Medical Aid in Dying

Medical aid in dying is a medical practice that gives mentally competent individuals with a life expectancy of fewer than six months a prescription for lethal medication that they can administer themselves when they choose to die. Also known as physician-assisted dying or simply aid in dying, the practice was formerly called physician-assisted suicide. However, in recent years, multiple physician groups, including the American Academy of Hospice and Palliative Medicine and the American Academy of Family Physicians, have adopted policies that reject the term suicide in this context. Additionally, in 2008,  the American College of Legal Medicine,a pre-eminent organization that helps shape policy on issues involving medicine and the law, adopted a resolution denouncing the use of the word “suicide” when referring to people who choose to end their lives when they are terminally ill. 

The guiding principle behind aid-in-dying is “death with dignity.” Advocates believe that individuals who are already dying from a terminal illness have the right to determine when and by what means their life ends. Research suggests that most people who pursue the option do so not as a result of unbearable suffering, but because they want to have some control over what remains of their life. For many, just having the prescription is enough to provide that sense of control. According to data provided by Compassion & Choices, over one-third of people who go through the process of obtaining a prescription for MAID never take the lethal drugs. For those who do, exhaustion and fatigue are the primary reasons given for their decision, not physical suffering or pain. 

Aid-in-Dying Safeguards

In the U.S., safeguards are built into aid-in-dying laws in order to protect vulnerable individuals. These typically include requirements such as:

• The individual must be a mentally competent adult. Those with intellectual disabilities or dementia are precluded from participating in MAID. 
• Requests for MAID must be made by the patient in writing; in some states, the request must be made twice with a waiting period between requests.
• A mental health evaluation may be deemed necessary in order to ensure that the individual is not suffering from treatable depression or suicidal ideation related to a treatable cause.
• Two physicians or a physician and another healthcare provider are required to approve the request. 
• The medication must be self-administered through the oral or rectal route. Intravenous administration is prohibited. 

Medical Aid in Dying vs Euthanasia

Medical aid in dying is distinct from euthanasia, which is the intentional killing of another to alleviate their suffering. In the United States, a core tenet of all aid-in-dying laws is voluntary self-administration of the drugs used to induce death. However, this is not the case everywhere. Canada, for example, allows physicians and nurses to administer a lethal dose of medication to any adult who meets certain medical and legal criteria and has voluntarily requested it. Similarly, the Netherlands allows physicians to perform euthanasia on any person over the age of 16 whose suffering is extreme, whether or not they are terminally ill. Belgium, Luxembourg, Australia and New Zealand allow the practice as well. 

It’s important to note that euthanasia may be “active” or “passive.” Active euthanasia, sometimes called “mercy killing” involves doing something to an individual that will certainly cause their death, such as administering a lethal drug or poison. Passive euthanasia involves allowing someone to die by withholding or withdrawing treatment that will keep them alive, such as taking a person off life support. The former is outlawed in many countries, including the United States. However, passive euthanasia is widely practiced, legal and morally acceptable across most of the globe as long as it is done in accordance with the patient’s wishes or those of their next of kin. 

The Long History of Medical Aid in Dying

The concept of medical aid in dying is not a new one. For millennia, humans have explored the possibility of a swift and certain death when faced with intolerable and interminable suffering. In ancient Greece and Rome, for example,”mercy killing” was legal, and physicians would routinely provide lethal poisons to patients who were suffering from severe illness or disability. Even after the Greek physician and philosopher Hippocrates condemned the practice in the Hippocratic Oath, few physicians complied with his edict. Most believed that allowing a patient to linger in agony was a worse offense than helping them die a peaceful death.

During the mid-to-late Middle Ages, however, the rise to power of the Roman Catholic Church began to influence attitudes and cultural norms around physician-assisted death. The teachings of noted theologian and philosopher St. Thomas Aquinas, in particular, became a bedrock of the Church’s position on assisted dying and suicide. Aquinas taught, among other things, that redemptive suffering is consistent with God’s plan, and that suicide, even in the face of prolonged agony, is an irredeemable sin. In accordance with these teachings, the Church adopted the position that anyone who died by suicide would be denied Catholic funeral rites and burial in consecrated ground. The Church maintained this position until the late 1960s, when it began allowing a Catholic funeral and burial for people who had taken their own lives. It further softened its position in 1990, when Pope John Paul II changed the Church’s official teachings on the irredeemable nature of suicide, stating, “ We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for repentance.”

Medical Aid in Dying Through the 19th Century

Throughout the 16th and 17th centuries, cultural and religious opposition to suicide and physician-assisted death remained strong. And while the early settlers of the nascent United States rejected many of the tenets of Catholicism, they continued to adhere to British common law, which classified suicide and physician-assisted suicide as crimes. This opposition softened somewhat during the late 17th century Enlightenment, which introduced a greater emphasis on reason, the pursuit of happiness and personal autonomy. However, during  the early 18th century, the Great Awakening unleashed strong religious backlash against secular rationalism in the American colonies. By the early 1800s, this had solidified into almost complete rejection of the notion of assisted dying, and in 1828 New York became the first state to codify the prohibition in state law. By 1885, most of the U.S.territories had followed suit. 

These legal prohibitions and attitudes prevailed throughout most of the rest of the 19th century both in the U.S. and across the globe.

20th Century Ushers in Change

By the early 1900s, however, changes in medicine and pharmacology ushered in a new wave of interest in both euthanasia and physician-assisted death. In 1905 and 1906, two bills were introduced in the Ohio legislature that would allow aid in dying for terminally ill adults and euthanasia of infants who were ‘hideously deformed.” Both bills were defeated, but they opened up an ongoing debate about the ethics of medical aid in dying that continues to this day. 

Then in 1915, Dr. Harry J. Haiselden, then chief of staff at Chicago’s German-American Hospital, declined to perform potentially life-saving surgery on an infant who was born with multiple physical deformities. The infant died 5 days later, setting off a firestorm of debate that reverberated across the United States. Haiselden’s actions even became the subject of a 1917 film, “The Black Stork,” which sparked many prominent figures, including Helen Keller and Clarence Darrow, to speak out in his defense. Although the idea is abhorrent to most Americans today, their position was that doctors had the right and the duty to decide whether a disabled infant should live or die. 

In fact, neonatal euthanasia was the initial impetus to reform America’s aid-in-dying laws. Around the time of the Great Depression, when Americans were competing for scarce resources and scarcer jobs, the idea that severely physically or mentally handicapped children should be allowed to die was supported by nearly 45% of Americans, according to one public opinion poll. This idea dovetailed with the evolving eugenics movement, which advocated for the sterilization of disabled persons and the prohibition of interracial marriage for the benefit of society as a whole. Support for the concept waned considerably during WWII, however, when news of the Nazi’s mass extermination of millions of Jews and political prisoners, as well as disabled children and the mentally ill, reached America’s shores. 

Nonetheless, the movement towards legalizing medical aid in dying and euthanasia made slow but steady progress through much of the 20th century. In 1945, Switzerland became the first country to allow physicians to legally prescribe a lethal medication for patients who were terminally ill. But in the U.S. the end of World War II and the growth of the Middle Class left Americans less interested in discussions around suffering and death, and support for the concept waned. 

Perhaps as a result of this shift, the Euthanasia Society of America, which was formed in 1938 to promote the concept of medical aid in dying for the terminally ill, refocused its messaging to encourage public acceptance of passive euthanasia, or allowing natural death, versus allowing doctors to help patients die. This idea slowly gained support among Americans, a majority of whom believed that a dying person had the right to refuse treatment to prolong their life. In 1976 California became the first state in the nation to pass a law granting terminally ill individuals the right to authorize the withdrawal of life-sustaining treatment if it seemed that death was inevitable. By 1977, seven other states, New Mexico, Arkansas, Nevada, Idaho, Oregon, North Carolina, and Texas, had signed right-to-die bills into law. The right to refuse medical treatment was eventually codified in federal law in 1990, when Congress passed the Patient Self-Determination Act. 

The First Aid in Dying Law

As the 20th century progressed, a number of “right to die” organizations sprang up across the United States, each advocating for the right of terminally ill individuals to refuse life-saving treatment and receive aid in dying if that was their choice. Of these, perhaps the most influential was the Hemlock Society. Formed by Derek Humphrey in 1980, the organization was extremely successful in promoting the notion that terminally ill individuals have the right to choose the circumstances of their own death, whether by refusing treatment or by self-administering a legally prescribed lethal drug. By the early 1990s, it boasted over 50,000 members, and support for medical aid in dying among American adults reached an all-time high. The organization eventually rebranded itself as End of Life Choices, and in 2005 merged with Compassion in Dying to form Compassion & Choices, which is now the largest end-of-life advocacy organization in the United States. 

Throughout the 1990s, many state legislatures took up the issue of aid in dying with varying degrees of success. The first state to actually allow aid-in-dying was Oregon, which passed the Death with Dignity Act by voter initiative in 1994. But the federal government stopped the implementation of the law through a federal injunction while challenges to its validity worked their way through the courts. Eventually, in 1997, the act became law. Nonetheless, the federal government continued to take steps to make aid in dying difficult for Oregon’s citizens. These included the following: 

• In 1997, President Bill Clinton signed the federal Assisted Suicide Funding Restriction Act of 1997, which prohibits the use of federal Medicare funds for medical aid in dying. 
• That same year, the Supreme Court ruled in Washington v. Glucksberg that there is no constitutionally guaranteed  right to die. States may outlaw aid in dying if they choose.
• In 2001, U.S. Attorney General John Ashcroft issued a directive barring Oregon from implementing the Death with Dignity Act, claiming that the state had usurped the power of the federal government to limit the use of controlled substances in medical practice. That action led to a string of lawsuits that culminated in the 2006 Supreme Court ruling in Gonzalez v Oregon which upheld Oregon’s right to offer aid in dying to its citizens. 

Since that landmark Supreme Court decision, nine other U.S. states and the District of Columbia have enacted aid-in-dying laws. It is now legal in California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico and Washington. Further, Oregon recently passed legislation removing its residency requirement for aid in dying, meaning terminally ill individuals from other states can travel to Oregon to avail themselves of the Death with Dignity Act. 

Current Attitudes Towards Medical Aid in Dying

In the United States, support for medical aid in dying has been strong for decades. According to a 2018 Gallup poll, 72% of Americans believe that euthanasia should be legal and a slightly smaller majority believes that doctors should be allowed to help terminally ill patients “commit suicide.” This majority holds firm among regular churchgoers, but dips to 37% among those who attend church every week. This disparity most likely reflects the strong opposition to medical aid in dying by many religious faiths, including the Roman Catholic Church, many Protestant sects, Islam and Judaism. 

Acceptance of the concept of medical aid in dying also appears less robust among people of color, particularly African Americans and those of Hispanic descent. This appears to be borne out by a study published in Sociology of Health and Illness in 2019, which found that persons who participate in aid in dying are almost exclusively white. In Oregon, for example, where aid in dying has been legal for over 20 years, only 3% of patients who obtained aid-in-dying drugs were any race other than Caucasian. This also holds true in California, which is far more racially and ethnically diverse. Since the implementation of the California End of Life Options Act, 89.5% of those who participated in aid-in-dying have been white. 

This disparity may not reflect negative perceptions of medical aid in dying among people of color, however, but instead be a marker for decreased knowledge about and access to quality end-of-life care. Numerous studies have documented racial disparities in healthcare across all age groups, and this undoubtedly continues as people approach the end of life. Black and Hispanic Americans are far less likely to engage in hospice or palliative care services than whites, for example, and are more likely to request aggressive interventions during the last few months of life. This may reflect cultural beliefs around the notion of what constitutes a good death;  a deep distrust of the healthcare profession due to its historic victimization of Black and Hispanic individuals, or subtle discrimination by doctors who fail to explore end-of-life options with people of color in the same way they do with people who are white. 

In Europe, public opinion on medical aid in dying is more divided. While some countries have adopted laws allowing it, such as Switzerland, Belgium and the Netherlands, other countries have kept strict laws against it. In Great Britain, both aid in dying and euthanasia are illegal and punishable by up to 14 years in prison. The last aid-in-dying legislation proposed there was defeated in 2016. But another proposal to change the law to allow physician assisted death was introduced in 2021, and is currently being debated by the commons health and social care committee, which is expected to report its findings by late 2023. 

Meanwhile, Spain legalized both active euthanasia and medical aid in dying in 2021, but Italy continues to outlaw the practice entirely despite recent proposals to liberalize the law. Many other European countries are actively debating the issue, but it is almost certain that the legality of euthanasia and aid in dying will vary drastically across Europe for some time to come. 

Summary

In summary, medical aid in dying, once known as physician-assisted suicide, is a medical practice that allows individuals who meet certain medical and legal criteria to obtain a prescription that will allow them to take their own life. In the U.S., it is legal in only a handful of states, although public opinion is widely in favor of allowing the practice for competent, terminally ill adults. 

Medical aid-in-dying differs from euthanasia, a practice in which a healthcare professional administers life-ending medicines to an individual who meets certain medical criteria. Euthanasia is illegal in the United States, but it is legal in Canada and a number of countries throughout Europe. 

Sources:

“Assisted dying: The motivations, benefits and pitfalls of hastening death”. American Psychological Association. https://www.apa.org/monitor/2017/12/ce-corner#:~:text=%22In%20our%20research%2C%20the%20main,

“H.R.4449 – Patient Self Determination Act of 1990”. Congress.gov. https://www.congress.gov/bill/101st-congress/house-bill/4449

“Washington v. Glucksberg, 521 U.S. 702 (1997)”. Justia. https://supreme.justia.com/cases/federal/us/521/702/

“US Supreme Court upholds Oregon’s Death with Dignity Act”. The BMJ. https://pmc.ncbi.nlm.nih.gov/articles/PMC1352080/

“Oregon ends residency rule for Death with Dignity law”. OPB. https://www.opb.org/article/2022/03/28/oregon-ends-residency-rule-for-medically-assisted-suicide/#:~:text=requirement%20as%20unconstitutional-,Oregon%20will%20no%20longer%20require%20people%20to%20be%20residents%20of,challenged%20the%20requirement%20as%20unconstitutional.

“Americans’ Strong Support for Euthanasia Persists”. Gallup. https://news.gallup.com/poll/235145/americans-strong-support-euthanasia-persists.aspx

“Religious Groups’ Views on End-of-Life Issues”. Pew Research Center. https://www.pewresearch.org/religion/2013/11/21/religious-groups-views-on-end-of-life-issues/

“Expanded definitions of the ‘good death’? Race, ethnicity and medical aid in dying”. Sociology of Health & Illness. https://onlinelibrary.wiley.com/doi/10.1111/1467-9566.12903

“California End of Life Option Act”. Kaiser Permanente. https://healthy.kaiserpermanente.org/southern-california/health-wellness/life-care-plan/end-of-life-option-act

“Reckoning with histories of medical racism and violence in the USA”. PubMed Central. https://pmc.ncbi.nlm.nih.gov/articles/PMC7529391/

“Euthanasia and assisted suicide”. NHS. https://www.nhs.uk/tests-and-treatments/euthanasia-and-assisted-suicide/

“Italian Legal Euthanasia: Unconstitutionality of the Referendum and Analysis of the “Italian” Problem”. Frontiers in Sociology. https://www.frontiersin.org/journals/sociology/articles/10.3389/fsoc.2022.898783/full

“U.S. Scientists’ Role in the Eugenics Movement (1907–1939): A Contemporary Biologist’s Perspective”. Zebrafish. https://pmc.ncbi.nlm.nih.gov/articles/PMC2757926/

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“Assisted dying: The motivations, benefits and pitfalls of hastening death”. American Psychological Association. https://www.apa.org/monitor/2017/12/ce-corner

“Medical Aid-in-Dying Utilization Report”. Compassion & Choices. https://compassionandchoices.org/resource/medical-aid-in-dying-utilization-report/

“What Is Suicidal Ideation?”. WebMD. https://www.webmd.com/mental-health/suicidal-ideation

The availability of medical aid in dying (MAID) in some states has often prompted debates regarding its economic implications for healthcare systems. What is frequently viewed as a matter of potential cost savings for healthcare systems also holds a significant financial impact for those with life-limiting diseases and their loved ones. Supporters have suggested that MAID may potentially reduce costs associated with end-of-life care. But opponents have also argued that it could introduce additional ethical considerations due to its potential damage to the relationships between patients and providers. 

In the context of potential cost savings for healthcare systems, a common perspective holds that allowing terminally ill patients to choose medical aid in dying would reduce healthcare spending associated with end-of-life care. For example, one-quarter of Medicare spending accounts for care provided to patients during their final year of life. This can also have financial implications for the loved ones of these dying patients since a caregiver or family member is often covering many out-of-pocket costs to ensure maximum comfort at the end of life. However, it is important to note that most patients who request medical aid in dying are already enrolled in hospice and have discontinued many of the expensive components of care, such as curative treatments.

There are a few ethical implications concerning the financial impact of medical aid in dying, particularly as economic shifts continue to negatively influence the accessibility and affordability of healthcare. A common concern is that patients who are aware of the financial burden of care may feel pressured to choose medical aid in dying as a means to reduce the cost of care that is managed by their family or loved ones. Another common concern is that the financial impact may influence the relationship between patients and their providers. While healthcare providers would typically view the patient’s request for MAID as a decision made in the context of quality of life and personal values and goals, the financial implications may prompt them to question the patient’s motives. An equally damaging consideration is that patients may begin to question whether the quality of care that they receive from their healthcare provider is influenced by a need to reallocate resources. 

The conversation and controversy surrounding the economic implications of medical aid in dying among patients, providers, and the healthcare system remain ongoing as new financial concerns continue to arise. It remains a sensitive topic among MAID advocates, especially concerning those who feel that the practice is already financially prohibitive. Ultimately, healthcare providers, patients, and their families must consider the influence and impact of MAID in the context of personal finances and choices that will be in the best interest of the patients involved. 

Sources

“End-of-Life Care, Not End-of-Life Spending”. JAMA Forum. https://jamanetwork.com/channels/health-forum/fullarticle/2760146 

“Insurance Coverage & Medical Aid in Dying”. Compassion & Choices. https://compassionandchoices.org/resource/insurance-coverage-medical-aid-dying/

Medical aid in dying (MAID) is currently legal in a limited number of states, and each state has its own safeguards and eligibility criteria that individuals must meet to access the procedure. However, increased advocacy for expanded access to MAID and a noticeable shift in public opinion regarding end-of-life options may aid in facilitating the evolution of medical aid in dying within the United States. More notably, more states may begin to pass legislation to legalize MAID or expand the eligibility criteria. 

A greater acceptance of medical aid in dying and more widespread public awareness may have the potential to increase the visibility of MAID to lawmakers who can revisit existing laws. This opens the possibility of expanding access in a number of ways. This could include standardizing important components in each state’s approach to MAID or expanding access to additional patient populations that are currently ineligible. Eventually, the options for MAID that are available in other countries might become accessible to patients in the United States. 

Advances in medical ethics and the provision of end-of-life care might further shape the future of medical aid in dying. The ethical concerns and dilemmas that are a topic of ongoing debate in the present might otherwise be resolved with the introduction of new guidelines and protocols. These changes could further enhance end-of-life care training provided to healthcare professionals, improve support systems and resources provided to patients and families, and help provide answers to many of the difficult questions that surround MAID in today’s landscape. 

Finally, it is important to acknowledge that the future of medical aid in dying will likely depend significantly on the clarification and amendment of current legal frameworks. Whether there are changes in perspectives on ethics, the delivery of care, or the patient populations that can access MAID, all of these components will need significant legal support and oversight. Ultimately, consistent and unified advocacy surrounding MAID will remain a necessity to ensure the provision of this end-of-life care option continues to progress. 

Sources

“Supporters optimistic that aid-in-dying legislation could get vote in 2024 General Assembly”. Maryland Matters. https://marylandmatters.org/2023/12/04/supporters-optimistic-that-aid-in-dying-legislation-could-get-vote-in-2024-general-assembly/

The decision to deny access to medical aid in dying (MAID) for those who meet eligibility criteria can have significant consequences for those individuals and their loved ones. When individuals with life-limiting diseases are denied access to MAID, it can have an intense psychological and emotional impact due to the implications it can have on their quality of life. Notably, it may cause some individuals to feel that their autonomy has been violated or that they lack control over important decisions regarding their care. 

Some individuals may experience increased distress due to the possibility of experiencing prolonged suffering or loss of function due to disease progression. This possibility is not only overwhelming for those who have a life-limiting disease, but also for their loved ones who may be having difficulty witnessing an overall decline in health and physical function. Both may begin to feel helpless or that they are running out of options. They may also experience financial difficulties associated with the cost of care and medical interventions. 

Denying access to medical aid in dying may also have the potential to increase the risk of individuals harming themselves. The inability to die on their own terms through medical aid in dying may influence some individuals to seek alternative methods of ending their lives. In seeking and attempting to die using alternative methods, there is an increased risk of these individuals experiencing serious injuries and paralysis rather than fatality. It also exposes loved ones to the potential trauma of finding the body of a loved one who has taken their own life through violent means, such as a firearm.

Overall, denying access to MAID for those who have met the eligibility criteria can have a detrimental effect on patients and their loved ones. It can result in a variety of psychological and emotional turmoil, financial setbacks, and even serious setbacks to physical health. Ultimately, it highlights the importance of providing end-of-life care options that respect the preferences and values of those who have life-limiting diseases. 

Sources

“Experiences and perspectives of people who pursued medical assistance in dying”. The Official Publication of The College of Family Physicians of Canada. https://pmc.ncbi.nlm.nih.gov/articles/PMC6135118/ 

“Rethinking Medical Aid in Dying: What Does It Mean to ‘Do No Harm?’”. Journal of the Advanced Practitioner in Oncology. https://pmc.ncbi.nlm.nih.gov/articles/PMC10258856/

When a family opposes someone’s decision to choose medical aid in dying, it can quickly become an emotionally charged situation. Alternative sources of support in these situations can include a counselor or therapist, a patient advocate, an end-of-life doula, or even a local organization that advocates for MAID. The available support may vary depending on the individual’s location and local resources. 

Reaching out to mental health professionals, such as counselors or therapists, can be helpful since they provide a safe space to share thoughts and emotions. A therapist can create a more supportive environment for the individual to process the opposition from their family. They can also help the client develop coping strategies to help manage the conflict. Depending on the expertise of the counselor or therapist, they may also offer family therapy to allow family members to voice their thoughts, fears and concerns. 

Connecting with a patient advocate is another option. These individuals know the challenges that can emerge when patients pursue medical aid in dying. Patient advocates can provide education and guidance about MAID and allay the family’s fears about how the process will unfold. Similarly, an elder mediator can help guide discussions so that the dying individual and the family members who oppose their decision feel heard. Many end-of-life doulas are also skilled at navigating these challenging conversations with their clients. They can help facilitate the discussion that encourages loved ones to support their loved one’s final wishes, even if they disagree.  

Often, organizations that participate in advocacy for MAID have additional resources for individuals seeking support. These can include support groups, hospices, clinicians, and other options to help individuals navigate their MAID decision in a supportive and positive environment. Ultimately, it is essential for individuals considering MAID to establish a support network that will uphold and respect their autonomy while providing emotional support when necessary, especially if family members or other loved ones are not receptive to their decision. 

Sources

“In some families, medical assistance in dying is anything but a peaceful ending”. Broadview. https://broadview.org/medical-assistance-in-dying-families/ 

“Death with Dignity”. Good Therapy. https://www.goodtherapy.org/blog/psychpedia/death-with-dignity 

“Elder and Family Mediation Services”. National Care Planning Council. https://www.longtermcarelink.net/eldercare/elder_mediation.htm

It may be difficult for loved ones to understand and accept your decision to pursue MAID, resulting in conflicting emotions after the death has occurred. Some individuals find peace in knowing that their loved one was able to die according to their preferences and values. They may also feel reassured by the understanding that their loved one was comfortable prior to death, and that there weren’t any concerns surrounding pain or suffering. Some studies have found that they may experience less grief and traumatic stress.

However, some individuals may have difficulty coping with their grief due to the perspective that their loved one chose to end their life. They may experience intense emotions such as guilt because they were unable to persuade their loved one to make a different choice, or even anger surrounding their loved one’s decision. Some individuals may feel confused about why their loved one would choose to die, or may view this decision as a form of suicide, which may be deeply upsetting to them. 

Although anticipatory grief is often present among the loved ones of those with a terminal illness, MAID may influence how they experience this grief. Individuals who have gradually attempted to prepare themselves for the eventual decline of their loved one’s health due to the progression of their disease may feel even less prepared at the realization that death may occur sooner than expected. 

The stigma associated with medical aid in dying can also affect how loved ones navigate their grief. Perspectives vary widely, and some individuals may express moral objections or negative perceptions that can make others feel judged if their loved one dies due to MAID. It can also be a potentially isolating experience since other people may have difficulty relating to this type of loss and may struggle to support the bereaved effectively. Both of these possibilities can result in disenfranchised grief. Ultimately, these factors may make loved ones feel less comfortable openly expressing their grief, limiting their ability to process the loss. 

Sources

“​​Experiences of grief-bereavement after a medically assisted death in Canada: Bringing death to life”. Death Studies. https://www.tandfonline.com/doi/full/10.1080/07481187.2021.1876790 

“Exploring the experience of supporting a loved one through a medically assisted death in Canada”. The Official Publication of the College of Family Physicians of Canada. https://pmc.ncbi.nlm.nih.gov/articles/PMC6135137/ 

“Grief and MAiD: Lessons Learned from Oregon”. Canadian Virtual Hospice. https://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/For+Professionals/For+Professionals/The+Exchange/Current/Grief+and+MAiD_+Lessons+Learned+from+Oregon.aspx

Medical aid in dying (MAID), viewed through the lens of various religious and spiritual traditions, evokes a wide array of perspectives. Some traditions regard life as sacred and oppose MAID, while others’ stances may vary based on personal faith and beliefs. Here, we delve into some of these perspectives and the principles that shape them.

In Judaism, the sanctity of life often results in opposition to MAID. However, the principle of reducing unnecessary suffering, known as “tza’ar ba’alei chayim,” plays a crucial role in Jewish discussions about MAID. This intersection of principles generates differing opinions within the Jewish community, particularly concerning terminally ill individuals or those experiencing immense distress.

Islam also regards life as sacred, with the belief that only Allah has the authority to end life. Consequently, MAID is generally considered forbidden, or “haram”. However, Islamic scholars often agree with withdrawing life-sustaining treatment for terminally ill patients, aligning with the principle of no obligation to prolong suffering. This context has led to a range of interpretations regarding MAID’s implications for patients.

There are a myriad of perspectives on MAID among Christian denominations. Life’s sanctity, upheld by Roman Catholics, Southern Baptists, and United Methodists, leads these denominations to oppose MAID, believing that the timing and manner of death are God’s domain. Conversely, denominations such as the United Church of Christ believe in the importance of individual autonomy and the provision of pastoral support in making end-of-life decisions. 

Buddhism, with its emphasis on reducing suffering and fostering compassion, also holds life as sacred. Consequently, MAID is often opposed due to potential negative impacts on karma and rebirth. However, interpretations vary among Buddhists. Hinduism, sharing similar beliefs in reincarnation and karma, generally opposes MAID. But the principle of non-violence, or “ahimsa,” which underscores causing no harm or pain, often sparks conflicting perspectives on MAID.

These perspectives on MAID, as diverse as their religious and spiritual origins, highlight the complex interplay of beliefs, values, and interpretations. They are shaped by the human experience and understanding of suffering, death, and the afterlife. Maintaining respectful dialogue is crucial to further understand and inform the collective conversation about MAID, as well as its varied perspectives among the devout.

Sources

“What is Reform Judaism’s position on allowing terminally ill people who are mentally competent to request medication from doctors to allow them to end their own lives?” Reform Judaism. https://reformjudaism.org/learning/answers-jewish-questions/what-reform-judaisms-position-allowing-terminally-ill-people-who 

“Medical Assistance in Dying: Challenges for Muslim Healthcare Professionals”. Journal of Pastoral Care & Counseling. https://www.researchgate.net/publication/327769636_Medical_Assistance_in_Dying_Challenges_for_Muslim_Healthcare_Professionals 

“Faithfully Facing Dying”. United Church of Christ. https://www.ucc.org/what-we-do/justice-local-church-ministries/justice/health-and-wholeness-advocacy-ministries/health-care-justice/faithfully_facing_dying/ 

“Buddhist Ethics and End-of-Life Care Decisions”. Journal of Social Work in End-of-Life & Palliative Care. https://www.tandfonline.com/doi/full/10.1080/15524256.2013.794060 

“MAID: Medical Aid in Dying”. Britannica. https://www.britannica.com/procon/MAID-medical-aid-in-dying-debate#hinduism

Medical aid in dying (MAID), viewed through the lens of various religious and spiritual traditions, evokes a wide array of perspectives. Some traditions regard life as sacred and oppose MAID, while others’ stances may vary based on personal faith and beliefs. Here, we delve into some of these perspectives and the principles that shape them.

In Judaism, the sanctity of life often results in opposition to MAID. However, the principle of reducing unnecessary suffering, known as “tza’ar ba’alei chayim,” plays a crucial role in Jewish discussions about MAID. This intersection of principles generates differing opinions within the Jewish community, particularly concerning terminally ill individuals or those experiencing immense distress.

Islam also regards life as sacred, with the belief that only Allah has the authority to end life. Consequently, MAID is generally considered forbidden, or “haram”. However, Islamic scholars often agree with withdrawing life-sustaining treatment for terminally ill patients, aligning with the principle of no obligation to prolong suffering. This context has led to a range of interpretations regarding MAID’s implications for patients.

There are a myriad of perspectives on MAID among Christian denominations. Life’s sanctity, upheld by Roman Catholics, Southern Baptists, and United Methodists, leads these denominations to oppose MAID, believing that the timing and manner of death are God’s domain. Conversely, denominations such as the United Church of Christ believe in the importance of individual autonomy and the provision of pastoral support in making end-of-life decisions. 

Buddhism, with its emphasis on reducing suffering and fostering compassion, also holds life as sacred. Consequently, MAID is often opposed due to potential negative impacts on karma and rebirth. However, interpretations vary among Buddhists. Hinduism, sharing similar beliefs in reincarnation and karma, generally opposes MAID. But the principle of non-violence, or “ahimsa,” which underscores causing no harm or pain, often sparks conflicting perspectives on MAID.

These perspectives on MAID, as diverse as their religious and spiritual origins, highlight the complex interplay of beliefs, values, and interpretations. They are shaped by the human experience and understanding of suffering, death, and the afterlife. Maintaining respectful dialogue is crucial to further understand and inform the collective conversation about MAID, as well as its varied perspectives among the devout.

Sources

“What is Reform Judaism’s position on allowing terminally ill people who are mentally competent to request medication from doctors to allow them to end their own lives?” Reform Judaism. https://reformjudaism.org/learning/answers-jewish-questions/what-reform-judaisms-position-allowing-terminally-ill-people-who 

“Medical Assistance in Dying: Challenges for Muslim Healthcare Professionals”. Journal of Pastoral Care & Counseling. https://www.researchgate.net/publication/327769636_Medical_Assistance_in_Dying_Challenges_for_Muslim_Healthcare_Professionals 

“Faithfully Facing Dying”. United Church of Christ. https://www.ucc.org/what-we-do/justice-local-church-ministries/justice/health-and-wholeness-advocacy-ministries/health-care-justice/faithfully_facing_dying/ 

“Buddhist Ethics and End-of-Life Care Decisions”. Journal of Social Work in End-of-Life & Palliative Care. https://www.tandfonline.com/doi/full/10.1080/15524256.2013.794060 

“MAID: Medical Aid in Dying”. Britannica. https://www.britannica.com/procon/MAID-medical-aid-in-dying-debate#hinduism

Medical aid in dying (MAID) is a clinical procedure that allows patients to receive medication from a physician to hasten their death. Since patients need to have a prognosis of 6 months or less to live and are required to self-administer the medication as part of the eligibility criteria, physical and physiological issues have the potential to affect the process when the patient decides they’re ready to take the medication. Most notably, since many patients are in a physically weakened state within the final months of their lives, it can be difficult for them to administer the medication on their own or administer it correctly. 

Some patients may have difficulty swallowing, either due to general weakness or the presence of an esophageal obstruction. Depending on the route of administration, such as by mouth or using a syringe, accidental spillage of the mixture may occur when attempting to self-administer. Taking a lower dose than prescribed has the potential to cause discomfort and may not result in immediate death. Assuming that the patient can administer the medications despite the physical challenges, physiological issues can also arise based on the status of the patient’s health and any associated symptoms they may experience due to chronic disease or side effects from other medications. Additionally, patients who have been taking opiates and antianxiety medication for pain and distress for a significant period of time often have developed a tolerance to the drugs used in MAID, which can prolong the time to death.

Digestion issues can significantly affect the absorption rate of aid-in-dying medications and reduce the lethality of the dose. Most of the medications that are prescribed in a MAID protocol are absorbed into the duodenum, which is part of the small intestine. For absorption to occur, the stomach has to empty and transfer its contents to the duodenum, which is delayed in patients with gastroparesis and other digestive disorders. Issues such as constipation and diarrhea can also affect absorption, particularly if the patient is unable to successfully self-administer the medication rectally. 

Sources

“Medical Aid in Dying: An Overview of Care and Considerations for Patients With Cancer”. Oncology Nursing Society. https://www.ons.org/publications-research/cjon/26/6/medical-aid-dying-overview-care-and-considerations-patients-cancer 

“Gastroparesis”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/syc-20355787

According to a 2018 study, the most common reason patients request medical aid in dying (MAID) is disease-related symptoms. This was most prominent among patients with cancer or malignancies compared to patients with neurological diseases or end-stage organ failure. Since these patients have already experienced symptoms such as pain or nausea, they know that there is a likelihood these symptoms will increase in severity and discomfort as death becomes more imminent. Patients who had requested MAID but did not utilize it during the study indicated that the fear of future suffering was their reason for making the request. 

Although disease-related symptoms are the most common reason, there are other reasons why patients may request MAID. These reasons can include the desire to maintain control and autonomy and concerns about the quality of life, including loss of independence, loss of function, lack of mobility, loss of the ability to speak or communicate, and the inability to participate in meaningful activities. Whether patients request MAID to prevent further suffering, to prevent loss of function, or for similar reasons, the prominent theme that emerges is that most people want to experience a death that aligns with their preferences. And they want to have the opportunity to decide on the timing and manner of their death while they still can. 

Sources 

“Reasons for requesting medical assistance in dying”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC6135145/ 

“Experiences and perspectives of people who pursued medical assistance in dying”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC6135118/ 

“Medical Assistance in Dying (MAiD): A Descriptive Study From a Canadian Tertiary Care Hospital”. American Journal of Hospice and Palliative Medicine. https://journals.sagepub.com/doi/abs/10.1177/1049909119859844

In the United States, current legislation does not permit family members, surrogates, healthcare agents, conservators, or other decision-makers to request medical aid in dying (MAID) on behalf of the patient. Additionally, although part of the eligibility criteria for MAID indicates that the patient must be able to make decisions regarding their care, the patient cannot include their request for MAID in their advance directive. The patient must request MAID following the specific directions and criteria outlined in the law, reflecting that the decision is voluntary and an act of autonomy. 

While this criterion aims to safeguard against misuse or coercion in the practice of MAID, it can inadvertently limit end-of-life choices for certain patient populations. Advocates have voiced concerns that these criteria may exclude individuals with disabilities, especially those with cognitive impairments. Despite their ability to express preferences, these individuals might not have their wishes acknowledged due to the perception that their disabilities affect their decision-making capacity. To address this, advocates propose considering supported decision-making as an alternative to surrogate decision-making, promoting increased accessibility to MAID.

In supported decision-making, the patient maintains their autonomy and ability to share their preferences with a supported decision-maker to establish that they have the capacity to make decisions regarding their care. This differs from surrogate decision-making, which grants the surrogate the full authority to make decisions on behalf of the patient. Currently, Colorado, Washington, and the District of Columbia are the only jurisdictions in the U.S. that have enacted legislation addressing both supported decision-making and MAID. However, how these legislations intersect in end-of-life settings remains to be seen since supported decision-making usually applies in other contexts, such as pain management. For now, MAID will only remain accessible to patients who can initiate and complete the request process independently within the context of the current eligibility criteria. 

Sources

“End of Life Option Act”. Sutter Health. https://www.sutterhealth.org/patient-resources/records-planning/end-of-life-option 

“Supported Decision Making Program”. Administration for Community Living. https://acl.gov/programs/consumer-control/supported-decision-making-program 

“Supported Decision-Making and Merciful Health Care Access: Respecting Autonomy at End of Life for Individuals with Cognitive Disabilities”. Washington and Lee Law Review. https://scholarlycommons.law.wlu.edu/cgi/viewcontent.cgi?article=4813&context=wlulr

Psychiatrists have a crucial role in medical aid in dying, assessing the patient’s mental health and evaluating their decision-making capacity. Since depression and other psychiatric disorders can impair a patient’s ability to make sound decisions, these evaluations are necessary to ensure that there aren’t any underlying mental health concerns that may influence the patient’s decision to choose medical aid in dying. It is important to note that a psychiatric evaluation is not always mandatory in states where MAID is authorized and is typically conducted when the physician holds concerns regarding the patient’s competency and capacity. 

When psychiatrists are involved in a request for MAID, they work in collaboration with the patient’s care team to ensure that the patient is fully aware of their alternative options and the consequences of their decisions. Due to the diverse array of perspectives and sensitivity regarding MAID, some psychiatrists may perceive this end-of-life decision as an ethical or moral dilemma and may be uncomfortable with their involvement in the process. Additionally, some psychiatrists may feel that the practice of MAID is contradictory to their code of ethics and may struggle with their personal biases.

Sometimes psychiatrists can provide additional counseling and support to patients who have requested MAID. This is typically more common among patients who struggle with psychological distress but are deemed to have the competence and capacity for decision-making. Options such as psychotherapy, motivational interviewing, and other interventions can help patients explore perspectives regarding their quality of life, preparatory grief, or their overall experience in relation to their prognosis. Since the patient’s loved ones are often affected by the patient’s decision to pursue MAID, some psychiatrists may help patients explore their relationships and the impact of their decision or provide additional support to the patient’s family and loved ones. 

Sources

“Role of Psychiatrists in Assisted Dying: A Changing Trend”. Psychiatry Online. https://psychiatryonline.org/doi/10.1176/appi.ajp-rj.2016.110902 

“Medical Assistance in Dying: Ongoing Challenges for Psychiatrists”. Psychiatry Advisor. https://www.psychiatryadvisor.com/features/medical-assistance-in-dying-ongoing-challenges-for-psychiatrists/ 

“Medical Aid in Dying: Ethical and Practical Issues for Psychiatrists”. Psychiatric Times. https://www.psychiatrictimes.com/view/medical-aid-dying-ethical-and-practical-issues-psychiatrists

Medication regimens for medical aid in dying (MAID) are developed explicitly in lethal combinations to ensure that patients die. Still, there are rare incidents involving complicated or prolonged deaths. These rare incidents can occur if the regimen includes medications not typically recommended for MAID, such as benzodiazepines or opioids, or if the provider has overestimated the lethality of the prescribed medicines in terminally ill patients. In these instances, the most common complications that can occur are failure to induce coma, awakening from the coma, or death that takes longer than anticipated. 

In some cases, complications may occur due to symptoms associated with the patient’s condition. The presence of symptoms that prevent proper medication absorption or interfere with self-administration can indicate that complications may occur. While these complications don’t prevent the patient from dying, they can delay or stop the dying process from progressing as intended (for example, the patient may remain awake after they were expected to become unconscious.) Common symptoms associated with MAID complications include gut issues and difficulty swallowing. Other factors include obesity, sedative tolerance, substance use, and difficulty following instructions. Additionally, young patients with a healthy cardiovascular system may have an increased risk of prolonged death since they are typically more resilient and resistant to medications that are toxic to the heart.

Although the patient’s self-administration of the MAID medication regimen is part of the eligibility criteria for patients in the United States, it has been suggested that self-administration is associated with MAID complications. Potential complications of self-administration include difficulty administering medications with a large syringe (for example, through a nasogastric or rectal tube) or difficulty taking the drugs due to their unpleasant taste. Since providers can only prescribe medications for MAID and cannot legally administer them, patients considering this end-of-life option are encouraged to discuss their concerns surrounding potential complications and how to avoid them. While it should be emphasized that complications and prolonged deaths are rare, dedicating additional time to planning and preparing for MAID can help patients and their loved ones feel reassured and at peace before administering the MAID drugs.

Sources

“Spain will become the sixth country worldwide to allow euthanasia and assisted suicide”. The BMJ. https://www.bmj.com/content/372/bmj.n147/rr-0 

“Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands”. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/nejm200002243420805 

“Factors for Prolonged Deaths (Red Flags)”. Academy of Aid-in-Dying Medicine. https://www.acamaid.org/courses/redflags 

“Medical Aid in Dying: When Legal Safeguards Become Burdensome Obstacles”. The ASCO Post. https://ascopost.com/issues/december-25-2017/medical-aid-in-dying-when-legal-safeguards-become-burdensome-obstacles/ 

“Provision of medical assistance in dying: a scoping review”. BMJ Open.https://pmc.ncbi.nlm.nih.gov/articles/PMC7348461/

The most common diagnoses of patients who request medical aid in dying (MAID) include cancer, neurodegenerative diseases such as ALS and dementia, respiratory diseases such as COPD, and heart disease. Among these patient populations, patients with cancer are the most likely to request MAID; 74% of patients across 9 jurisdictions were found to have a cancer diagnosis at the time of the request. Since many patients fear the loss of autonomy, poor quality of life, and inability to care for themselves at the end of life, they may consider MAID as a way to retain control and achieve a death that aligns with their values and preferences. 

A study examining 18 years of data pertaining to patient utilization of MAID in Oregon demonstrated similar findings regarding patients diagnosed with cancer and other forms of terminal illness. These findings were based on 991 patients who died following self-administration of a MAID medication regimen. The most common diagnoses were:

• Cancer: 762 patients (77.1%)
  • Lung cancer: 177 patients (17.9%)
  • Breast cancer: 73 patients (7.4%)
  • Pancreatic cancer: 63 patients (6.4%)
  • Colon cancer: 61 patients (6.2%)
  • Prostate cancer: 40 patients (4.0%)
  • Ovarian cancer: 36 patients (3.6%)
    
• Other diagnoses: 312 patients (31.6%)
  • Amyotrophic lateral sclerosis: 79 patients (8.0%) 
  • Respiratory disease: 44 patients (4.5%)
  • Cardiac disease: 26 patients (2.6%)
  • HIV/AIDS: 9 patients (0.9%) 
  • Other illnesses: 68 patients (6.9%)
  • Unknown: 3 patients 

While these findings provide insight into chronic disease prevalence among patients requesting MAID, it is important to consider that these are generalizations drawn based on limited access to MAID in the United States. Although it helps in conceptualizing the most common diagnoses among patients who request assistance, it remains challenging to fully quantify how these percentages might shift if MAID were an approved practice nationwide. Another important factor to consider is that patient utilization and access to MAID may vary based on insurance coverage, income or patient eligibility. In instances where MAID is financially prohibitive to patients or they aren’t eligible, their diagnoses are not represented in these findings.

Sources

“Medical Aid in Dying: Ethical and Practical Issues”. Journal of the Advanced Practitioner in Oncology. https://pmc.ncbi.nlm.nih.gov/articles/PMC10184842/ 

“Cancer Patients Most Likely to Use Medical Aid in Dying”. Cancer Therapy Advisor. https://www.cancertherapyadvisor.com/news/cancer-patients-most-likely-to-use-medical-aid-in-dying/ 

“Characterizing 18 Years of the Death With Dignity Act in Oregon”. JAMA Network. https://pmc.ncbi.nlm.nih.gov/articles/PMC5824315/

The average cost of medical aid in dying (MAID) varies based on the state where the patient resides and whether they have insurance coverage. Generally, the anticipated expenses associated with MAID arise from fees for consultations or office visits with healthcare providers and prescriptions for aid-in-dying medications. State-funded and private insurance plans in Hawaii, Oregon, and California cover costs for medication and consultations related to MAID according to specific criteria defined by end-of-life acts in those states. 

Uninsured patients have to pay out-of-pocket expenses to receive MAID. Patients who have federally funded insurance such as Tricare and Medicare are also subject to these expenses since the Assisted Suicide Funding Restriction Act (ASFRA) prohibits the use of federal funds to cover this end-of-life option. This restriction is often expensive for out-of-pocket payers since multiple consultations and office visits are typically required to meet eligibility criteria, and prescription medication costs frequently fluctuate. For example, one patient in California owed $2,100 in out-of-pocket expenses due to the cost of consultations with physicians ($1400) and aid-in-dying medications ($700). These costs are nearly comparable to the projected cost of MAID in Ontario, Canada, although these projections reflect a simplified process with fewer healthcare consultations. 

In the United States, patients requesting MAID need a minimum of two consultations with a physician. However, additional consultations can be required to evaluate the patient’s competency and capacity to make decisions regarding their care. Additionally, the cost of medications can vary based on what the physician prescribes and can quickly become financially prohibitive. For example, the price of secobarbital (Seconal) once the most frequently prescribed aid-in-dying medication, increased significantly when Valeant Pharmaceuticals International acquired rights to market the drug in 2015. The once affordable medication can now cost over $4000 for a lethal dose, often making it challenging for patients to afford. Alternative medications or combinations of medications can cost considerably less. However, these medicines may increase physical distress and/or extend the dying process. Shortages of these medications can also contribute to increased costs. 

Sources 

“Our Care, Our Choice Act”. HMSA. Retrieved from https://prc.hmsa.com/s/article/Our-Care-Our-Choice-Act-prc 

“Opinion: Medical aid in dying was a blessing for my husband. But a federal law makes it inaccessible for millions of Americans”. CNN. Retrieved from https://www.cnn.com/2022/09/03/opinions/medical-aid-in-dying-inaccessible-fairchild/index.html 

“Cost estimate for Bill C-7: Medical Assistance in Dying”. Office of the Parliamentary Budget Officer. Retrieved from https://qsarchive-archiveqs.pbo-dpb.ca/web/default/files/Documents/Reports/RP-2021-025-M/RP-2021-025-M_en.pdf
 
“Aid-in-dying medications can run from $500 to $4,000 in Colorado”. The Denver Post. Retrieved from https://www.denverpost.com/2017/12/14/colorado-aid-in-dying-medications-cost/

Although most aid-in-dying experts recommend that an individual taking medical aid in dying (MAID) drugs shouldn’t be alone at the time of administration, there are no specific indications of who should be present. Understandably, many people choose to have their loved ones present when they self-administer their MAID drugs since it ensures they are surrounded by the people who matter the most to them before their death. Having loved ones present also provides one more opportunity for them to share final sentiments or achieve some closure before the death occurs. 

Some individuals don’t have family, friends or loved ones who can be present with them when they take their MAID drugs. In those circumstances, the general recommendation is to ask hospice staff or clinicians to be present. While healthcare professionals cannot assist the individual with administering the drugs, they can provide support and comfort in a manner that is consistent with their personal values and professional ethics. However, this can vary based on the healthcare facility’s or hospice provider’s policy. Some advocacy organizations also help match individuals pursuing MAID to an aid-in-dying volunteer or a death doula who is willing to be present when the medication is taken.

While some dying persons may prefer to die alone, it is generally not recommended with MAID. Since many people who opt for medical aid in dying are weak due to disease progression, they may have difficulty preparing the medication or following the proper protocols. Additionally, if the medications are taken incorrectly or the dying process does not proceed as intended, the individual may need additional care or support. The presence of at least one other person can ensure that the MAID process is completed appropriately and help reduce the possibility of complications. 

Sources

“Physician Aid-in-Dying”. UC San Diego Health. https://health.ucsd.edu/patients/aid-in-dying/ 

“The Nurse’s Role When a Patient Requests Medical Aid in Dying”. American Nurses Association. https://www.nursingworld.org/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/social-causes-and-health-care/the-nurses-role-when-a-patient-requests-medical-aid-in-dying-web-format.pdf 

“Some Hospice Medical Aid in Dying Policies Require Staff to Leave Room”. Relias. https://www.clinician.com/articles/some-hospice-medical-aid-in-dying-policies-require-staff-to-leave-room

The length of time until death after ingesting medical aid-in-dying (MAID) medications can vary based on the progression of the patient’s disease and their ability to absorb the medicine. Individuals who are further along in the progression of their terminal illness may die more quickly after taking the medication due to the disease’s impact on their physical condition. Similarly, individuals who have difficulty absorbing medicines due to their illness may experience an extended time before death. Given all these factors, death may occur as soon as 5 minutes or even 18 hours after the person takes the medicine. 

The length of time to death can also vary based on the prescribed medications. Some medications are less effective in younger patients or those with stronger hearts when compared to older adults or elderly patients. Physicians can prescribe different medications or combinations to reduce the likelihood of a prolonged dying process if they suspect a patient may be more resilient. However, even in scenarios involving extended lengths of time before death, most patients will fall asleep or become unconscious within the first 5 to 10 minutes after taking the designated medications. 

A recent study found that the median time between ingesting the medicines and death was 6 minutes, and the extended time was 1 hour and 27 minutes. In most instances, patients died within 3 to 15 minutes. The length of time to death also varied based on the medications patients received. For example, patients who self-administered lidocaine experienced a prolonged time until death compared to those who did not receive lidocaine as part of their medication protocol. 

Being mindful of concerns surrounding prolonged time to death and the emotional impact it can have on family members and loved ones, patients should always discuss which medication protocol may be the best fit for their needs and preferences.

Sources
“The Doctors Who Invented a New Way to Help People Die”. The Atlantic. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

Many patients choose to take aid-in-dying medications in their homes or private residences. It is also possible for MAID to be performed in a care facility, but this often varies based on state laws. Data from Oregon has shown that 90% of patients who choose MAID will die at home. This option allows patients to die peacefully in a familiar environment with loved ones nearby. 

Patients who decide to perform MAID at home typically dedicate time to preparation and planning. Some prefer to prepare their space and make it as comfortable as possible before they take the prescribed medications. They may plan together with a trusted caregiver to ensure that their needs are taken care of before taking the next steps, or they may opt to invite loved ones over to spend time with them during the process. Many patients who request MAID are already receiving home hospice care, so they may receive additional support and resources to help them relax before the procedure. Patients may also request that their physician be present when they take the medication.

In some situations, patients may take their aid-in-dying medications in a facility such as a nursing home instead of in their home. As an example, some patients who request aid in dying live in skilled nursing or assisted living facilities due to the extent of their condition and the need for care. Many of these facilities prohibit aid in dying on the premises due to legal, medical and ethical concerns. However, there are some long-term care facilities that do allow patients to take aid-in-dying medications if the facility is classified as a private residence. Patients who may be considering aid in dying and are entering long-term care should be aware of the facility’s policies in advance.

Sources

“Physician-Assisted Death and Long-Term Services and Supports”. National Academies of Sciences, Engineering, and Medicine. https://nap.nationalacademies.org/read/25131/chapter/7#103 

“What is Medical Aid-In-Dying?”. Dying Right North Carolina. https://dyingrightnc.org/faq/ 

“Clinical Criteria for Physician Aid in Dying”. Journal of Palliative Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC4779271/

Current safeguards to prevent misuse of medical aid in dying (MAID) include:

• Fulfilling all eligibility criteria.
• Submitting multiple requests.
• Meeting with numerous healthcare professionals.
• Evaluating the patient’s competency and capacity to make a decision.

Although eligibility criteria for MAID are sometimes regarded as strict, they are necessary to ensure that this practice isn’t easily accessible to individuals who might misuse the process in some way.

Before any provider will consider a request for MAID, interested patients must meet the following criteria: 

• The patient must be an adult of at least 18 years of age or older 
• The patient must be terminally ill with a prognosis of six months or less left to live. 
• The patient must be capable of making decisions regarding their care
• The patient must be able to administer the aid-in-dying medications to themselves. 

The patient must meet all the criteria to proceed with the process. It is important to note that there are different methods for assessing patient competency and the capacity to make a decision. Some physicians make these assessments during their initial appointment to discuss MAID with the patient. Still, others may refer to a mental health provider for a formal and validated evaluation. The definition of capacity varies by state, as do the requirements for consulting with a mental health provider regarding MAID. In some states, this consultation is mandatory if there is any indication of a psychiatric disorder. In other states, it is only required if the psychiatric condition may impair the patient’s ability to make a decision. 

Throughout the process, the patient will meet with multiple healthcare professionals. These can include their prescribing physician, another consulting physician and a mental health professional for a capacity evaluation. In addition to completing these consultations, patients must submit multiple requests in different formats. This requirement also varies by state but can involve submitting a specific number of written requests and acknowledgments in addition to verbal requests within a designated period. For example, California requires patients to make two verbal requests for aid-in-dying medications with at least 48 hours between the requests. Patients must also complete an aid-in-dying request form from the Medical Board of California, which the patient and two witnesses must sign.

Sources

“Medical Aid in Dying”. Compassion & Choices. https://compassionandchoices.org/our-issues/medical-aid-in-dying/ 

“Assessing Competency in Aid-in-Dying Patients”. MedPage Today. https://www.medpagetoday.com/meetingcoverage/aapl/75971 

“Medical Aid in Dying: Ethical and Practical Issues”. Journal of the Advanced Practitioner in Oncology. https://pmc.ncbi.nlm.nih.gov/articles/PMC10184842/ 

“FAQs: End of Life Option Act at UCSF”. UCSF Health. https://www.ucsfhealth.org/education/faq-end-of-life-option-act-at-ucsf

A patient’s request for medical aid in dying (MAID) can be denied if they do not meet the eligibility criteria and demonstrate the capacity to make decisions in their own care. Similarly, even if the eligibility criteria and capacity requirements are met, the patient’s physician is not required to approve the request or prescribe the designated medications to aid the patient’s death. Therefore, residence in a state that authorizes MAID is not a guarantee that the patient will receive approval of their request. 

It is important to understand that although MAID is a legalized medical practice in multiple states, physicians are not required or obligated to provide it. For example, the End of Life Options Act (SB 128) allows California residents to request MAID if they meet the criteria but also indicates that participation is voluntary for all parties involved including patients, physicians, and healthcare staff. Some physicians are uncomfortable with providing MAID because they believe that it isn’t aligned with their medical ethics code, their values in relation to life, or their religious beliefs. 

Another example of unique circumstances that may cause MAID to be denied can be observed in Washington State’s Death with Dignity Act. In Washington State, healthcare facilities have the right to prevent pharmacists and providers from participating in the act. Participation can be prevented if the facility provides written notice to the general public and practicing providers on the premises to make them aware that MAID is prohibited. In these scenarios, the impacted providers are still allowed to determine that the patient has a terminal prognosis, share information about the Washington Death with Dignity Act, and give the patient a referral to another provider that may be able to offer MAID. 

Sources

“The Facts about Medical Aid in Dying”. Compassion & Choices. https://compassionandchoices.org/resource/the-facts-about-medical-aid-in-dying/ 

“Physician Aid in Dying”. UC San Diego Health. https://health.ucsd.edu/patients/aid-in-dying/ 

“When Patients Choose to End Their Lives”. The New York Times. https://www.nytimes.com/2021/04/05/well/live/aid-in-dying.html 

“Frequently Asked Questions About Death With Dignity”. Washington State Department of Health. https://doh.wa.gov/data-and-statistical-reports/health-statistics/death-dignity-act/frequently-asked-questions-about-death-dignity

Medical professionals determine eligibility for medical aid in dying according to a set of criteria based on the clinician’s assessment of the patient’s ability to understand the intricacies of making a decision and its potential consequences. The criteria for eligibility and capacity must be met along with a physician’s approval before a patient can receive medical aid in dying (MAID). Eligibility and capacity are also paired with safeguards to ensure that patients who have requested MAID are aware of alternative options and their right to rescind their request if they change their minds. 

In order to be eligible to receive MAID, patients must meet each of the following four criteria. 

• The patient must be an adult of at least 18 years of age or older 
• The patient must be terminally ill with a prognosis of six months or less left to live. 
• The patient must  be capable of making decisions regarding their own care
• The patient must be able to administer the aid-in-dying medications to themselves. 

Some states require that the patient’s prognosis must be determined by two physicians, although this can vary by jurisdiction. The requirement that the patient must be able to make their own healthcare decisions acknowledges the role of capacity when requesting MAID. 

There are different ways to determine general psychological capacity, such as the use of validated assessments like the MacArthur Competence Assessment Tool for Treatment. Although there are a number of validated capacity assessments available, there aren’t any that have specifically been developed for determining capacity for MAID. Some of the main elements associated with patient capacity in assessment tools include 

• Understanding information and treatment relevant to their condition, 
• Awareness of the implications of their care circumstances along with the potential consequences of their decisions
• The ability to reason about the risks and benefits of these decisions,
• The expression of their decision. 

Additionally, clinicians can assess decision-making capacity through conversation with the patient, which can help to identify if the patient is exhibiting terminal delirium or symptoms of concurrent mental illness. 

Sources

“Medical Aid in Dying”. Compassion & Choices. https://compassionandchoices.org/our-issues/medical-aid-in-dying/ 

“Medical Aid in Dying: Ethical and Practical Issues”. Journal of the Advanced Practitioner in Oncology. https://pmc.ncbi.nlm.nih.gov/articles/PMC10184842/ 

“The influence of cognitive distortions on decision-making capacity for physician aid in dying”. International Journal of Law and Psychology. https://www.sciencedirect.com/science/article/abs/pii/S0160252720300868?casa_token=5m2p7hSm0AwAAAAA:aAHAXTNi92QkWU3QDbKN45eJ1wTlhUGrElGckYDVr0aynojThjMQypFHf4kX8UsO4xpvR9Mf 

“Assessment of capacity to give informed consent for medical assistance in dying: a qualitative study of clinicians’ experience”. CMAJ Open. https://pmc.ncbi.nlm.nih.gov/articles/PMC8084565/

Participation in medical aid in dying (MAID) is entirely voluntary. Patients interested in the procedure are informed by their providers that they may change their minds at any time and requesting MAID does not obligate them to follow through. Even if the prescription has been issued and the patient has the medication, they have the right to choose not to ingest it.

Providers’ duties that receive MAID requests vary by state, but the majority of processes have opportunities for the patient to change their mind. Providers who discuss requests for MAID with patients during their appointments dedicate time to assessing the patient’s decision-making capacity. They discuss alternatives with the patient to ensure that they’re aware of options they can consider instead of MAID. Throughout the process, the provider and respective staff are allowed to offer opportunities for the patient to rescind their request. 

In California, the process for requesting and receiving MAID includes clearly defined opportunities to rescind the request. Patients need to make three requests for MAID, including two verbal requests and one written request. The two verbal requests must be made at least 15 days apart, which can serve as an opportunity for the patient to change their mind before moving forward with the other requests. The patient will then have to complete multiple consultations regarding their request, which provides additional opportunities to rescind the request if desired. Additionally, the provider is required to discuss expectations of how to store and self-administer the medication and also includes another opportunity for the patient to change their mind prior to the authorization of the prescription. 

It has been estimated that one-third of patients eligible for MAID choose not to take the medication after receiving their prescription. Among these patients, the driving factors supporting their change of mind revolve around a reduction in the fear of losing control and an increase in autonomy. Regardless of when the patient has made the request for MAID or how much progress they have made in the process for approval, participation is always voluntary and patients are not forced to proceed with the process if they decide that they are no longer interested. 

Sources

“Medical Aid in Dying”. Compassion & Choices. https://compassionandchoices.org/our-issues/medical-aid-in-dying/ 

“Physician Aid-in-Dying”. UW Medicine: Department of Bioethics and Humanities. https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/73

“California End of Life Option Act (EOLOA)”. UCLA Health. https://www.uclahealth.org/patient-resources/support-information/patient-education/california-end-life-option-act-eoloa 

“When Patients Choose to End Their Lives”. New York Times. https://www.nytimes.com/2021/04/05/well/live/aid-in-dying.html

Healthcare professionals are not allowed to assist paralyzed patients with the administration of aid-in-dying medications since the eligibility criteria for MAID indicate that patients must be able to self-administer the medication. Even if the paralyzed patient has provided informed consent and demonstrates decision-making capacity, their inability to administer the medication themselves would make them ineligible for MAID. If a healthcare professional, such as a nurse, were to assist in administering the medication, they would be deemed liable for the patient’s death since their direct participation with the intent to hasten death would categorize this practice as euthanasia, which is illegal in the U.S., instead of MAID. 

Requirements based on the patient’s ability to self-administer have proven challenging for patients with conditions such as ALS, multiple sclerosis, spinal cord injuries, and Parkinson’s disease. In the earlier stages of these diseases, patients may still have the mobility and physical function necessary to self-administer aid-in-dying medications, but might not meet the criteria of a terminal prognosis with six or fewer months to live. As these diseases progress and patients begin to experience limitations in the ability to move their arms or swallow liquids and food, they might meet the criteria for the terminal prognosis, but are unable to meet the criteria for self-administration anymore. 

Additionally, some paralyzed patients may acquire the medications by meeting all of the criteria initially but then struggle with deciding when to self-administer. They realize that if they continue to wait, they risk becoming unable to take the medication on their own, but they also express that they are not emotionally or physically ready to die yet. Some patients prefer to delay taking their aid-in-dying medications to spend more time with their families or make the most out of the remainder of their time before their disease progression worsens. It’s a difficult choice for them to make since it may prevent them from dying according to their own preferences. 

Without the possibility of a healthcare professional to assist in the administration of medication, patients who are paralyzed or have disabilities have reduced access to MAID, even if they live in a state where it is authorized. The progression and limitations of their diseases often complicate their decision to move forward with pursuing MAID despite their ability to meet the eligibility criteria. As a result, activists continue to advocate for criteria and legislative changes that will be more inclusive to their community.

Sources

“Medical Aid in Dying & People with Disabilities”. Compassion & Choices. https://compassionandchoices.org/resource/medical-aid-dying-people-disabilities/ 

“A Fight to Die”. Bloomberg. https://www.bloomberg.com/news/features/2021-12-17/death-with-dignity-right-to-die-laws-leave-patients-with-impossible-choice 

“An ALS patient’s dilemma: End his own life, or die slowly of the disease?” NBC News. https://www.nbcnews.com/news/us-news/als-patient-s-dilemma-end-his-own-life-or-die-n993421

Reporting and documentation requirements for medical aid in dying (MAID) can vary based on state-level legislation regarding assisted death. Physicians and medical examiners are expected to adhere to the standard requirements for reporting a death regardless of whether the patient died as a result of MAID or other circumstances. However, in most states, the attending physician is required to submit additional paperwork following the death of a patient if it is related to MAID. For example, in New Jersey, the attending physicians are required to submit the following documentation within 30 days of the patient’s death: 

• Request for Medication to End My Life in a Humane and Dignified Manner form 
• Consulting Physician Compliance Form
• Attending Physician Compliance Form 
• Mental Health Professional Compliance Form 

These forms are then submitted to the state medical examiner for further review and may be used as generalized de-identified data in an annual report by the state’s legislature for assisted death. Since laws surrounding MAID often change rapidly, visiting the Department of Health’s website in your state is generally recommended for the most recent information regarding necessary documentation.

The Death Certificate in MAID

In the United States, the death certificate typically does not indicate that the patient died due to MAID. Instead, the cause of death is usually attributed to the underlying disease, and the manner of death is listed as natural causes. This practice is consistent across states where MAID is legal. Due to concerns surrounding patient privacy, most state-level legislation also includes language that prevents any reference to the use of MAID.This means that the manner of death cannot be listed as assisted death or suicide, and the death certificate cannot mention the medications used to bring about the patient’s death. 

It is worth noting, however, that other countries may follow different procedures for reporting the cause and manner of death. In Canada, for example, where there are no national guidelines for death reporting,  the cause of death may be reported as toxicity from the aid-in-dying medications and the manner may be recorded as medically assisted death.

Sources

“Completion of Medical Certificates of Death after an Assisted Death: An Environmental Scan of Practices”. Healthcare Policy/Politiques de Sante’. https://pmc.ncbi.nlm.nih.gov/articles/PMC7008676/ 

“New Jersey Medical Aid in Dying for the Terminally Ill Act”. Official Site of the State of New Jersey. https://www.nj.gov/health/advancedirective/documents/maid/MAID_FAQ.pdf

Of the countries where MAID is legal, there are two in which children and minors are able to receive medical assistance in dying. Starting in 2014, Belgium has legally allowed MAID for minors of all ages. In order to receive it, strict medical criteria must be adhered to, the child must be able to understand the situation — including undergoing evaluation by a pediatric psychiatrist — and there must be written consent from parents. In Belgium, emancipated minors are able to request MAID according to the same criteria as adults. 

In the Netherlands, children up to the age of 16 require a parent or guardian’s permission, while there must be parental involvement for those aged 16 or 17. All patients must have “unbearable suffering” without the possibility for improvement, and the request for medical aid in dying must be “voluntary, well considered and with full conviction.”

Even in these countries with legally sanctioned MAID for minors, it is worth noting the practice is quite rare. In 2022, there was one instance in the Netherlands, and from 2016 to 2019 in Belgium, four minors received MAID. 

Sources

“Legislative Background: Medical Assistance in Dying (Bill C-14, as Assented to on June 17, 2016)”. Government of Canada. https://www.justice.gc.ca/eng/rp-pr/other-autre/adra-amsr/p3.html 

“Child Euthanasia in Belgium”. O’Neill Institute. https://oneill.law.georgetown.edu/child-euthanasia-in-belgium/ 

“Netherlands to broaden euthanasia rules to cover children of all ages”. The Guardian. https://www.theguardian.com/society/2023/apr/14/netherlands-to-broaden-euthanasia-rules-to-cover-children-of-all-ages 

“’Dying With Dignity’: Dutch Mark 20 Years of Euthanasia”. VOA. https://www.voanews.com/a/dying-with-dignity-dutch-mark-20-years-of-euthanasia-/6510974.html 

“Belgium euthanasia data from 2019 shows continued expansion”. Australian Care Alliance. https://www.australiancarealliance.org.au/belgium_euthanasia_data_from_2019_shows_continued_expansion

Medical aid in dying (MAID) legislation has undergone many significant changes over time. The collective effort to legalize the practice of MAID originates back in the early 1990s when Oregon became the first state to pass the Death with Dignity Act in November 1994. In the decades that followed, several other states were able to implement their own laws pertaining to MAID. However, it is worth noting that the practice of MAID in the United States is still noticeably restricted in comparison to its practice in other countries. 

Presently, ten states and the District of Columbia have legalized MAID. These ten states include Oregon, Washington, Montana, Vermont, California, Colorado, Hawai’i, New Jersey, Maine, and New Mexico. According to the laws in these states, individuals must meet specific criteria in order to be eligible for medical aid in dying. Some states have their own variations on additional criteria, such as how many witnesses need to sign the paperwork or how many requests must be submitted to a healthcare provider. However, the general criteria to be eligible for MAID are as follows: 

• The patient must be an adult of at least 18 years of age or older 
• The patient must be terminally ill with a life expectancy of six months or less
• The patient must be capable of making decisions regarding their care
• The patient must be able to administer the aid-in-dying medications to themselves. 

While there has been progress in the evolution of medical aid in dying legislation, it has encountered controversy and faced challenges in achieving equal representation across various populations. This includes patients with disabilities or those diagnosed with diseases that may eventually hinder self-administration of aid-in-dying medications. In light of these concerns and ongoing advocacy, it is likely that medical aid in dying legislation will continue to evolve to align with shifting public opinion and legal perspectives on the ethical implications of hastening death.

Sources

“Oregon Death with Dignity Act History”. Compassion & Choices. https://compassionandchoices.org/in-your-state/oregon/history/ 

“States Where Medical Aid in Dying is Authorized”. Compassion & Choices. https://compassionandchoices.org/states-where-medical-aid-in-dying-is-authorized/

“Medical Aid in Dying”. Compassion & Choices. https://compassionandchoices.org/our-issues/medical-aid-in-dying/

The Assisted Suicide Funding Restriction Act (ASFRA) is a federal law that was passed in 1997 to prohibit the use of federal funds to pay for healthcare services or items that may cause, assist, or hasten the deaths of individuals by euthanasia, mercy killing, or assisted suicide. This means that patients receiving Medicare, Tricare, Social Security, or other federal healthcare coverage cannot use their benefits to pay for the costs of medical aid in dying (MAID). Patients with these benefits are expected to pay out of pocket for any of the expenses associated with MAID. 

According to ASFRA, the indicated practices are criminal offenses throughout most of the United States. Insofar as the federal government provides financial support for healthcare services and advocacy to protect rights, paying for healthcare services or items that would imply approval of these practices is unlawful. The act also indicates that legal developments at the time increased the likelihood that services intended to assist or hasten death would become legal in different states nationwide. While ASFRA does not directly name medical aid in dying as one of the prohibited practices, it broadly implies that federal funds cannot be used as payment for it due to the purpose of the services and items involved. 

It is important to note that ASFRA does consider intentionality when determining whether a healthcare item or service results in death for a patient. Although ASFRA does not authorize the use of federal funds for services or items that can cause, assist, or hasten death, it does not apply to items or services used to relieve pain or discomfort in end-of-life settings. ASFRA also specifically indicates that the law does not apply to withholding or withdrawing nutrition, hydration, medical treatment, or medical care since these actions are not intended to cause or hasten death. For example, using federal funds to provide an actively dying patient with morphine to relieve their pain despite a known risk of slowing their breathing does not violate ASFRA since the physician’s intent is only to manage the patient’s discomfort. This is different from using federal funds to provide a patient with a specific medication regimen that is certain to result in their death. 

Sources 

“Assisted Suicide Funding Restriction Act of 1997”. Centers for Medicare & Medicaid Services. https://www.cms.gov/files/document/se20014.pdf 

“Assisted Suicide Funding Restriction”. U.S. House of Representatives. https://uscode.house.gov/view.xhtml?path=/prelim@title42/chapter138&edition=prelim

While each jurisdiction defines its policies and statutes on medical aid in dying (MAID), individual healthcare insurers must determine if the procedure is covered by their policies. Insurers are allowed to cover procedures deemed necessary and effective based on each patient’s medical needs. Insurance coverage for MAID often means the insurer covers the costs associated with the prescribed aid-in-dying medications and any related appointments. However, the decision to provide coverage can vary significantly between public and private health insurers. For example, although Medicare does not cover aid-in-dying medications, the federal Medicaid program in California does.

MAID’s legality in certain states doesn’t always guarantee that insurers in those states will approve coverage for the associated costs. Many state-funded and private insurers in Oregon, California, and Hawaii provide coverage for the cost of medications and evaluation appointments, but standardized coverage has not been established across all states where MAID is legal. Patients who rely on government-sponsored insurance for health care coverage may find that MAID is inaccessible due to prohibitive costs if their insurer is unwilling to approve the procedure. This is largely associated with the Assisted Suicide Funding Restriction Act, which forbids federal spending to pay for end-of-life care.

Concerns and obstacles associated with health insurance coverage for MAID differ slightly when considering life insurance. Life insurance coverage is specific to providing funds when the insured individual dies, so coverage decisions affect whether beneficiaries will receive the designated death benefit payment. For example, term life insurance may opt not to cover the death benefit payment for beneficiaries if the insured dies during the exclusion period. Deaths during an exclusion period are subject to investigation to allow the life insurance company to confirm whether insurance fraud occurred.

The complexities surrounding insurance coverage for MAID highlight the importance of open communication among insurers, patients, and healthcare providers. Individuals considering MAID should be encouraged to understand the extent of their insurance coverage and the potential financial implications associated with their choice. As laws pertaining to MAID continue to evolve and advocacy remains consistent, health care and life insurance coverage for MAID may become more widely accessible.

Sources

“Insurance Coverage & Medical Aid in Dying”. Compassion & Choices. https://compassionandchoices.org/resource/insurance-coverage-medical-aid-dying/ 

“Key Facts About the End of Life Option Act for Patients & Families”. Coalition for Compassionate Care of California. https://coalitionccc.org/CCCC/CCCC/Resources/Consumer-Information-on-EoLOA.aspx 

“Opinion: Medical aid in dying was a blessing for my husband. But a federal law makes it inaccessible for millions of Americans”. CNN. https://www.cnn.com/2022/09/03/opinions/medical-aid-in-dying-inaccessible-fairchild/index.html 

“H.R.1003 – Assisted Suicide Funding Restriction Act of 1997”. Congress. https://www.congress.gov/bill/105th-congress/house-bill/1003 
“How do life insurance companies handle death with dignity cases?”. Quick Quote. https://www.quickquote.com/life-insurance-and-death-with-dignity/

Medical aid in dying (MAID) is currently authorized in 10 states and the District of Columbia. This authorization means that eligible patients can request a prescription for a medication regimen to hasten their death and their physician can prescribe the medications without any legal implications. Every state in which MAID is authorized has an act that indicates the criteria that must be met to legally provide MAID to patients. These states include: 

• California
  • California End of Life Option Act
• Colorado
  • Colorado End of Life Options Act
• Hawai’i
  • Hawai’i Our Care, Our Choice Act
• Maine
  • Maine Death With Dignity Act
• New Jersey
  • New Jersey Medical Aid in Dying for the Terminally Ill Act
• New Mexico
  • New Mexico Elizabeth Whitefield End-of-Life Options Act
• Oregon
  • Oregon Death with Dignity Act
• Vermont
  • Vermont Patient Choice and Control and the End of Life Act
• Washington
  • D.C. Death with Dignity Act
• Montana
  • Baxter V. Montana
• District of Columbia

Laws pertaining to MAID only exist at the state level at this time, which is why regulations and authorizations vary from state to state. Oregon was the first state to authorize MAID back in 1997, whereas New Mexico is the most recent state, having passed its legislation in 2021. The majority of these state authorizations were obtained through legislation; Montana is the only state that legalized MAID through a court ruling. 

It is important to acknowledge that Medical Aid in Dying (MAID) is still inaccessible to the majority of patients in the United States. Presently, 36 states have explicit prohibitions against MAID, while four states either lack legislative provisions or have not yet addressed their legality. It is crucial to note that, despite the absence of defined laws against it in certain states, MAID remains an illegal practice unless authorized by specific state legislation.

Sources

“States Where Medical Aid in Dying is Authorized”. Compassion & Choices. https://compassionandchoices.org/states-where-medical-aid-in-dying-is-authorized/ 

“MAID: Medical Aid in Dying”. Britannica. https://www.britannica.com/procon/MAID-medical-aid-in-dying-debate