Illinois Medical Aid-in-Dying Law Takes Effect Amid Legal Challenges

Illinois’ End-of-Life Options for Terminally Ill Patients Act, 410 ILCS 22 (P.A. 104-0441, also known as “Deb’s Law”), took effect on September 12, 2026, making Illinois the first Midwestern state to authorize medical aid in dying. Below, we look at the law’s legal requirements and legal challenges, and consider how healthcare organizations should evaluate whether and how they will participate, update applicable policies and protocols, and monitor the pending lawsuits for further developments.

Key Takeaways

• • The Act permits Illinois-licensed physicians to prescribe medication that a qualified, terminally ill adult Illinois resident may self-administer to end his or her life, subject to detailed procedural safeguards and reporting obligations.

• • A federal court declined to preliminarily enjoin the Act in a disability-rights challenge (Payne v. Pritzker), finding the plaintiffs lacked standing to obtain that relief.

• • In two separate religious-liberty and free-speech challenges, stipulated temporary restraining orders now bar the State from enforcing the Act (and related Health Care Right of Conscience Act provisions) against the plaintiffs and, in one case, against members of several plaintiff associations, including the Illinois Catholic Health Association.

• • Health care providers, particularly hospitals, hospices, long-term care facilities, and faith-based systems, should review their policies, staff training, and documentation practices now.

Overview of the Act

Governor JB Pritzker signed the Act in December 2025 after a two-year legislative effort. Like most other states’ medical aid-in-dying statutes, the Act is modeled on Oregon’s 1997 Death with Dignity Act. Its principal provisions are summarized below.

Eligibility

A “qualified patient” must be an adult Illinois resident with a terminal illness expected to result in death within six months, who has the mental capacity to make medical decisions and is able to self-administer (ingest) the medication. Both an attending physician and a consulting physician must confirm the patient’s terminal illness, prognosis, and mental capacity.

A person does not qualify solely because of advanced age, disability, or a mental health condition, including depression. Illinois residency may be established by any of several means, such as an Illinois driver’s license or state ID, Illinois voter registration, property ownership or a lease in Illinois, or an Illinois residence address on a prior-year tax return.

Patient-Initiated Requests

Only the patient may request aid-in-dying medication. A surrogate, health care agent, attorney-in-fact, guardian, or advance directive cannot make the request. The patient may also rescind the request at any time, and the physician must offer the opportunity to rescind at the time of the second oral request.

Patient-Initiated Request Requirements

• • The patient must make an oral request, submit a written request on the Illinois Department of Public Health (IDPH) form, and repeat the oral request no fewer than five days after the first one. The waiting period does not apply if the patient is expected to die within five days.

• • The written request must be signed by two witnesses attesting that the patient has capacity, is acting voluntarily, and is not being coerced. At least one witness must be independent: not a relative, not a person entitled to part of the patient’s estate, and not an owner, operator, or employee of the health care entity treating or housing the patient. The attending physician and any interpreter may not serve as witnesses.

• • Patients who cannot make an oral request because of a disability may use reasonable accommodations and auxiliary aids under Title III of the Americans with Disabilities Act.

Physician Obligations

• • The attending physician must be licensed to practice medicine in all its branches in Illinois and have primary responsibility for treating the patient’s terminal disease.

• • The physician must ensure the request is not the product of coercion and must inform the patient of all feasible end-of-life options, including additional treatment, comfort care, hospice care, palliative care, and pain control, along with their risks and benefits.

• • If the attending or consulting physician doubts the patient’s capacity or suspects a mental health condition impairing judgment, the patient must be referred to a licensed mental health professional. If that professional finds incapacity or impaired judgment, the medication may not be prescribed.

• • The physician must counsel the patient on self-administration, safekeeping, and disposal of unused medication, the importance of having another person present, and not taking the medication in a public place. The medication must be ingested; it may not be given by injection or infusion.

• • The physician must submit an Attending Physician Checklist Form to IDPH within 30 days of prescribing and a Follow-Up Form within 60 days after learning of the patient’s death following ingestion. Willful failure to submit required records may result in discipline.

• • The death certificate must list the underlying terminal illness as the cause of death and may not designate the death as a suicide or homicide.

Participation and Conscience

Participation is voluntary. The Act provides that only willing health care professionals will provide aid-in-dying care, and it sets out physicians’ rights to decline without discipline. Health care institutions may prohibit the practice by clinicians acting on the institution’s behalf.

However, a physician who is unable or unwilling to carry out a request must transfer the patient’s medical record without delay if the patient transfers care. Objecting providers also remain subject to informational and referral obligations, which are now the main subject of the religious-liberty litigation described below.

Litigation Challenging the Act

Practical Considerations for Healthcare Providers

Determine Whether Your Organization Will Participate

• • Institutions that will not participate should adopt and communicate a written policy, recognizing that the TROs cover only the specific plaintiffs, entities, and association members identified in the orders.

Confirm Coverage

• • Entities and clinicians relying on the Kirchoff order should document their association membership as of the relevant dates and be ready to provide written confirmation to IDPH or IDFPR promptly.

Update Protocols for Participating Providers

Organizations that will offer aid-in-dying care should adopt written protocols that track each step the Act requires, including:

• • Request documentation: using IDPH's written request form, the related witness attestations and, where needed, IDPH's interpreter attachment.

• • Waiting period: confirming that the second oral request comes at least five days after the first, unless the patient is expected to die within five days.

• • Referrals: referring every patient to a consulting physician. Patients must also be referred to a licensed mental health professional when either physician doubts the patient's capacity or suspects impaired judgment.

• • Prescribing and dispensing: delivering the prescription to a licensed pharmacist, or dispensing directly if the physician is authorized by the DEA, and counseling the patient on safekeeping and disposal of unused medication.

• • Death certificates: listing the underlying terminal illness as the cause of death, and not designating the death as a suicide or homicide.

• • IDPH reporting: filing the Attending Physician Checklist Form within 30 days of prescribing, and the Follow-Up Form within 60 days after learning that the patient died after taking the medication.

Ensure Timely Record Transfers and ADA Accommodations

• • Ensure that records are transferred without delay when patients move their care, and that ADA accommodations are available for patients who cannot make oral requests.

Monitor Ongoing Litigation

• • Track the Seventh Circuit’s decision in NIFLA/Schroeder, the show-cause proceedings in Payne, and any consolidation or preliminary injunction briefing in the religious-liberty cases. Each could change the scope of providers’ informational and referral obligations.

Address Participation in Health Care Transactions

• • In health care transactions, consider diligence on target policies and compliance with the Act, and address participation and conscience issues in affiliation, management, and joint venture agreements involving faith-based systems.

This alert reflects publicly available information as of October 23, 2026, and is provided for general informational purposes only. It is not legal advice. For questions about how the Act or the pending litigation may affect your organization, please contact your Hinshaw attorney.