is legal” (p. 3042). These statistics are 
consistent in New York’s neighboring state New Jersey where MAiD 
has been legal since 2019. According to a 2022 MAiD data report from 
the Chief State Medical Examiner’s office, 90% of people who received 
medication for MAiD were white, 83% were over the age of 65, and 
58% had at least a bachelor’s degree. The report also states, “heart 
disease was the leading cause of death in the general population in New 
Jersey…followed closely by [cancer]. However, for those participating 
in the [MAiD] program in New Jersey, [cancer] is the leading underlying 
illness accounting for 48% of cases,” while cardiovascular disease 
accounted for 14% of cases (The Office of the Chief State Medical 
Examiner, 2023, p.6). MAiD advocates interpret this data as evidence 
that MAiD is neither abused or misused to target people living with 
disabilities in states where it is legal. 

Perhaps what is more important than countering MAiD opponents’ 
critiques and conjectures with statistics from other states is to 
understand and acknowledge their concerns. The eugenics movement 
that swept the world through the late 19th and early 20th centuries had 
an indelible impact on the United States. The disability rights groups that 
oppose MAiD are speaking to the history of forced institutionalization, 
sterilization, and euthanasia rooted in a pseudoscientific endeavor 
to undermine people with disabilities as less worthy of dignity and 
autonomy (EveryBody, 2013). Recounting this history leads disability 

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rights groups to draw parallels between the past and the present when 
legislation such as MAiD arises.

Part of their concern also stems from international aid-in-dying 
practices. In addition to UN experts’ concerns in Canada, disability 
rights groups look to examples in Europe. The Netherlands has 
practiced euthanasia since 1985. It was initially an unofficial but 
tolerated practice and was eventually codified into Dutch law in 2002 
(Groenewoud et al., 2021). The Dutch have expanded their practice from 
focusing solely on terminally ill people to include people suffering from 
psychiatric disorders that are deemed “unbearable and irremediable,” 
and many of which are considered disabilities in the United States (van 
Veen et al., 2022, p.1). In April 2023, the Dutch law expanded to include 
children of all ages who have a terminal illness (The Guardian, 2023). 
Although many safeguards are part of MAiD laws in U.S. jurisdictions, 
including age restrictions, disability rights groups view the evolution of 
Dutch laws as an example of a gradual return of eugenics.

SUPPORT FOR MAID

The MAiD Act is sponsored by the Assembly Health Committee Chair 
Amy Paulin in the New York State Assembly with 50 co-sponsors, and 
the New York Senate Judiciary Chair Brad Hoylman-Sigal with 12 co-
sponsors. The reintroduction of the bill in 2021 (then A.4321/S.6471) led 
to unprecedented advocacy with supporters sending more than 3,600 
letters to state lawmakers (Granquist, 2024). Although the Act did not 
pass in 2022, a 2021 Marist poll showed that 58% of New York voters 
supported MAiD at that time (Marist College, 2021, p.27). Recent polling 
data conducted by YouGov and commissioned by Death with Dignity 
and Completed Life Initiative revealed that 72% of New York voters 
support MAiD, 23% oppose, and 6% are not sure (Hoffman, 2024). 
The poll shows that support is consistent across demographics. This 
includes Catholics (65%) and people with disabilities (73%) even though 
Catholic leaders and disability rights organizations are MAiD’s most 
vocal opponents. MAiD is also supported in New York by organizations 
who seek to expand options to terminally ill people at the end of life, 

including End of Life Choices New York (2021) and Compassion and 
Choices (2024). 

As the names of organizations who support MAiD emphasize, they view 
the legislation as empathetic support for terminally ill people who wish 
to die with choice and dignity. They also make a distinction between 
MAiD and suicide. Death with Dignity (2024) defines the difference by 
explaining that suicide is “the act of taking one’s own life voluntarily and 
intentionally,” whereas MAiD involves “an adult patient with terminal 
illness who is deemed mentally competent [who] chooses to hasten their 
death through a physician’s assistance.” Some national professional 
associations agree with these distinctions. The American Public Health 
Association (2014) explains that MAiD is part of a “patient’s right to 
self-determination,” and that a terminally ill person can assess what 
constitutes a “good death” according to their circumstances. The 
American Medical Women’s Association and the American Medical 
Student Association also emphasize MAiD as part of patient autonomy 
(Schroepfer et al., 2022).

In January 2024, the New York State Bar Association (NYSBA) 
Task Force on Medical Aid in Dying released its Report and 
Recommendations on MAiD in New York. The report included a 
summary of statements from a public hearing conducted in November 
2023. Advocates included people living with life-threatening illnesses 
who described their fears of not having MAiD available if treatment is 
no longer viable or desirable. Others were family members and loved 
ones of people who died with terminal illnesses while experiencing 
excruciating pain. Some described the attempts, completions, or 
requests from their now deceased loved ones to end their own lives 
knowing that MAiD was not an option in New York and the trauma they 
experienced as part of their bereavement. Other supporters were family 
members and loved ones of people who were able to utilize MAiD as 
residents in states where it is legal. They described the dignity, peace, 
and community support these people were able to experience by having 
more control over the circumstances of their death (New York State Bar 
Association, 2024). 

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While the NYSBA Task Force ultimately endorsed the New York MAiD 
Act, the final report contained recommendations for safeguards 
for “special populations,” as well as funding, insurance, and 
training for healthcare professionals (p.6). The overall aims of these 
recommendations are to ensure that patients fully understand their 
rights and end-of-life options and that MAiD is an equitable option 
available to people with terminal illnesses despite their insurance 
coverage or socioeconomic status. This last concern is based on federal 
laws that prohibit federal funding to pay for MAiD prescriptions which 
precludes people dependent on federal insurance options such as 
Medicare and Medicaid from utilizing MAiD. While this recommendation 
is counter to the concerns of opponents who worry that low-income 
people will be coerced into utilizing MAiD, the NYSBA supports the 
recommendation with data indicating there are people interested in 
utilizing MAiD in states where it is legal but are unable to do so because 
the prescription is prohibitively expensive. Furthermore, the report points 
to biases and inequities throughout the healthcare system that prevent 
adequate access and education about end-of-life options to people 
from lower socio-economic and socially-marginalized groups. They 
claim these inequities largely contribute to underutilization of MAiD in 
marginalized communities (p. 29).

CURRENT END-OF-LIFE OPTIONS IN NEW YORK STATE

There exists a spectrum of end-of-life choices for patients to 
legally explore in New York, and social workers already engage in 
conversations and practices with patients around these choices. If 
MAiD passes in New York, social workers are likely to be instrumental 
in providing education and support to patients through MAiD. Fujioka et 
al. (2018) conducted a literature review from jurisdictions where MAiD 
is legal, and concluded, “social workers… are integral in the execution 
of MAiD in tandem with physicians and adopt a wide range of roles” 
(p. 1572). As such, social workers and the communities they serve can 
benefit from understanding patient rights and the spectrum of end-of-life 
options for terminally ill patients regardless of MAiD’s success in New 
York. 

The best-known options related to end-of-life care are advanced 
directives. Advanced directives are documents that explain a person’s 
medical care choices if they are unable to communicate them. This 
includes orders that can be specified in a Living Will such as Do Not 
Resuscitate (DNR) and Do Not Intubate (DNI) orders as well as Medical 
Orders for Life-Sustaining Treatment (MOLST) that guide families and 
medical professionals in determining whether life-saving measures 
should be utilized for a patient during critical situations. Another 
advanced directive is the health care proxy, which cedes control to one 
or more persons whom the patient appoints to make medical decisions 
on their behalf if they cannot communicate their wishes. Health care 
proxies can use a Living Will to carry out a person’s wishes, but if no 
Living Will exists, they can still legally make decisions on behalf of the 
patient (New York State Attorney General, n.d.). If a health care proxy 
is not assigned and a person cannot communicate their wishes, state 
laws determine who can make decisions on behalf of a patient (U.S. 
Department of Health and Human Services, 2022). In New York State, 
that person would likely be a legal guardian, a spouse or domestic 
partner, or an adult child (New York State Department of Health, n.d.). 
Health care professionals such as social workers can provide education 
and serve as witnesses for advanced directives.

Hospice and palliative care services are also available to terminally ill 
New Yorkers. Hospice provides support to patients who are terminally 
ill when curative approaches are either not desired by the patient or 
are not available to the patient at any point from diagnosis through 
treatment. It includes comprehensive services such as nursing, pain 
management, social work, and spiritual care. Palliative care is available 
to patients with chronic illnesses that are not necessarily terminal and 
who desire pain management assistance and other supportive services 
either with or without treatment (U.S. Department of Health and Human 
Services, 2021). Both services are fully covered by Medicare and 
Medicaid and are generally fully covered by private insurance plans as 
well (VITAS Healthcare, n.d.). 

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Two New York State laws, the Palliative Care Information Act (PCIA) 
and the Palliative Care Access Act (PCAA) require physicians, nurse 
practitioners, general hospitals, nursing homes, home care agencies, 
enhanced assisted living residences, and special needs assisted living 
residences to offer information and counseling concerning palliative 
care and end-of-life options and facilitate access to such care. Despite 
these laws, New York State ranks last in the United States for hospice 
utilization with reports that PCIA and PCAA are largely ignored and 
unenforced (New York State Bar Association, 2024). When education, 
counseling, and referrals to palliative care and hospice do occur, social 
workers are generally involved in some or all stages of the process. 
Robust and consistent practices in providing education about hospice 
and palliative care are recognized as crucial MAiD safeguards for 
proponents and opponents alike.  

Another legal option for terminally ill patients is Voluntary Stopping of 
Eating and Drinking (VSED). Although VSED is not without controversy, 
it is generally protected as a patient’s right to determine their own 
treatment, including refraining from treatment. It is an option that 
can be specified in an advanced directive, which includes refusal of 
feeding tubes to sustain a patient’s life (End of Life Choices New York, 
2021). Although it is generally differentiated from suicide, there is no 
standardization about how it is characterized on a death certificate 
which can impact a patient’s life insurance policy and end-of-life wishes 
(Uemura et al., 2023).  It is also a difficult, physically grueling process 
that requires a strong will on the part of a patient and their caregivers. 
As such, some families of New Yorkers who died by VSED are strong 
advocates for MAiD (New York State Bar Association, 2024). 

If a terminally ill New York resident is interested in pursuing MAiD, it is 
possible to travel to another state or country where MAiD is legal. While 
most other states require a person to be a resident, Oregon and Vermont 
lifted the ban on non-residents in 2023 (Paine, 2023). Traveling for MAiD 
is not ideal for many people at the end of life, primarily because it can 
be emotionally difficult, which is a major impetus for proponents of the 

law in New York State (N.Y. Legis. Assemb, 2023). It is also prohibitively 
expensive for many people and requires time, planning, and resources 
that many people at the end of their lives may not have. Families of 
New Yorkers who suffered because they were unable to travel for 
MAiD are also strong advocates for the legislation (New York State Bar 
Association, 2024).

MAID AND SOCIAL WORK 
SOCIAL WORK ASSOCIATIONS AND MAID

There are currently neither standards about social workers’ engagement 
with MAiD nor specifications in the New York MAiD Act about social 
workers’ roles. Most social work associations do not take an official 
position on the issue but affirm that the profession’s ethics and values 
support and advocate for patients’ rights and end-of-life choices. The 
National Association for Social Workers (NASW) Standards for Practice 
in Palliative & End of Life Care states, 

Social workers working in palliative and end of life care are 
expected to be familiar with the common and complex bioethical 
considerations and legal issues [including MAiD]. End of life 
issues are recognized as controversial because they reflect the 
varied value systems of different groups (NASW, 2004). 

This statement emphasizes the holistic nature of social work in 
navigating the complexities of end-of-life issues with individuals and 
families. Cultural awareness and sensitivity are upheld as important 
aspects for social workers engaging in palliative and end-of-life care.  

The Association of Oncology Social Work (AOSW) expands on the 
NASW statement by upholding “the right of every patient to make 
decisions about living and dying that are reflective of their goals and 
values and are consistent with the law of their jurisdiction” (Schroepfer 
et al., 2022, p. 823). Both associations highlight the importance of 
self-reflection in social work when supporting individuals and families 
addressing end-of-life concerns. Although these statements point 

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to social work values, they do not explicitly explore end-of-life care 
options, including MAiD, through the lens of social work values. Such 
an exploration reveals that some social work values align with MAiD 
policies and practices while others do not. 

SOCIAL WORK VALUES ALIGNED WITH MAID

Arguments in favor of MAiD emphasize it as an end-of-life choice that 
promotes a patient’s dignity. This directly relates to the social work 
value of upholding the dignity and worth of a person (NASW, 2021). A 
2022 comprehensive review of data from Oregon, collected from the 
time the law passed in 1998, reveals that these values are consistent 
with utilization of MAiD in the state. The main concerns reported by 
Oregonians who utilized MAiD related mostly to their loss of autonomy 
and dignity and their inability to engage in activities that made life 
enjoyable (Oregon Health Authority: Public Health Division, 2023). This 
indicates that MAiD is serving terminally ill Oregonians as intended by 
centering and upholding their choices and dignity. 

The MAiD Act also respects the desires of many terminally ill people 
to experience their end of life within the meaningful and comfortable 
environment of their own home. The New York MAiD Act explicitly 
mentions the highly publicized death of Brittany Maynard, a 29-year-old 
resident of California who died from a brain tumor. Maynard traveled 
to Oregon for MAiD and advocated for its enactment in California as 
she was dying so that others could have the option to die at home. 
Her advocacy strongly contributed to the enactment of California’s 
law in 2015 (N.Y. Legis. Assemb, 2023). Citing the example of Brittany 
Maynard, proponents of the law aim to support terminally ill New York 
residents so they do not have to cross state lines to receive MAiD. This 
resonates with statistical data showing that terminally ill people generally 
prefer to die at home. Roughly 93% of MAiD participants in Oregon 
have chosen to die at home since the law was passed (Oregon Health 
Authority: Public Health Division, 2023). New Jersey reported similar 
statistics in 2022 with 92% of patients utilizing MAiD dying at home 

(The Office of the Chief State Medical Examiner, 2023). The New York 
bill contains similar language to Oregon’s law and is likely to promote 
dignity for terminally ill people who utilize it in New York as well.

SOCIAL WORK VALUES UNALIGNED WITH MAID 

There are also social work values that do not align with MAiD, 
particularly with regard to social justice. Oppositional arguments 
cautioning against a slippery slope towards eugenicist practices 
resonate with some communities of color who have been impacted by 
abuses of the eugenics movement. A comparison of two recent polls 
of New York voters demonstrate a correlation between trust in medical 
providers and support for MAiD, particularly among Black voters. A 
2023 Siena College poll found 58% of respondents support “legislation 
that would allow a doctor to prescribe lethal drugs that a terminally ill 
patient with demonstrated decision-making capacity could take on their 
own in order to end their own life” (Siena College Research Institute, 
2023, p. 5). Just two months later in January 2024, a poll conducted 
by YouGov found 72% of respondents support pending legislation 
that “would allow a terminally ill patient–for whom two doctors have 
determined has under six months to live–the right to request and receive 
a prescription for medication to end their life” (Hoffman, 2024, p. 1). 
Support for MAiD among New Yorkers proved far higher in the YouGov 
poll (2024) emphasizing patient autonomy compared to the Siena 
College poll (2023), which highlights doctors prescribing “lethal drugs” 
to patients. Black voters were particularly attuned to the nuances of 
each poll’s phrasing: 66% of Black voters stated that they support MAiD 
in the YouGov poll (Hoffman, 2024) while only 28% stated that they 
support MAiD in the Siena College poll (2023). Although it is significant 
for New York voters in general that the MAiD Act centers patient 
autonomy over the power of medical providers, this is especially true for 
Black Americans who have historically suffered, and continue to suffer, 
life-threatening and sometimes fatal harms at the hands of medical 
institutions.  

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Considering social workers’ commitment to social justice, it is crucial 
to examine these nuances and their implications. Structural racism 
in health care is deeply rooted in U.S. history. Harriet Washington’s 
book Medical Apartheid (2008), for example, illustrates the lack of 
transparency, medical experimentation, intentional harm, and even 
murder of Black Americans throughout history at the hands of medical 
institutions and how this history reverberates across the U.S. healthcare 
system today. A 2019 study by Cain & McCleskey further emphasized 
the impact of structural racism in U.S. healthcare. By conducting focus 
groups in Los Angeles, California, they determined that while there 
are a variety of nuanced opinions based on race and ethnicity, African 
American and Latino participants who opposed MAiD highlighted 
structural racism in healthcare as a major reason (Cain & McCleskey, 
2019, p. 1185).  

In light of this history and its enduring impact, MAiD raises complex 
social justice concerns related to inequitable healthcare access for 
people of color, both across the lifespan and in end-of-life options. Data 
show people of color generally do not utilize MAiD in states where it is 
legal, with 95.6% of those who do identifying as white. This seems to 
refute opponents’ concerns about race-based coercion into MAiD on 
the part of healthcare institutions. At the same time, it is worth noting 
that similar disparities exist in hospice and palliative care, which are 
also underutilized by people of color (Teano, 2020). This is especially 
true in New York State which has the lowest hospice utilization rate in 
the nation (New York State Bar Association, 2024). Both proponents 
and opponents of MAiD point to this data, but for different reasons. 
MAiD proponents argue that structural racism in health care leads to 
physicians not discussing hospice and palliative care options with 
patients of color, even though this information is generally shared, 
understood, and accessible for white patients. MAiD opponents, 
however, claim that the underutilization of hospice and palliative care 
relates to a lack of trust between physicians and communities of color. 
Overall, this complex landscape indicates that despite low rates of MAiD 
utilization among communities of color, constant vigilance is needed to 

ensure misuse does not emerge and to promote social justice in end-of-
life care. Social workers have a key role to play in this endeavor.

PREPARATIONS FOR MAID AMONG NEW YORK  
SOCIAL WORKERS

Given the increasing support for MAiD in New York, it is prudent 
for social workers to consider their role in relation to this issue. 
Understanding the MAiD laws in the context of history, cultural 
considerations and nuances, social work values, and other end-of-life 
options available to New York residents covers many crucial elements. 
The NASW and AOSW encourage social workers to engage in self-
reflection to understand whether they can ethically serve a client and 
to refer them elsewhere if they are unable to do so. Social workers 
must therefore reflect on their own beliefs and attitudes toward end 
of life experiences and care and how this shapes their personal views 
of MAiD (Schroepfer et al., 2022). If they are able to ethically engage, 
social workers can also explore navigating cultural nuances and different 
belief systems in relation to MAiD with patients and their families. The 
holistic perspective of social work provides a unique opportunity to 
serve as additional safeguards against misuse and abuse of MAiD. By 
understanding the concerns of proponents and opponents alike, social 
workers are equipped to ethically discuss MAiD while centering the 
dignity and rights of all patients, regardless of their medical and end-of-
life choices.  

Social workers should also encourage and support self-reflection, 
education, and advocacy on the interdisciplinary teams in which 
they work. Given MAiD’s complex relationship with social justice, it is 
important for other professionals who engage in conversations about 
end-of-life options to investigate their own beliefs, biases, and ethics. 
Social work associations and social workers engaging in end-of-life 
care can prepare training workshops and materials to guide health 
care professionals through education and self-reflection on topics such 
as ableism and racial biases in medicine. They can also collaborate 

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Granquist, E. (2024, February 8). New York death with dignity: Options at the end of life. 
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Groenewoud, A. S., Atsma, F., Arvin, M., Westert, G. P., & Boer, T. A. (2021). Euthanasia 
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on interdisciplinary practices and procedures in relation to end-of-
life options and conversations with patients. Providing opportunities 
for stronger interdisciplinary teams that are informed and equipped 
to navigate the nuances of challenging end-of-life conversations can 
provide a stronger support system for patients, increase possibilities for 
patient-centered collaboration, and provide more robust advocacy for 
patients engaging with interdisciplinary healthcare teams. 

Given the social justice concerns and underutilization of hospice and 
palliative care in New York, social workers can also strengthen their 
advocacy roles in relation to MAiD. They can work to inform patients 
about their rights and the spectrum of end-of-life options available 
to them while also advocating for more equitable healthcare for 
patients in general. While proponents and opponents of MAiD come to 
different conclusions about whether the law should pass, they agree 
that healthcare equity is a strong safeguard against MAiD abuses. By 
strengthening equity in the health care system through advocacy, social 
workers can serve not only as a unifying force in the divide around 
MAiD but also as social justice leaders serving to remedy longstanding 
structural inequities in the United States. 

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