In order to comply with California’s End of Life Option Act, healthcare organizations must post their medical aid in dying (AID) policy on their publicly accessible website. We analyzed available policies for whether organizations choose to participate in AID and whether organizations add restrictions to or conditions of participation for healthcare providers or patients that are not contained in the text of the law. Our research demonstrates that healthcare organizations, most of them private, mediate medical decision-making rights granted by the state. This chapter focuses on a few organizations’ AID policies to illustrate this process, and demonstrates how employment contracts with healthcare professionals and medical staff bylaws and staff privileges for physicians constrain involvement in AID and affect the physician–patient relationship. This chapter argues that the spread of AID across the United States is mostly a symbolic victory for patient rights advocates because in practice, this option is not available to many patients due to healthcare organizations’ policies. This chapter concludes by suggesting changes to informed consent practices so that seriously ill patients are informed about whether their current care providers participate in AID before the patients would need to make the request, so they can find new doctors if this is an end-of-life option they wish to pursue.