Can a Patient Survive the MAID Process?

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/