Here are highlights of the latest legal developments regarding end-of-life decision making. We cover these in the first of two semi-annual 2026 supplements to The Right to Die: The Law of End-of-Life Decisionmaking.

The Association of Organ Procurement Organizations (AOPO) has just published a press release stating that it "is alarmed that, for the first time in 14 years, the annual number of deceased organ donations in the United States has declined." AOPO calls on "all stakeholders in organ donation and transplantation – from OPOs to our hospital partners and federal regulators – to unite in restoring public trust." But this will be challenging with so many: * High profile errors in death determination through circulatory criteria * High profile errors in death determination through neurologic criteria * High profile breaches of the dead donor rule in traditional DCD and DBD cases * High profile breaches of the dead donor rule in NRP cases * High profile lapses in procurement safety and efficiency * High profile violations of fair allocation rules

For decades, studies have shown that television portrayals of CPR are unrealistic and may impede code status discussions. While The Pitt does much better, a new study focuses on out-of-hospital cardiac arrests.  The researchers found "inaccuracies that may mislead viewers" and "frequent depiction of outdated practices." They recommend "collaborative efforts between public health agencies and content creators" because that could assist in achieving American Heart Association goals, such as helping lay responders envision using CPR to help a loved one at home. 

A new resource is now available. Talk VSED is a UK-based, citizen-led working group consisting of family members of those who have chosen voluntarily stopping eating and drinking (VSED), End of Life Doulas and former healthcare professionals with experience of or an interest in VSED.  They have come together as volunteers to promote awareness and understanding of VSED as a legal choice, and to support informed, respectful conversations on the subject.

Here are some of the presentations that I plan to make in 2026. Expand Right to Die Options for Older Americans: Twelve Ways to Avoid Late-Stage Dementia, HEMLOCK SOCIETY OF SAN DIEGO, San Diego, California (January 17, 2026). VSED: Ethically Supporting Patients Who Hasten Death by Voluntarily Stopping Eating & Drinking, VETERANS HEALTH ADMINISTRATION (January 29, 2026).   The Boundaries of Bodily Autonomy: Power, Ethics, and Law - Randolph W. Thrower Symposium, EMORY UNIVERSITY SCHOOL OF LAW, Atlanta, Georgia (February 5, 2026).  Brain Death Backlash: Unregenerately Variable and Illegal Standards for Determination of Death by Neurological Criteria, MACLEAN CENTER UNIVERSITY OF CHICAGO, Chicago, Illinois (February 25, 2026). Brain Death Contestation, PEDIATRIC NEUROCRITICAL CARE EDUCATION SERIES (UNIVERSITY OF PITTSBURGH CRITICAL CARE MEDICINE) (March 13, 2026). Brain Death Roundtable, 2026 CRITICAL CARE CONGRESS (SOCIETY OF CRITICAL CARE MEDICINE), Chicago, Illinois (March 22-24, 2026). Ethical Dilemmas in the Unrepresented Patient, 2026 CRITICAL CARE CONGRESS (SOCIETY OF CRITICAL CARE MEDICINE), Chicago, Illinois (March 22-24, 2026). Dead Donor Rule Disregarded: Four Pervasive Derelictions (Brain Death, DCD, NRP, and PMI), BAPTIST HEALTH SOUTH FLORIDA, Miami, Florida (March 25, 2026). Scientific Committee, FIFTH INTERNATIONAL CONFERENCE ON END-OF-LIFE LAW, ETHICS, AND POLICY (ICEL5), Brisbane, Australia (April 8-11, 2026). He Wouldn't Want This: Minimal Comfort Feeding for Patients with Advanced Dementia, FIFTH INTERNATIONAL CONFERENCE ON END-OF-LIFE LAW, ETHICS, AND POLICY (ICEL5), Brisbane, Australia (April 8-11, 2026) (with Hope Wechkin). Third Annual Faye Girsh Lecture, UNIVERSITY OF CALIFORNIA SAN DIEGO SCHOOL OF MEDICINE, San Diego, California (May 13-15, 2026). Empowering End of Life Care: Medical Aid in Dying (Evolution of MAID Law), END OF LIFE OPTIONS COLORADO SECOND ANNUAL CONFERENCE, Golden, Colorado (June 6-7, 2026). Scientific Committee, INTERNATIONAL SHARED DECISION MAKING CONFERENCE (ISDM2026), Dartmouth, New Hampshire (July 7-10, 2026) Top 10 Legal Developments in Bioethics and Public Health, AMERICAN SOCIETY OF BIOETHICS & HUMANITIES (ASBH) 27th ANNUAL CONFERENCE, Indianapolis, Indiana (October 14-17, 2026). WORLD FEDERATION RIGHT TO DIE CONFERENCE, Tokyo, Japan (November 25-28, 2026).

Here are highlights of the latest legal developments regarding end-of-life decision making. We cover these in the first of two semi-annual 2026 supplements to The Right to Die: The Law of End-of-Life Decisionmaking.

It was gratifying to see over 500 registered for my recent presentation "New and Emerging Right to Die Options: Twelve Ways to Avoid Late-Stage Dementia."   If you missed it, here is a link to the YouTube video. The twelve options are: * Traditional Advance Directive * VSED * Swiss MAID * Inert Gas Asphyxiation * VSED by AD * VSED by SDM * MCF by AD or SDM * VSED Bridge to U.S. MAID * Non-medical Options * U.S. MAID * MAID by AD * MAID by SDM

For decades, studies have shown that television portrayals of CPR are unrealistic and may impede code status discussions. While The Pitt does much better, a new study focuses on out-of-hospital cardiac arrests.  The researchers found "inaccuracies that may mislead viewers" and "frequent depiction of outdated practices." They recommend "collaborative efforts between public health agencies and content creators" because that could assist in achieving American Heart Association goals, such as helping lay responders envision using CPR to help a loved one at home. 

Rhode Island attorney and Senator Matthew L. LaMountain has just introduced S.B. 2115. This bill would require "all hospitals in Rhode Island shall have a notary public on staff and available twenty-four (24) hours a day and seven (7) days a week."  This is a good idea because many inpatients want or need to complete advance directives and other documents. Yet, these documents require qualified witnesses or notaries who are unavailable.  The problem has been somewhat alleviated in most states by permitting remote notaries and remote witnesses. But having an IRL notary public shall available to "visit the patient in their room during the hospitalization" should help address the persistently low rate of advance directives. 

Wayne Sumner offers a devastating response to MAID critics in the Canadian Journal of Bioethics.  He distinguishes between two different kinds of objection to MAID: principled v pragmatic. Principled objections usually take the form of contending that MAID is just inherently wrong, or at least ethically problematic, by virtue of intentionally causing death or violating the sanctity of life. Pragmatic objections, on the other hand, raise no ethical issue with MAID itself, but are critical of the legal regime established to administer it: its eligibility criteria are too broadly drawn, or its procedures are too lax, or its safeguards are insufficiently stringent.  Sumner then shows that MAID is not as special as it is commonly made out to be. By situating MAID within the broader context of end-of-life care, it becomes clear that every alleged concern about MAID applies equally to WLST, VSED, or any other option.  So, until a better explanation of what the critics find to be so special about MAID, Sumner contends that their objection to it is, at bottom, principled rather than pragmatic. Consequently, the ultimate issue for them is not patient safety or other pragmatic concerns but the ethical status of MAID itself.

The Association of Organ Procurement Organizations (AOPO) has just published a press release stating that it "is alarmed that, for the first time in 14 years, the annual number of deceased organ donations in the United States has declined." AOPO calls on "all stakeholders in organ donation and transplantation – from OPOs to our hospital partners and federal regulators – to unite in restoring public trust." But this will be challenging with so many: * High profile errors in death determination through circulatory criteria * High profile errors in death determination through neurologic criteria * High profile breaches of the dead donor rule in traditional DCD and DBD cases * High profile breaches of the dead donor rule in NRP cases * High profile lapses in procurement safety and efficiency * High profile violations of fair allocation rules

It was gratifying to see over 500 registered for my recent presentation "New and Emerging Right to Die Options: Twelve Ways to Avoid Late-Stage Dementia."   If you missed it, here is a link to the YouTube video. The twelve options are: * Traditional Advance Directive * VSED * Swiss MAID * Inert Gas Asphyxiation * VSED by AD * VSED by SDM * MCF by AD or SDM * VSED Bridge to U.S. MAID * Non-medical Options * U.S. MAID * MAID by AD * MAID by SDM

Winel Andrea George has been a Florida R.N. since 2017. But when working at Palm Garden of Aventura on November 12, 2024, George initiated CPR on 68-year-old A.S. even though A.S. had a DNR order. The state Board of Nursing determined that this failed to meet "minimal standards of acceptable and prevailing nursing practice." At the end of December 2025, George settled the administrative complaint for $4200, most of which was reimbursement for the investigation. I will shortly be updating this website with more civil monetary fines, settlements, and jury verdicts against clinicians and entities for administering life-sustaining treatment contrary to an advance directive or POLST.  

Rhode Island attorney and Senator Matthew L. LaMountain has just introduced S.B. 2115. This bill would require "all hospitals in Rhode Island shall have a notary public on staff and available twenty-four (24) hours a day and seven (7) days a week."  This is a good idea because many inpatients want or need to complete advance directives and other documents. Yet, these documents require qualified witnesses or notaries who are unavailable.  The problem has been somewhat alleviated in most states by permitting remote notaries and remote witnesses. But having an IRL notary public shall available to "visit the patient in their room during the hospitalization" should help address the persistently low rate of advance directives. 

Here are some of the presentations that I plan to make in 2026. Expand Right to Die Options for Older Americans: Twelve Ways to Avoid Late-Stage Dementia, HEMLOCK SOCIETY OF SAN DIEGO, San Diego, California (January 17, 2026). VSED: Ethically Supporting Patients Who Hasten Death by Voluntarily Stopping Eating & Drinking, VETERANS HEALTH ADMINISTRATION (January 29, 2026).   The Boundaries of Bodily Autonomy: Power, Ethics, and Law - Randolph W. Thrower Symposium, EMORY UNIVERSITY SCHOOL OF LAW, Atlanta, Georgia (February 5, 2026).  Brain Death Backlash: Unregenerately Variable and Illegal Standards for Determination of Death by Neurological Criteria, MACLEAN CENTER UNIVERSITY OF CHICAGO, Chicago, Illinois (February 25, 2026). Brain Death Contestation, PEDIATRIC NEUROCRITICAL CARE EDUCATION SERIES (UNIVERSITY OF PITTSBURGH CRITICAL CARE MEDICINE) (March 13, 2026). Brain Death Roundtable, 2026 CRITICAL CARE CONGRESS (SOCIETY OF CRITICAL CARE MEDICINE), Chicago, Illinois (March 22-24, 2026). Ethical Dilemmas in the Unrepresented Patient, 2026 CRITICAL CARE CONGRESS (SOCIETY OF CRITICAL CARE MEDICINE), Chicago, Illinois (March 22-24, 2026). Dead Donor Rule Disregarded: Four Pervasive Derelictions (Brain Death, DCD, NRP, and PMI), BAPTIST HEALTH SOUTH FLORIDA, Miami, Florida (March 25, 2026). Scientific Committee, FIFTH INTERNATIONAL CONFERENCE ON END-OF-LIFE LAW, ETHICS, AND POLICY (ICEL5), Brisbane, Australia (April 8-11, 2026). He Wouldn't Want This: Minimal Comfort Feeding for Patients with Advanced Dementia, FIFTH INTERNATIONAL CONFERENCE ON END-OF-LIFE LAW, ETHICS, AND POLICY (ICEL5), Brisbane, Australia (April 8-11, 2026) (with Hope Wechkin). Third Annual Faye Girsh Lecture, UNIVERSITY OF CALIFORNIA SAN DIEGO SCHOOL OF MEDICINE, San Diego, California (May 13-15, 2026). Empowering End of Life Care: Medical Aid in Dying (Evolution of MAID Law), END OF LIFE OPTIONS COLORADO SECOND ANNUAL CONFERENCE, Golden, Colorado (June 6-7, 2026). Scientific Committee, INTERNATIONAL SHARED DECISION MAKING CONFERENCE (ISDM2026), Dartmouth, New Hampshire (July 7-10, 2026) Top 10 Legal Developments in Bioethics and Public Health, AMERICAN SOCIETY OF BIOETHICS & HUMANITIES (ASBH) 27th ANNUAL CONFERENCE, Indianapolis, Indiana (October 14-17, 2026). WORLD FEDERATION RIGHT TO DIE CONFERENCE, Tokyo, Japan (November 25-28, 2026).

The Final Exit Network advises people on how they can hasten death through insert has asphyxiation. But FEN Exit Guides do not physically help anyone obtain, assemble, or use any equipment.  Unfortunately, the daughter and son-in-law of 91-year-old Mildred “Milsy” Roller may have done what FEN Exit Guides do not. They bought some of the necessary equipment. And they stood to financially benefit from Roller's death.   Consequently, the Boulder County, Colorado District Attorney has obtained grand jury indictments for manslaughter. Even though MAID is authorized in Colorado, assisted suicide remains criminally prohibited.  

The Association of Organ Procurement Organizations (AOPO) has just published a press release stating that it "is alarmed that, for the first time in 14 years, the annual number of deceased organ donations in the United States has declined." AOPO calls on "all stakeholders in organ donation and transplantation – from OPOs to our hospital partners and federal regulators – to unite in restoring public trust." But this will be challenging with so many: * High profile errors in death determination through circulatory criteria * High profile errors in death determination through neurologic criteria * High profile breaches of the dead donor rule in traditional DCD and DBD cases * High profile breaches of the dead donor rule in NRP cases * High profile lapses in procurement safety and efficiency * High profile violations of fair allocation rules

Wayne Sumner offers a devastating response to MAID critics in the Canadian Journal of Bioethics.  He distinguishes between two different kinds of objection to MAID: principled v pragmatic. Principled objections usually take the form of contending that MAID is just inherently wrong, or at least ethically problematic, by virtue of intentionally causing death or violating the sanctity of life. Pragmatic objections, on the other hand, raise no ethical issue with MAID itself, but are critical of the legal regime established to administer it: its eligibility criteria are too broadly drawn, or its procedures are too lax, or its safeguards are insufficiently stringent.  Sumner then shows that MAID is not as special as it is commonly made out to be. By situating MAID within the broader context of end-of-life care, it becomes clear that every alleged concern about MAID applies equally to WLST, VSED, or any other option.  So, until a better explanation of what the critics find to be so special about MAID, Sumner contends that their objection to it is, at bottom, principled rather than pragmatic. Consequently, the ultimate issue for them is not patient safety or other pragmatic concerns but the ethical status of MAID itself.

It was such a pleasure to extrapolate all my work (from 2007-2025) on medical futility in the ICU over to the mental health clinic. Working with expert psychiatrists, we just published "Addressing ‘Futility’ in Psychiatry: A Consensus Statement" is available open access here in Psychological Medicine.    While the concept of futility has been used widely in somatic medicine, to date, there has been limited consideration of its relevance to psychiatry. We summarize the findings of an international, multidisciplinary workshop involving clinicians, ethicists, philosophers, patient advocates, and persons with lived experience, which was focused on describing futility in psychiatry and developing ethical guidelines for making futility judgments.   We outline three leading concepts of futility as they have been used in somatic medicine: physiological futility, quantitative futility, and qualitative futility. We examine the application of these concepts to the care of persons with mental illness, finding that the notion of qualitative futility is most likely to be fruitful. We consider how the concept of qualitative futility in psychiatry could relate to other ethically salient concepts such as terminal mental illness and recovery.  We consider (1) who should have authority to make futility judgments in psychiatry (i.e. patients, providers, others), (2) what the process for introducing and evaluating futility judgments should be, and (3) how futility assessments should respond to patients’ goals and values. We identify potential risks of futility assessments, including psychological harms and premature treatment discontinuation, as well as potential benefits, such as reductions in harmful treatments and helpful reevaluation of the goals of care.  Workshop participants regarded the concept of psychiatric futility as potentially useful. They identified how the concept could be applied to psychiatric care, as well as ethical limits on doing so.

Here are some of the presentations that I plan to make in 2026. Expand Right to Die Options for Older Americans: Twelve Ways to Avoid Late-Stage Dementia, HEMLOCK SOCIETY OF SAN DIEGO, San Diego, California (January 17, 2026). VSED: Ethically Supporting Patients Who Hasten Death by Voluntarily Stopping Eating & Drinking, VETERANS HEALTH ADMINISTRATION (January 29, 2026).   The Boundaries of Bodily Autonomy: Power, Ethics, and Law - Randolph W. Thrower Symposium, EMORY UNIVERSITY SCHOOL OF LAW, Atlanta, Georgia (February 5, 2026).  Brain Death Backlash: Unregenerately Variable and Illegal Standards for Determination of Death by Neurological Criteria, MACLEAN CENTER UNIVERSITY OF CHICAGO, Chicago, Illinois (February 25, 2026). Brain Death Contestation, PEDIATRIC NEUROCRITICAL CARE EDUCATION SERIES (UNIVERSITY OF PITTSBURGH CRITICAL CARE MEDICINE) (March 13, 2026). Brain Death Roundtable, 2026 CRITICAL CARE CONGRESS (SOCIETY OF CRITICAL CARE MEDICINE), Chicago, Illinois (March 22-24, 2026). Ethical Dilemmas in the Unrepresented Patient, 2026 CRITICAL CARE CONGRESS (SOCIETY OF CRITICAL CARE MEDICINE), Chicago, Illinois (March 22-24, 2026). Dead Donor Rule Disregarded: Four Pervasive Derelictions (Brain Death, DCD, NRP, and PMI), BAPTIST HEALTH SOUTH FLORIDA, Miami, Florida (March 25, 2026). Scientific Committee, FIFTH INTERNATIONAL CONFERENCE ON END-OF-LIFE LAW, ETHICS, AND POLICY (ICEL5), Brisbane, Australia (April 8-11, 2026). He Wouldn't Want This: Minimal Comfort Feeding for Patients with Advanced Dementia, FIFTH INTERNATIONAL CONFERENCE ON END-OF-LIFE LAW, ETHICS, AND POLICY (ICEL5), Brisbane, Australia (April 8-11, 2026) (with Hope Wechkin). Third Annual Faye Girsh Lecture, UNIVERSITY OF CALIFORNIA SAN DIEGO SCHOOL OF MEDICINE, San Diego, California (May 13-15, 2026). Empowering End of Life Care: Medical Aid in Dying (Evolution of MAID Law), END OF LIFE OPTIONS COLORADO SECOND ANNUAL CONFERENCE, Golden, Colorado (June 6-7, 2026). Scientific Committee, INTERNATIONAL SHARED DECISION MAKING CONFERENCE (ISDM2026), Dartmouth, New Hampshire (July 7-10, 2026) Top 10 Legal Developments in Bioethics and Public Health, AMERICAN SOCIETY OF BIOETHICS & HUMANITIES (ASBH) 27th ANNUAL CONFERENCE, Indianapolis, Indiana (October 14-17, 2026). WORLD FEDERATION RIGHT TO DIE CONFERENCE, Tokyo, Japan (November 25-28, 2026).

Here is a link to free reprints of my recent article - "Brain Death: Five Mandates to Continue Technologic Support After Death." The same issue includes other articles on brain death, including by luminaries like James Bernat.  

Winel Andrea George has been a Florida R.N. since 2017. But when working at Palm Garden of Aventura on November 12, 2024, George initiated CPR on 68-year-old A.S. even though A.S. had a DNR order. The state Board of Nursing determined that this failed to meet "minimal standards of acceptable and prevailing nursing practice." At the end of December 2025, George settled the administrative complaint for $4200, most of which was reimbursement for the investigation. I will shortly be updating this website with more civil monetary fines, settlements, and jury verdicts against clinicians and entities for administering life-sustaining treatment contrary to an advance directive or POLST.  

The Coalition for Compassionate Care of California is developing five new patient-centered decision aids to support shared decision-making during serious illness or health crises. Physicians are invited to complete a brief two-question survey by Feb. 13, 2026, to help identify which treatments are most in need of these tools.  CCC already has decision aids for CPR, mechanical ventilation, tube feeding, and artificial hydration. The evidence on the effectiveness of PDAs is robust. But real-world implementation remains sparse. Alarmingly, use of PDAs remains low even when specifically mandated by federal law.  

Wayne Sumner offers a devastating response to MAID critics in the Canadian Journal of Bioethics.  He distinguishes between two different kinds of objection to MAID: principled v pragmatic. Principled objections usually take the form of contending that MAID is just inherently wrong, or at least ethically problematic, by virtue of intentionally causing death or violating the sanctity of life. Pragmatic objections, on the other hand, raise no ethical issue with MAID itself, but are critical of the legal regime established to administer it: its eligibility criteria are too broadly drawn, or its procedures are too lax, or its safeguards are insufficiently stringent.  Sumner then shows that MAID is not as special as it is commonly made out to be. By situating MAID within the broader context of end-of-life care, it becomes clear that every alleged concern about MAID applies equally to WLST, VSED, or any other option.  So, until a better explanation of what the critics find to be so special about MAID, Sumner contends that their objection to it is, at bottom, principled rather than pragmatic. Consequently, the ultimate issue for them is not patient safety or other pragmatic concerns but the ethical status of MAID itself.

The Final Exit Network advises people on how they can hasten death through insert has asphyxiation. But FEN Exit Guides do not physically help anyone obtain, assemble, or use any equipment.  Unfortunately, the daughter and son-in-law of 91-year-old Mildred “Milsy” Roller may have done what FEN Exit Guides do not. They bought some of the necessary equipment. And they stood to financially benefit from Roller's death.   Consequently, the Boulder County, Colorado District Attorney has obtained grand jury indictments for manslaughter. Even though MAID is authorized in Colorado, assisted suicide remains criminally prohibited.