New York has become the 14th U.S. jurisdiction to authorize medical aid in dying. I had expected the statute to be the worst MAID law in the entire world. The amendments originally requested by the Governor would have added more access restrictions than any other jurisdiction on Earth. But the Governor apparently compromised on some of those amendments.   For example, New York has a MAID 2.0 waiting period. But it follows Hawaii in requiring a "mandatory mental health evaluation" even though all available evidence shows that adds nothing in terms of patient safety. The law does not become effective until August 2026.

I am getting ready for my talk for the MacLean Center for Clinical Medical Ethics 2025-26 lecture series. My talk is "Brain Death Backlash: Unregenerately Variable and Illegal Standards for Determination of Death by Neurological Criteria."  But check out the other talks that will all be archived on YouTube. Just this month on the same topic are Lainie Ross on "Defining Death: The Case for Choice," Brendan Parent on "Respecting and Learning from the Dead: Ethical Research Involving the Physiologically Maintained Deceased," and David Magnus on "Brain Death Is Really Death. It’s Just Not REALLY Death." 

The delivery of patient-centered end-of-life care is often impeded by systemic barriers, such as fragmented communication, prognostic uncertainty, and institutional cultures prioritizing curative treatment over comfort-focused care. Consequently, many patients undergo interventions that prolong suffering rather than alleviate it.  A new study just published in Surgery, conducted qualitative interviews with surgical ICU providers to explore their perspectives on what constitutes a bad death and identify barriers preventing delivery of patient-centered end-of-life care. ("What Does It Mean to Die a Bad Death? Provider Perspectives in the Surgical Intensive Care Unit") The authors identify 4 key themes on what constitutes a bad death: (1) poor symptom management, (2) nonbeneficial care, (3) poor communication, and (4) lack of closure and preparation for death.

I am getting ready for my talk for the MacLean Center for Clinical Medical Ethics 2025-26 lecture series. My talk is "Brain Death Backlash: Unregenerately Variable and Illegal Standards for Determination of Death by Neurological Criteria."  But check out the other talks that will all be archived on YouTube. Just this month on the same topic are Lainie Ross on "Defining Death: The Case for Choice," Brendan Parent on "Respecting and Learning from the Dead: Ethical Research Involving the Physiologically Maintained Deceased," and David Magnus on "Brain Death Is Really Death. It’s Just Not REALLY Death." 

I posted here a prepublication draft of my article forthcoming in the University of Illinois Chicago Law Review: "Unwanted Medical Treatment Harms Patients: Taxonomy of Healthcare Consent Infractions"    Patients in the United States are subject to an ever-growing “avalanche” of unwanted medical treatment (UMT).  This is ethically, economically, and legally wrong. First, UMT constitutes a serious violation of patient autonomy and self-determination.  Second, it is waste (and often fraud or abuse) of scarce healthcare resources. Third, but for rare exceptions, administering UMT contravenes settled legal rules and principles around consent and battery. This article describe four types of unwanted medical treatment and how the law addresses (or fails to address) them. The four types of UMT are  * Treatment over patient objections * Treatment with zero consent  * Treatment with coerced consent * Treatment with uninformed consent This legal taxonomy highlights the full scope and scale of UMT. 

The European Court of Human Rights has just ruled that clinicians may unilaterally withhold or withdraw life-sustaining treatment over patient or family objections. (Medmoune v. France). And that does not violate human rights protections, so long as the process comports with procedural fairness. 44-year-old A.M. was struck by a vehicle in May 2022, suffering catastrophic brain damage. While A.M. had an advance directive stating that he would want treatment even in that condition, his treating clinicians determined it was “manifestly inappropriate and not in conformity with the patient’s medical condition."   The ECHR ruled that French law was consistent with human rights law. First, evidence from the patient and family was considered. Second, there were repeated medical assessments, input from outside specialists and ethics bodies, and continuous dialogue with the family. Third, the family was afforded judicial review of the hospital's decision. Notably, this sort of procedural due process is what I have defended for years. 

New York has become the 14th U.S. jurisdiction to authorize medical aid in dying. I had expected the statute to be the worst MAID law in the entire world. The amendments originally requested by the Governor would have added more access restrictions than any other jurisdiction on Earth. But the Governor apparently compromised on some of those amendments.   For example, New York has a MAID 2.0 waiting period. But it follows Hawaii in requiring a "mandatory mental health evaluation" even though all available evidence shows that adds nothing in terms of patient safety. The law does not become effective until August 2026.

The European Court of Human Rights has just ruled that clinicians may unilaterally withhold or withdraw life-sustaining treatment over patient or family objections. (Medmoune v. France). And that does not violate human rights protections, so long as the process comports with procedural fairness. 44-year-old A.M. was struck by a vehicle in May 2022, suffering catastrophic brain damage. While A.M. had an advance directive stating that he would want treatment even in that condition, his treating clinicians determined it was “manifestly inappropriate and not in conformity with the patient’s medical condition."   The ECHR ruled that French law was consistent with human rights law. First, evidence from the patient and family was considered. Second, there were repeated medical assessments, input from outside specialists and ethics bodies, and continuous dialogue with the family. Third, the family was afforded judicial review of the hospital's decision. Notably, this sort of procedural due process is what I have defended for years. 

New York has become the 14th U.S. jurisdiction to authorize medical aid in dying. I had expected the statute to be the worst MAID law in the entire world. The amendments originally requested by the Governor would have added more access restrictions than any other jurisdiction on Earth. But the Governor apparently compromised on some of those amendments.   For example, New York has a MAID 2.0 waiting period. But it follows Hawaii in requiring a "mandatory mental health evaluation" even though all available evidence shows that adds nothing in terms of patient safety. The law does not become effective until August 2026.

South Korea is considering crossing a line that has been rather sharp and bright in the United States. It is considering incentives to withhold or withdraw life-sustaining treatment.  Notably, this appears to be not just an incentive to complete an advance directive. That is already commonly discussed across the United States. Rather, this appears to be an incentive to complete the advance directive in a certain way: to decline life-sustaining therapy.  South Korea President Lee Jae Myung

I posted here a prepublication draft of my article forthcoming in the University of Illinois Chicago Law Review: "Unwanted Medical Treatment Harms Patients: Taxonomy of Healthcare Consent Infractions"    Patients in the United States are subject to an ever-growing “avalanche” of unwanted medical treatment (UMT).  This is ethically, economically, and legally wrong. First, UMT constitutes a serious violation of patient autonomy and self-determination.  Second, it is waste (and often fraud or abuse) of scarce healthcare resources. Third, but for rare exceptions, administering UMT contravenes settled legal rules and principles around consent and battery. This article describe four types of unwanted medical treatment and how the law addresses (or fails to address) them. The four types of UMT are  * Treatment over patient objections * Treatment with zero consent  * Treatment with coerced consent * Treatment with uninformed consent This legal taxonomy highlights the full scope and scale of UMT. 

I posted here a prepublication draft of my article forthcoming in the University of Illinois Chicago Law Review: "Unwanted Medical Treatment Harms Patients: Taxonomy of Healthcare Consent Infractions"    Patients in the United States are subject to an ever-growing “avalanche” of unwanted medical treatment (UMT).  This is ethically, economically, and legally wrong. First, UMT constitutes a serious violation of patient autonomy and self-determination.  Second, it is waste (and often fraud or abuse) of scarce healthcare resources. Third, but for rare exceptions, administering UMT contravenes settled legal rules and principles around consent and battery. This article describe four types of unwanted medical treatment and how the law addresses (or fails to address) them. The four types of UMT are  * Treatment over patient objections * Treatment with zero consent  * Treatment with coerced consent * Treatment with uninformed consent This legal taxonomy highlights the full scope and scale of UMT. 

Our recent article reviewing VSED advance directives is now available open access here from the Journal of Law, Medicine, and Ethics. People use advance directives to express preferences that direct their future care when they lack decision-making capacity. One form of advance directive, a “dementia directive,” records preferences about living in various stages of dementia. This is important because many Americans want to avoid living with advanced progressive dementia. Unfortunately, traditional advance directives cannot dependably achieve this goal. In contrast, some dementia directives can achieve this goal, by directing cessation of manually assisted feeding and drinking. While many dementia directives have been published, most have gaps and omissions that thwart the goal of avoiding extended intolerable life in advanced dementia. To overcome these problems, we formulated a new dementia directive. This article explains the value of this new directive.  We proceed in six stages. First, we review the prevalence of advanced dementia. Second, we identify the disadvantages of another option for accomplishing the goal of not living into advanced dementia, preemptive VSED. Third, we distinguish notable court cases where dementia directives were unsuccessful. Fourth, we review nine prominent dementia directives, noting how the Northwest Justice Project’s Advance Directive for VSED remedies those shortcomings. Fifth, we review this directive’s legal status. Sixth, we articulate its ethical justification.

Bob Uslander is one of the most experienced U.S. clinicians when it comes to VSED and MAID. His San Diego based company, Empowered Endings, offers a very clear and family-focused description of VSED. 

South Korea is considering crossing a line that has been rather sharp and bright in the United States. It is considering incentives to withhold or withdraw life-sustaining treatment.  Notably, this appears to be not just an incentive to complete an advance directive. That is already commonly discussed across the United States. Rather, this appears to be an incentive to complete the advance directive in a certain way: to decline life-sustaining therapy.  South Korea President Lee Jae Myung

Here are my academic outputs from January 2026.   PUBLICATIONS THE RIGHT TO DIE: THE LAW OF END-OF-LIFE DECISIONMAKING (Wolters Kluwer Law & Business 2026) (with Alan Meisel & Kathy L. Cerminara) (1st semi-annual update). LINK Brain Death: Five Mandates to Continue Technologic Support after Death, 26(1) AMERICAN JOURNAL OF BIOETHICS 41-43 (2026). LINK Addressing “Futility” in Psychiatry: A Consensus Statement, 56 PSYCHOLOGICAL MEDICINE e16 (2026) (with Brent M. Kious, Sarah Levitt, Sisco van Veen, Daniel Buchman, Lucy Costa, Katharina Froelich, Paul Hoff, Anna Lindblad, Susan Metselaar, Loïc Moureau, Gerald Neitzke, Heidi Schenker, Julia Strupp, Manuel Trachsel, and Anna Lisa Westermair). LINK PRESENTATIONS 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). LINK VSED: Ethically Supporting Patients Who Hasten Death by Voluntarily Stopping Eating & Drinking, VETERANS HEALTH ADMINISTRATION (January 29, 2026).

South Korea is considering crossing a line that has been rather sharp and bright in the United States. It is considering incentives to withhold or withdraw life-sustaining treatment.  Notably, this appears to be not just an incentive to complete an advance directive. That is already commonly discussed across the United States. Rather, this appears to be an incentive to complete the advance directive in a certain way: to decline life-sustaining therapy.  South Korea President Lee Jae Myung

Our recent article reviewing VSED advance directives is now available open access here from the Journal of Law, Medicine, and Ethics. People use advance directives to express preferences that direct their future care when they lack decision-making capacity. One form of advance directive, a “dementia directive,” records preferences about living in various stages of dementia. This is important because many Americans want to avoid living with advanced progressive dementia. Unfortunately, traditional advance directives cannot dependably achieve this goal. In contrast, some dementia directives can achieve this goal, by directing cessation of manually assisted feeding and drinking. While many dementia directives have been published, most have gaps and omissions that thwart the goal of avoiding extended intolerable life in advanced dementia. To overcome these problems, we formulated a new dementia directive. This article explains the value of this new directive.  We proceed in six stages. First, we review the prevalence of advanced dementia. Second, we identify the disadvantages of another option for accomplishing the goal of not living into advanced dementia, preemptive VSED. Third, we distinguish notable court cases where dementia directives were unsuccessful. Fourth, we review nine prominent dementia directives, noting how the Northwest Justice Project’s Advance Directive for VSED remedies those shortcomings. Fifth, we review this directive’s legal status. Sixth, we articulate its ethical justification.

Bob Uslander is one of the most experienced U.S. clinicians when it comes to VSED and MAID. His San Diego based company, Empowered Endings, offers a very clear and family-focused description of VSED. 

Perhaps no state has done more to document the impact of unrepresented patents than Massachusetts. Following a series of reports and media coverage is yet another story in the Boston Globe.   "Hospital administrators say that too often patients, before they become incapacitated, fail to complete a health care proxy form, a simple document available online that designates a representative to make health care decisions for the patient if they can’t." "Without that form, incapacitated patients, most often older people with dementia, or younger patients who’ve had a brain injury, get stuck in the hospital as administrators embark on a legal maze seeking a court-appointed guardian."

Our recent article reviewing VSED advance directives is now available open access here from the Journal of Law, Medicine, and Ethics. People use advance directives to express preferences that direct their future care when they lack decision-making capacity. One form of advance directive, a “dementia directive,” records preferences about living in various stages of dementia. This is important because many Americans want to avoid living with advanced progressive dementia. Unfortunately, traditional advance directives cannot dependably achieve this goal. In contrast, some dementia directives can achieve this goal, by directing cessation of manually assisted feeding and drinking. While many dementia directives have been published, most have gaps and omissions that thwart the goal of avoiding extended intolerable life in advanced dementia. To overcome these problems, we formulated a new dementia directive. This article explains the value of this new directive.  We proceed in six stages. First, we review the prevalence of advanced dementia. Second, we identify the disadvantages of another option for accomplishing the goal of not living into advanced dementia, preemptive VSED. Third, we distinguish notable court cases where dementia directives were unsuccessful. Fourth, we review nine prominent dementia directives, noting how the Northwest Justice Project’s Advance Directive for VSED remedies those shortcomings. Fifth, we review this directive’s legal status. Sixth, we articulate its ethical justification.

Here are my academic outputs from January 2026.   PUBLICATIONS THE RIGHT TO DIE: THE LAW OF END-OF-LIFE DECISIONMAKING (Wolters Kluwer Law & Business 2026) (with Alan Meisel & Kathy L. Cerminara) (1st semi-annual update). LINK Brain Death: Five Mandates to Continue Technologic Support after Death, 26(1) AMERICAN JOURNAL OF BIOETHICS 41-43 (2026). LINK Addressing “Futility” in Psychiatry: A Consensus Statement, 56 PSYCHOLOGICAL MEDICINE e16 (2026) (with Brent M. Kious, Sarah Levitt, Sisco van Veen, Daniel Buchman, Lucy Costa, Katharina Froelich, Paul Hoff, Anna Lindblad, Susan Metselaar, Loïc Moureau, Gerald Neitzke, Heidi Schenker, Julia Strupp, Manuel Trachsel, and Anna Lisa Westermair). LINK PRESENTATIONS 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). LINK VSED: Ethically Supporting Patients Who Hasten Death by Voluntarily Stopping Eating & Drinking, VETERANS HEALTH ADMINISTRATION (January 29, 2026).

Join me at the International Conference on Clinical Ethics and Consultation (ICCEC) from June 10-13, 2026 for Robot Surrogates: AI’s Growing Role in Both Guiding and Making Healthcare Decisions for Unrepresented and Other Incapacitated Patients. My presentation shows how to use "robot surrogates" for unrepresented and other incapacitated patients.    Surrogates. Substantial evidence shows that surrogates exercise substitute judgment unsatisfactorily. They are poor at making the same treatment decisions for incapacitated patients that those patients would have made for themselves. In response, clinical ethicists have engaged in substantial discussion about Patient Preference Predictors and similar models. Proponents argue that PPPs can guide surrogates to make decisions that better accord with the incapacitated patient’s goals, preferences, and values. Now, pervasive use of AI and large language models in healthcare has exponentially expanded these discussions. Using both personal and demographic data, robot surrogates can predict how this patient would decide in this situation. Unrepresented Patients. Using robot surrogates can be even more helpful with one of the biggest and most persistent problems in clinical ethics: decision making for unrepresented patients. Different jurisdictions and different healthcare systems take variable approaches. For example, the decision maker for an unrepresented patient might be a hospital committee, a single physician, or a public guardian. But as strangers to the patient, all are even less likely than an appointed agent or default surrogate to make value congruent treatment decisions. Consequently, the relative value of AI/LLM robot proxies is even greater for unrepresented patients than for incapacitated patients with surrogates. And we confront even bigger questions. Should robot proxies merely “guide” the decision maker? Can they establish default choices? Or even “be” the decision maker. How to Use Robot Surrogates. This presentation describes and illustrates three new roles for robot surrogates: (1) resolving conflicts between family members, (2) resolving surrogate uncertainty about what the patient would want, and (3) guiding decision making for unrepresented patients. This presentation summarizes the extent to which robot surrogates are already being used for these roles and obstacles to wider implementation.

Bob Uslander is one of the most experienced U.S. clinicians when it comes to VSED and MAID. His San Diego based company, Empowered Endings, offers a very clear and family-focused description of VSED. 

Here are my academic outputs from January 2026.   PUBLICATIONS THE RIGHT TO DIE: THE LAW OF END-OF-LIFE DECISIONMAKING (Wolters Kluwer Law & Business 2026) (with Alan Meisel & Kathy L. Cerminara) (1st semi-annual update). LINK Brain Death: Five Mandates to Continue Technologic Support after Death, 26(1) AMERICAN JOURNAL OF BIOETHICS 41-43 (2026). LINK Addressing “Futility” in Psychiatry: A Consensus Statement, 56 PSYCHOLOGICAL MEDICINE e16 (2026) (with Brent M. Kious, Sarah Levitt, Sisco van Veen, Daniel Buchman, Lucy Costa, Katharina Froelich, Paul Hoff, Anna Lindblad, Susan Metselaar, Loïc Moureau, Gerald Neitzke, Heidi Schenker, Julia Strupp, Manuel Trachsel, and Anna Lisa Westermair). LINK PRESENTATIONS 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). LINK VSED: Ethically Supporting Patients Who Hasten Death by Voluntarily Stopping Eating & Drinking, VETERANS HEALTH ADMINISTRATION (January 29, 2026).