Delaware Becomes 12th U.S. Jurisdiction to Authorize Medical Aid in Dying, First Since 2021

Compassion & Choices (2025)

20 May 2025

Delaware Governor Matt Meyer today signed the Ron Silverio/Heather Block Delaware End-of-Life Options Act into law in a public signing ceremony, ending a decade of dedicated advocacy led by Compassion & Choices Action Network and fulfilling his September 2024 promise to authorize the option of medical aid in dying for terminally ill Delawareans. 

The new law will grant a terminally ill, mentally capable adult with six months or less to live the option to request a prescription from their healthcare provider for medication they can choose to self-ingest and die on their own terms. Delaware is the 12th U.S. jurisdiction to authorize medical aid in dying (10 other states plus Washington, D.C.) and the first to do so since New Mexico in April 2021. The law takes effect on January 1, 2026 or once the final regulations are formed to support the law, whichever is sooner. 

“Today I’m going to sign a bill that speaks to compassion, dignity, and respect for personal choice,” said Governor Meyer in an emotional speech before the signing. “This signing today is about relieving suffering and giving families the comfort of knowing that their loved one was able to pass on their own terms, without unnecessary pain, and surrounded by the people they love most.”

The info is here.

Here is a brief summary.

On May 20, 2025, Delaware Governor Matt Meyer signed the Ron Silverio/Heather Block Delaware End-of-Life Options Act into law, making Delaware the 12th U.S. jurisdiction to authorize medical aid in dying. This legislation allows mentally capable adults diagnosed with a terminal illness and a prognosis of six months or less to request a prescription for medication they can choose to self-administer to end their lives peacefully. 

Key Provisions:

Eligibility Criteria: Patients must be at least 18 years old, residents of Delaware, diagnosed with a terminal illness with a prognosis of six months or less, mentally capable of making healthcare decisions, and able to self-ingest the prescribed medication. 

Compassion & Choices

Safeguards: The law includes multiple safeguards, such as requiring two healthcare providers to confirm the diagnosis and prognosis, two waiting periods, and ensuring that patients are informed about all end-of-life care options, including palliative care and hospice. 

The law is set to take effect on January 1, 2026, or upon the completion of necessary regulations, whichever comes first.

States & districts permitting MAiD.

Oregon (1997); Washington (2008); Montana (2009) – Legalized through a state Supreme Court ruling; 

Vermont (2013); California (2015); Colorado (2016); District of Columbia (2017); Hawai‘i (2018); New Jersey (2019); Maine (2019); New Mexico (2021); Delaware (2025)

The Benefits of Adopting a Positive Perspective in Ethics Education

Knapp, S., Gottlieb, M. C., & 

Handelsman, M. M. (2018).

Training and Education in Professional Psychology,

12(3), 196–202.

https://doi.org/10.1037/tep0000195

Abstract

Positive ethics is a perspective that encourages psychologists to see professional ethics as an effort to adhere to overarching ethical principles that are integrated with personal values, as opposed to efforts that focus primarily on avoiding punishment for violating the ethics codes, rules, and regulations. This article reviews the foundations of positive ethics, argues for the benefits of adopting a positive approach in ethics education, and considers recent findings from psychological science that support the value of a positive perspective by improving moral sensitivity, setting high standards for conduct, and increasing motivation to act ethically.

Here are some thoughts:

The article argues that traditional ethics training often focuses narrowly on rules and punishments—a “floor” approach that teaches students simply what they must not do—while neglecting the broader, aspirational ideals that give ethics its vitality. In contrast, a positive ethics perspective invites psychologists to anchor their professional conduct in overarching principles and personal values, framing ethics as an opportunity to excel rather than a set of minimum requirements. Drawing on concepts from positive psychology and decision science (such as approach versus avoidance motivation and prescriptive versus proscriptive morality), the authors show how a positive approach deepens moral sensitivity, elevates standards of care beyond mere compliance, and taps into intrinsic motivations that make ethical practice more meaningful and less anxiety-provoking.

This perspective matters for psychologists because it reshapes how we learn, teach, and model ethical behavior. By broadening ethical reflection to include everyday decisions—from informed consent to collegial interactions—a positive ethics framework equips practitioners to recognize and respond to moral dimensions they might otherwise overlook. Training that highlights internal motivations and the connection between personal values and professional standards not only reduces the fear and cognitive narrowing associated with punishment-focused teaching, but also fosters stronger professional identity, better decision making under stress, and higher-quality care for clients and communities.

Ethical drift: when good people do bad things

Kleinman C. S. (2006).

JONA'S healthcare law, ethics and regulation, 

8(3), 72–76. 

https://doi.org/10.1097/00128488-200607000-00004

 Abstract

There are many factors in today’s healthcare environment which challenge nurses and nursing administration in adhering to ethical values. This article discusses the phenomenon of ethical drift, a gradual erosion of ethical behavior that occurs in individuals below their level of awareness. It is imperative for nurse managers and executives to be aware of the danger that workplace pressures pose in encouraging ethical drift at all levels of nursing, and to take steps to prevent this phenomena from occurring in their facilities.

Here is a summary and some thoughts:

The article explores how well-intentioned nurses and healthcare leaders can gradually erode their own ethical standards without realizing it. Under pressures such as staffing shortages, budget constraints, and competing organizational demands, small justifications for bending the rules accumulate until significant breaches become normalized. Kleinman illustrates this phenomenon through scenarios in which nurse managers unconsciously override physicians’ orders or skew performance appraisals to meet immediate needs, ultimately exposing themselves and their institutions to liability, moral distress, and burnout. She traces ethical drift to broader shifts in moral philosophy—where diverse, and sometimes conflicting, theories of right action make it easier to rationalize incremental deviations—and emphasizes that its insidious nature lies in occurring below conscious awareness until serious harm has already been done.

For psychologists, understanding ethical drift is vital because it mirrors key concepts in social and cognitive psychology, such as moral disengagement, obedience to authority, and the slippery-slope effect of incremental rationalization. Industrial-organizational psychologists can apply these insights to design training, support groups, and leadership practices that reinforce core values and ethical vigilance in high-pressure environments. Clinical psychologists and supervisors working with healthcare professionals must recognize how stress and systemic demands can undermine personal integrity and patient care, integrating strategies like values clarification, reflective practice, and peer feedback into interventions. By bringing psychological theory to bear on the gradual erosion of ethical behavior, psychologists help ensure that individuals and organizations remain aligned with the foundational principles of care and professional integrity.

Ethical Fading: The Role of Self-Deception in Unethical Behavior

Tenbrunsel, A. E., & Messick, D. M. (2004).

Social Justice Research, 17(2), 223–236.

https://doi.org/10.1023/b:sore.0000027411.35832.53

Abstract

This paper examines the root of unethical dicisions by identifying the psychological forces that promote self-deception. Self-deception allows one to behave self-interestedly while, at the same time, falsely believing that one's moral principles were upheld. The end result of this internal con game is that the ethical aspects of the decision “fade” into the background, the moral implications obscured. In this paper we identify four enablers of self-deception, including language euphemisms, the slippery slope of decision-making, errors in perceptual causation, and constraints induced by representations of the self. We argue that current solutions to unethical behaviors in organizations, such as ethics training, do not consider the important role of these enablers and hence will be constrained in their potential, producing only limited effectiveness. Amendments to these solutions, which do consider the powerful role of self-deception in unethical decisions, are offered.

Here are some thoughts:

For psychologists, the concept of ethical fading is vital because it reveals the unconscious cognitive and emotional processes that allow otherwise principled individuals to act unethically. Tenbrunsel and Messick’s identification of four self-deception enablers—euphemistic language that obscures harm, the slippery-slope effect that numbs moral sensitivity, biased causal attributions that deflect blame, and self-serving self-representations—aligns closely with established constructs in social and cognitive psychology such as motivated reasoning, framing effects, and defense mechanisms . By understanding how moral considerations “fade” from awareness, psychologists can refine theories of moral cognition and affect, deepening insight into how people justify or conceal unethical behavior.

This framework also carries significant practical and research implications. In organizational and clinical settings, psychologists can design interventions that counteract ethical fading—reshaping decision frames, interrupting incremental justifications, and exposing hidden biases—rather than relying solely on traditional ethics education. Moreover, it opens new avenues for empirical study, from measuring the conditions under which moral colors dim to testing strategies that re-salientize ethical concerns, thereby advancing both applied and theoretical knowledge in the psychology of morality and self-deception.

Different judgment frameworks for moral compliance and moral violation

Shirai, R., & Watanabe, K. (2024).

Scientific Reports, 14(1).

https://doi.org/10.1038/s41598-024-66862-9

Abstract

In recent decades, the field of moral psychology has focused on moral judgments based on some moral foundations/categories (e.g., harm/care, fairness/reciprocity, ingroup/loyalty, authority/respect, and purity/sanctity). When discussing the moral categories, however, whether a person judges moral compliance or moral violation has been rarely considered. We examined the extent to which moral judgments are influenced by each other across moral categories and explored whether the framework of judgments for moral violation and compliance would be different. For this purpose, we developed the episodes set for moral and affective behaviors. For each episode, participants evaluated valence, arousal, morality, and the degree of relevance to each of the Haidt's 5 moral foundations. The cluster analysis showed that the moral compliance episodes were divided into three clusters, whereas the moral violation episodes were divided into two clusters. Also, the additional experiment indicated that the clusters might not be stable in time. These findings suggest that people have different framework of judgments for moral compliance and moral violation.

Here are some thoughts:

This study investigates the nuances of moral judgment by examining whether people employ distinct frameworks when evaluating moral compliance versus moral violation. Researchers designed a series of scenarios encompassing moral and affective dimensions, and participants rated these scenarios across valence, arousal, morality, and relevance to Haidt's five moral foundations. The findings revealed that moral compliance and moral violation appear to be judged using different frameworks, as evidenced by the cluster analysis which showed different cluster divisions for compliance and violation episodes. 

This research carries significant implications for psychologists, deepening our understanding of the complexities inherent in moral decision-making and extending the insights of theories like Moral Foundations Theory. Furthermore, the study provides valuable tools, such as the developed set of moral and affective scenarios, for future investigations in moral psychology. Ultimately, a more refined grasp of moral judgment processes can inform efforts to mediate conflicts and foster enhanced social understanding.

On bullshit, large language models, and the need to curb your enthusiasm

Tigard, D. W. (2025).

AI And Ethics.

https://doi.org/10.1007/s43681-025-00743-3

Abstract

Amidst all the hype around artificial intelligence (AI), particularly regarding large language models (LLMs), generative AI and chatbots like ChatGPT, a surge of headlines is instilling caution and even explicitly calling “bullshit” on such technologies. Should we follow suit? What exactly does it mean to call bullshit on an AI program? When is doing so a good idea, and when might it not be? With this paper, I aim to provide a brief guide on how to call bullshit on ChatGPT and related systems. In short, one must understand the basic nature of LLMs, how they function and what they produce, and one must recognize bullshit. I appeal to the prominent work of the late Harry Frankfurt and suggest that recent accounts jump too quickly to the conclusion that LLMs are bullshitting. In doing so, I offer a more level-headed approach to calling bullshit, and accordingly, a way of navigating some of the recent critiques of generative AI systems.

Here are some thoughts:

This paper examines the application of Harry Frankfurt's theory of "bullshit" to large language models (LLMs) like ChatGPT. It discusses the controversy around labeling AI-generated content as "bullshit," arguing for a more nuanced approach. The author suggests that while LLM outputs might resemble bullshit due to their lack of concern for truth, LLMs themselves don't fit the definition of a "bullshitter" because they lack the intentions and aims that Frankfurt attributes to human bullshitters.

For psychologists, this distinction is important because it asks for a reconsideration of how we interpret and evaluate AI-generated content and its impact on human users. The paper further argues that if AI interactions provide tangible benefits to users without causing harm, then thwarting these interactions may not be necessary. This perspective encourages psychologists to weigh the ethical considerations of AI's influence on individuals, balancing concerns about authenticity and integrity with the potential for AI to enhance human experiences and productivity.

Optimized Informed Consent for Psychotherapy: Protocol for a Randomized Controlled Trial

Gerke, L. et al. (2022).

JMIR Research Protocols, 11(9), e39843.

https://doi.org/10.2196/39843

Abstract

Background:

Informed consent is a legal and ethical prerequisite for psychotherapy. However, in clinical practice, consistent strategies to obtain informed consent are scarce. Inconsistencies exist regarding the overall validity of informed consent for psychotherapy as well as the disclosure of potential mechanisms and negative effects, the latter posing a moral dilemma between patient autonomy and nonmaleficence.

Objective:

This protocol describes a randomized controlled web-based trial aiming to investigate the efficacy of a one-session optimized informed consent consultation.

Methods:

The optimized informed consent consultation was developed to provide information on the setting, efficacy, mechanisms, and negative effects via expectation management and shared decision-making techniques. A total of 122 participants with an indication for psychotherapy will be recruited. Participants will take part in a baseline assessment, including a structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) disorders. Eligible participants will be randomly assigned either to a control group receiving an information brochure about psychotherapy as treatment as usual (n=61) or to an intervention group receiving treatment as usual and the optimized informed consent consultation (n=61). Potential treatment effects will be measured after the treatment via interview and patient self-report and at 2 weeks and 3 months follow-up via web-based questionnaires. Treatment expectation is the primary outcome. Secondary outcomes include the capacity to consent, decisional conflict, autonomous treatment motivation, adherence intention, and side-effect expectations.

Results:

This trial received a positive ethics vote by the local ethics committee of the Center for Psychosocial Medicine, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany on April 1, 2021, and was prospectively registered on June 17, 2021. The first participant was enrolled in the study on August 5, 2021. We expect to complete data collection in December 2022. After data analysis within the first quarter of 2023, the results will be submitted for publication in peer-reviewed journals in summer 2023.

Conclusions:

If effective, the optimized informed consent consultation might not only constitute an innovative clinical tool to meet the ethical and legal obligations of informed consent but also strengthen the contributing factors of psychotherapy outcome, while minimizing nocebo effects and fostering shared decision-making.

Here are some thoughts:

This research study investigated an optimized informed consent process in psychotherapy. Recognizing inconsistencies in standard practices, the study tested an enhanced consultation method designed to improve patients' understanding of treatment, manage their expectations, and promote shared decision-making. By comparing this enhanced approach to standard practice with a cohort of 122 participants, the researchers aimed to demonstrate the benefits of a more comprehensive and collaborative informed consent process in fostering positive treatment expectations and related outcomes. The findings were anticipated to provide evidence for a more effective and ethical approach to initiating psychotherapy.

Avoiding the road to ethical disaster: Overcoming vulnerabilities and developing resilience

Tjeltveit, A. C., & Gottlieb, M. C. (2010).

Psychotherapy: Theory, Research, Practice, 

Training, 47(1), 98–110.

https://doi.org/10.1037/a0018843

Abstract

Psychotherapists may, despite their best intentions, find themselves engaging in ethically problematic behaviors that could have been prevented. Drawing on recent research in moral psychology and longstanding community mental health approaches to prevention, we suggest that psychotherapists can reduce the likelihood of committing ethical infractions (and move in the direction of ethical excellence) by attending carefully to 4 general dimensions: the desire to facilitate positive (good) outcomes, the powerful opportunities given to professionals to effect change, personal values, and education. Each dimension can foster enhanced ethical behavior and personal resilience, but each can also contribute to ethical vulnerability. By recognizing and effectively addressing these dimensions, psychotherapists can reduce their vulnerabilities, enhance their resilience, reduce the risk of ethical infractions, and improve the quality of their work.

The article is paywalled, unfortunately.

Here are some thoughts:

The authors argue that psychotherapists, despite their good intentions, can engage in unethical behaviors that could be prevented. Drawing on moral psychology research, they suggest that ethical infractions can be reduced by focusing on four dimensions: the desire to help, the opportunities available to professionals, personal values, and education. Each of these dimensions can enhance ethical behavior and resilience, but also contribute to vulnerability. By addressing these dimensions, psychotherapists can reduce vulnerabilities, enhance resilience, and improve their practice. Traditional ethics education, focused on rules and codes, is insufficient. A broader approach is needed, incorporating contextual, cultural, and emotional factors. Resilience involves skills, personal characteristics, support networks, and their integration. Vulnerability includes general factors like stress, and idiosyncratic factors like personal history. Prevention involves self-awareness, emotional honesty, and addressing vulnerabilities. The DOVE framework (Desire, Opportunities, Values, Education) can help psychotherapists enhance resilience and minimize vulnerabilities, ultimately leading to more ethical and effective practice.

Understanding ethical drift in professional decision making: dilemmas in practice

Bourke, R., Pullen, R., & Mincher, N. (2021).

International Journal of Inclusive Education,

28(8), 1417–1434.

https://doi.org/10.1080/13603116.2021.1992679

Abstract

Educational psychologists face challenging decisions around ethical dilemmas to uphold the rights of all children. Due to finite government resources for supporting all learners, one of the roles of educational psychologists is to apply for this funding on behalf of schools and children. Tensions can emerge when unintended ethical dilemmas arise through decisions that compromise their professional judgement. This paper presents the findings from an exploratory study around educational psychologists’ understandings and concerns around ethical dilemmas they faced within New Zealand over the past 5 years. The study set out to explore how educational psychologists manage the ethical conflicts and inner contradictions within their work. The findings suggest that such pressures could influence evidence-based practice in subtle ways when in the course of decision making, practitioners experienced some form of ethical drift. There is seldom one correct solution across similar situations. Although these practitioners experienced discomfort in their actions they rationalised their decisions based on external forces such as organisational demands or funding formulas. This illustrates the relational, contextual, organisational and personal influences on how and when ‘ethical drift’ occurs.

Here are some thoughts:

This article is highly relevant to psychologists as it examines the phenomenon of "ethical drift," where practitioners may gradually deviate from ethical standards due to systemic pressures like limited resources or organizational demands.

Focusing on educational psychologists in New Zealand, the study highlights the tension between upholding children's rights—such as equitable education and inclusion—and navigating restrictive policies or funding constraints. Through real-world scenarios, the authors illustrate how psychologists might rationalize ethically ambiguous decisions, such as omitting assessment data to secure resources or tolerating reduced school hours for students.

The article underscores the importance of self-awareness, advocacy, and reflective practice to counteract ethical drift, ensuring that professional judgments remain aligned with core ethical principles and children's best interests. By addressing these challenges, the study provides valuable insights for psychologists globally, emphasizing the need for systemic support, ongoing dialogue, and ethical vigilance in complex decision-making environments.