New York’s Medical Aid in Dying Act officially took effect Wednesday, allowing certain terminally ill adults to request life-ending medication, though access to the law is expected to vary across the state as hospitals and healthcare systems determine whether and how they will participate.

With the law now in force, New York becomes the 13th U.S. jurisdiction to authorize medical aid in dying, joining 12 other states and Washington, D.C. Under the legislation, mentally competent adults who have been diagnosed with a terminal illness and are expected to live six months or less may request medication to peacefully end their lives.

The New York State Department of Health says patients must be capable of administering the medication themselves, a requirement intended to ensure that the decision is made voluntarily and intentionally. The law does not compel physicians, hospitals, or healthcare providers to participate, and many are still awaiting additional guidance from the Department of Health. State officials have also emphasized what the governor’s office describes as “additional guardrails that will make sure people won’t be taken advantage of.”

The new law remains highly controversial, with opponents warning that it could place vulnerable individuals at risk.

“As part of our work, the work of the church, we do a lot to care for the vulnerable, vulnerable populations. And that includes the medically disenfranchized, the poor, the medically underserved, and, of course, the disabilities community,” Kristen Curran, the New York State Catholic Conference’s Director of Government Relations said. “We do a lot of work with the disabilities community. And we know, again, having watched this law be implemented elsewhere. We know that this is a very dangerous and devastating law.”

Supporters argue that individuals facing terminal illness should be free to make their own end-of-life decisions without religious objections preventing others from exercising that option.

“We also don’t believe that the religious views of some should be able to stop other people from using a law if they so desire,” Death With Dignity National Legislative Consultant Geoff Sugerman said.

New York’s legislation closely mirrors Oregon’s pioneering law, which was first enacted in 1994. Since then, several states have modified their statutes by expanding eligibility, permitting advanced practice nurses and nurse practitioners to participate in the process, eliminating residency requirements, and shortening waiting periods between approval and the dispensing of medication. In New York, the required waiting period is five days.

The law has already been challenged in court.

Just last week, a federal district judge ruled that a lawsuit filed by a coalition of disability rights advocates could not proceed because the plaintiffs lacked legal standing, rejecting their request to block the law from taking effect.

A separate lawsuit has been filed by four Catholic religious orders and several Catholic healthcare ministries, which argue that the law violates their religious liberty by compelling them to participate in medical practices that conflict with their religious beliefs.