In August 2023, New York State implemented a law allowing medical aid in dying (MAID) for terminally ill patients, marking a significant turning point in end-of-life care. On the first day the law took effect, a group of healthcare professionals launched Quietus, believed to be the state’s first dedicated medical practice designed to help patients navigate and access this new right.

Quietus operates as a mobile service, providing comprehensive support to patients seeking medical aid in dying without maintaining a physical office. The team is composed of doctors, nurses, social workers, psychologists, and other clinicians who assist patients by managing necessary medical evaluations, psychological screenings, and the prescription process for lethal medication. To qualify under New York’s strictly regulated law, patients must be state residents, diagnosed with a terminal illness with a prognosis of six months or less to live, and comply with a mandatory five-day waiting period before obtaining the prescription.

The initiative arose in part from Dr. Tara Shapiro’s personal experience. After witnessing her mother-in-law, Janice Shapiro, who had a degenerative muscle disease, choose to end her life on her own terms in Vermont—one of the few states permitting out-of-state medical aid in dying—Dr. Shapiro began grappling with the ethical and professional challenges surrounding assisted death. As a palliative care physician with over 30 years of experience, Dr. Shapiro had long tended to patients facing death but had previously focused on comfort rather than accelerating the end of life.

Dr. Shapiro and her colleagues at Quietus have worked for months to establish the practice while addressing practical challenges such as drug procurement and delivery logistics. Many pharmacies were hesitant or unwilling to dispense the necessary medications due to concerns about protests or regulatory uncertainty. Quietus ultimately partnered with a willing family-owned pharmacy in Midtown Manhattan to supply lethal drug doses. The practice also confronts unique logistical issues, including ensuring safe delivery to patients’ residences, some in restricted-entry buildings, and handling the sensitive timing of medication administration.

The team acknowledges the emotional and ethical complexity of their work. While surveys indicate strong physician support in principle for medical aid in dying, relatively few doctors wish to be directly involved in facilitating it. Some healthcare providers raise concerns that participating in assisted death conflicts with the profession’s commitment to healing and preserving life. In contrast, Dr. Shapiro and her colleagues view the practice as a compassionate relief of suffering that aligns with the Hippocratic principle of “do no harm.”

Questions around availability and boundaries remain unresolved within Quietus. Daniel Cogan, the nurse practitioner leading the group, has advocated for a 24/7 response capability to meet patients’ needs promptly, but others worry such demands could lead to professional burnout. The team continues to deliberate over how to provide dignified, humane care while balancing practical limits.

Since opening, Quietus has begun seeing patients, including a middle-aged woman with terminal cancer who was their first client under the new law. Their process involves meticulous documentation to satisfy legal requirements, including recording patients’ explicit requests.

As medical aid in dying becomes increasingly accepted in more states—thirteen currently permit it—Quietus represents an early example of a specialized practice integrating legal, medical, and psychosocial aspects of this sensitive care. The team is prepared to offer assistance regardless of patients’ financial resources, though the sticker cost for the service is approximately $12,000, covering evaluations, prescriptions, logistics, and bereavement support.

For Dr. Shapiro, her work with Quietus is deeply personal. Reflecting on her mother-in-law’s own death and her family’s varied experiences with grief, she continues to explore what compassionate care at the end of life means. The emerging field of medical aid in dying confronts not only legal and clinical challenges but also profound questions about autonomy, suffering, and the role of healthcare providers in the final chapter of life.