Compassion & Choices is spearheading efforts to defend end-of-life autonomy as a fundamental right. Each courtroom victory and congressional engagement advances the fight to protect individuals and families at life’s end. In the past year, under President & CEO Kevin Díaz, our team carried that legacy forward, shielding medical aid in dying and essential end-of-life care from repeated threats while building new precedents that strengthen patient choice across the nation.

Championing end-of-life care in Congress

Compassion & Choices is focused on protecting end-of-life care at the federal level, where we pushed back against Medicaid cuts and advocated to safeguard hospice, palliative care and advance care planning for the people who rely on them most.

In Washington, D.C., our federal team secured a seventh successful defense of the District’s Death with Dignity law. Each successful defense sends a clear message — once enacted, end-of-life options become deeply rooted in the fabric of law and community. That outcome followed sustained engagement with House and Senate offices to oppose Financial Services and General Government Appropriations Bill (FSGG) riders and to reaffirm D.C. Home Rule. The House’s FSGG bill signaled provisions to overturn the law and bar the D.C. Council from adopting similar measures; the Senate Appropriations Committee’s version did not include language overturning the D.C. statute, an important distinction our team underscored in every conversation on the Hill.

We are focusing on policy that improves real-world access. We advocated for the CONNECT for Health Act, a proactive effort to make permanent the telehealth flexibilities first enacted during COVID. People use telehealth for important reasons: They may be homebound, too frail to travel, or facing symptoms that make clinic visits unsafe or unrealistic. Making the CONNECT for Health Act permanent protects these lifelines for people near the end of life by preserving critical geographic and site-of-service flexibilities.

Fighting for constitutional protections

In Kansas, Compassion & Choices, along with If/When/How: Lawyering for Reproductive Justice and Irigonegaray & Revenaugh, filed Vernon v. Kobach to challenge the state’s “pregnancy exclusion,” a provision that automatically voids the advance directives of pregnant people, stripping them of the same fundamental rights guaranteed to other adults. This case asserts that no individual should lose their right to plan for end-of-life care because they are pregnant. Compassion Legal successfully defended pregnant people’s rights in Almerico et al. v. State of Idaho et al. in 2021.

Filed on May 29, 2025, in Kansas state court, the case is brought on behalf of three Kansas women and two OB-GYNs who argue the law violates Kansas constitutional rights of personal autonomy, privacy and equal treatment by disregarding clearly expressed end-of-life decisions. The case has drawn national attention, including coverage in The Washington Post. Compassion Legal is closely monitoring pregnancy exclusions in other statutes and will keep working diligently to protect the healthcare decision-making rights of all people. 

Legal battles unfold in the courtroom

Compassion Legal is defending California’s End of Life Option Act against disability-discrimination claims brought in the United Spinal litigation. The case is now with the U.S. Court of Appeals for the Ninth Circuit, which first has to decide who is allowed to bring or join the lawsuit. On March 26, 2025, our co-counsel, John Kappos of O’Melveny, argued our clients’ motion to intervene before the Ninth Circuit. On March 28, 2025, the court put the case on hold while it awaits a related ruling about organizational standing in Arizona Alliance for Retired Americans v. Mayes.

Our position is straightforward: California’s law contains rigorous safeguards, requires that individuals have decision-making capacity and mandates self-administration; disability alone does not qualify someone for eligibility. This defense underscores a core principle that guides our work in every forum: Medical aid in dying is a voluntary, patient-directed option with guardrails designed to protect, not diminish, the autonomy and dignity of people at the end of life.

As President and CEO Kevin Díaz notes, “Participation is entirely voluntary, and the process remains firmly under the control of the terminally ill person through the mandate of self-administration. Importantly, having a disability alone does not qualify someone for eligibility.”

Building Compassion Legal

Compassion & Choices is expanding legal advocacy through Compassion Legal — The End-of-Life Justice Center at Compassion & Choices and the Compassion Legal Network of strategic pro bono firms and referral attorneys nationwide to advance cases, provide counsel and defend patient rights. Our legal helpline serves families navigating end-of-life decisions, ensuring individuals facing care barriers have access to guidance and support.

Individuals like Walter Hill benefit from Compassion Legal’s direct support. Walter was referred to the Compassion & Choices legal team after Johns Hopkins clinicians told him they could not turn off his pacemaker, even though it was causing him discomfort. He was advised to see another physician and keep applying pressure to Johns Hopkins staff, since going the legal route could have significantly delayed the care Walter was asking for. Walter followed this plan and one week later, Johns Hopkins informed him they would comply, and his pacemaker was turned off.

“I needed someone to hold my hand through this, and Compassion Legal guided me each step of the way. They encouraged my persistence in advocating for myself and were absolutely critical in helping me get the healthcare I needed.”