In Reply We read with interest Sperling’s letter, which raised 3 concerns regarding our article1 on Oregon’s Death With Dignity Act. First, the letter noted that only a small fraction of the patients discussed in our article1 used medical aid in dying (MAID) (note that our article and the letter both used older terms for this therapeutic option) because of uncontrolled pain. Our point was that unrelieved pain is a truly unfortunate reason underlying MAID use, in that dedicated palliative care should be able to relieve physical discomfort in nearly all cases.2 Sperling suggests that it would be better to draw the line between pain relief and other “approved” but controversial reasons (eg, loss of dignity), and that society will continue to accept even more provocative motives underlying the patient’s decision for MAID. While we are interested in whether we can better palliate patient concerns and alleviate the need for MAID, we do point out that there is no requirement for society, the attending physician, family, or anyone else to legally approve the patient’s reason for seeking MAID. Oregon tracks that information, but the option of using MAID is not subject to disapproval, regardless of why the patient desires it.