There has keen interest in medical aid in dying (MAID) among the Delaware medical community with the passage of House Bill 140, as evidenced by the record downloads of the MSD HealthRealities podcast on MAID.
Medical Aid in Dying: Insights From Both Sides of the Stethoscope
Summary of HB 140
The recently enacted the “Ron Silverio/Heather Block End of Life Options Law,” marks a significant milestone for terminally ill adults seeking control over their end-of-life decisions. This forward-thinking legislation, approved in May 2025, empowers eligible individuals to request and self-administer medication to end their lives in a humane and dignified way, while embedding a robust framework of safeguards, transparency, and respect for patient autonomy.
What Is the End of Life Options Law?
The new law recognizes the right of terminally ill adults in Delaware, who possess decision-making capacity, to voluntarily request medication that they can self-administer to bring about a peaceful death. The process is designed to be patient-centered and strictly voluntary, ensuring no one is coerced or pressured into making this profound choice, and surrogates cannot make this decision on another’s behalf.
Who Is Eligible?
- Must be an adult Delaware resident
- Must have a medically confirmed terminal illness expected to result in death within six months
- Must have decision-making capacity, as independently verified by both an attending and consulting physician or qualified nurse practitioner
- Cannot qualify based solely on age, disability, or mental illness (though decision-making capacity is rigorously assessed)
The Step-by-Step Process
1. Multiple Requests
Patients who wish to use this option must make two oral requests (spaced at least 15 days apart) and one written request using a detailed statutory form. The written request requires signatures from two adult witnesses, with strict rules to prevent conflicts of interest, no more than one can be a relative or have a stake in the patient’s estate, and health care providers directly involved in care cannot serve as witnesses.
2. Medical Responsibilities
Both an attending and a consulting physician or APRN (Advanced Practice Registered Nurse) must confirm the diagnosis, prognosis, voluntary decision, and mental capacity. If either suspects the patient lacks capacity, a referral to a psychiatrist or psychologist is mandatory. Only if the patient is confirmed to have capacity can the process move forward.
3. Waiting Periods and Safeguards
There is a minimum 15-day wait between the first oral and second oral request, plus at least 48 hours after the written request before medication can be prescribed. At every stage, patients have the absolute right to rescind their request, for any reason and at any time, even at the last moment.
4. Informed Consent and Alternatives
The law requires that patients receive exhaustive information about their diagnosis, prognosis, risks, expected outcomes, and alternatives, including comfort care, hospice, and palliative therapies. This ensures choices are genuinely informed.
Key Protections
Only the patient may self-administer the prescribed medication, and it can not be by injection or infusion, and never by someone else (“mercy killing” and euthanasia remain illegal).
Decisions around end-of-life medication do not affect insurance or annuity policies, and participation or non-participation cannot be compelled or penalized by insurers or healthcare providers.
Healthcare providers and institutions can opt out or refuse to participate without fear of civil or criminal liability, provided their actions are in good faith and consistent with professional standards.
Oversight and Integrity
The Department of Health and Social Services will collect anonymized compliance data, review medical records, and publish annual public reports ensuring the system is safe, transparent, and never abused. Patient confidentiality is carefully protected, and detailed reporting keeps the process accountable.
Implementation Timeline
The law becomes effective immediately but will be fully implemented upon adoption of final health regulations or by January 1, 2026, whichever comes first.
Delaware’s End of Life Options Law stands as a major affirmation of dignity, autonomy, and compassionate choice for those facing terminal illness. It strikes a careful balance: empowering patients while building in robust protections, oversight, and support every step of the way.
What’s the role of the Medical Society of Delaware?
The Medical Society of Delaware previously passed a resolution on neutrality in regards to MAID which included the following resolve:
“That the Medical Society of Delaware act as an unbiased, expert resource
to physicians, patients, and legislators regarding end of life options.”
Few issues are as ethically, emotionally, and clinically complex and it’s essential that the Medical Society of Delaware serve as an unbiased, expert resource to physicians, patients, and legislators regarding end-of-life options.
As the trusted voice of the medical profession in our state, MSD is uniquely positioned to provide balanced, evidence-based guidance grounded in clinical expertise and a deep understanding of patient care.
By maintaining neutrality and offering well-informed insights, MSD can ensure that all stakeholders:
- Physicians and health care providers navigating difficult conversations
- Patients facing profound decisions
- Legislators shaping policy.
- With access to the most accurate, compassionate, and up-to-date information.
This role strengthens trust in the medical profession
- supports autonomy and dignity in end-of-life care
- helps prevent the politicization of sensitive medical issues
- reinforces the MSD’s long-standing mission to advocate for the health and well-being of all Delawareans.
MAID Resources
Medical Aid in Dying: A Guide for Patients and their Supporters, by Lonny Shavelson, MD
The Death Doula’s Guide to Living Fully and Dying Prepared: An Essential Workbook to Help You Reflect Back, Plan Ahead, and Find Peace on Your Journey, by Francesca Arnoldy
Francesca also has a wonderful, informative blog about death doulas. Highly recommended.
Compassion & Choices website
Death with Dignity website
Academy of Aid-in-Dying
Medical Aid in Dying Listserv
Latest report on Medical Aid in Dying in Oregon
Additional Resources on MAID from Compassion & Choices
- This landing page summarizes information about HB140 and access to medical aid in dying in DE.
- This informational packet is designed for patients and lay people to help understand the law in DE and the process for accessing medical aid in dying.
- This fact sheet summarizes key information about HB140.
- End-of-Life Consultation is available to help answer end-of-life questions from both patients and providers.
- Navigating a Patient’s Request for Medical Aid in Dying is an additional resource developed for clinicians to answer questions that frequently arise during the process of considering and planning medical aid in dying.
Dr Bob, Brain Mechanic 