As the issue of assisted dying continues toward more expanded legal standing, we shift our primary focus from questions of patients' rights to the largely overlooked challenges that face physicians who elect to assist patients in ending their lives. Dr. Howard Grossman, a Manhattan internist and plaintiff in the unsuccessful New York lawsuit to the Supreme Court (Vacco v. Quill), came forward to say, “Anybody who has done it knows that it is a tremendous decision that you carry with you forever.”1 We focus our attention on the psychological experience and philosophical conflicts faced by physicians engaged in physician-assisted dying (PAD). Based on those potential conflicts, we argue for a new model of the physician and patient relationship in assisted dying: a medical friendship.We wish to express our most sincere appreciation to all the physicians who spoke so openly and generously about what can only be described as profound and life-altering experiences with dying patients. We also wish to thank the Section of Philosophy and Medical Ethics of the Vrije Universiteit Medical Center (Professor Evert van Leeuwen, Ph.D., Chair) for consenting to serve as the host institution for this study. This project was also made possible by a generous grant from the Research Foundation of the Professional Staff Congress of the City University of New York.