What Are Some Physical and Physiological Issues That Affect MAID?

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