FAQ – Medical Aid in Dying
About
Frequently asked questions about Medical Aid in Dying (MAID).
Q: What is medical aid in dying (MAID)?
A: Medical aid in dying refers to a medical practice governed by state legislation that allows mentally capable, terminally ill adults with six months or less to live to request a prescription for medication they can choose to take to die peacefully if their suffering becomes unbearable. It is sometimes also referred to as death with dignity, physician-assisted death/dying, aid in dying, or physician aid in dying.
Q: Who is eligible for medical aid in dying?
A: To qualify for aid-in-dying medication, you must:
Be an adult resident of a state where medical aid in dying is authorized. The states where aid-in-dying is legal are: Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, New Jersey, Maine, New Mexico, and Washington DC.
Be capable of making your own healthcare decisions
Have a terminal illness that will lead to death within six months, confirmed by two doctors
Find a doctor who is willing to dispense the needed medications. You can find a doctor by going to the A.C.A.MAID website.
Be willing to wait for up to two weeks, depending on the state, to obtain the medications
Be able to self-administer and ingest the aid-in-dying drug
For more information, go to the Death with Dignity website or the Compassion and Choices website.
Q: Is medical aid in dying mandatory in any situation?
A: No. It would be illegal for someone to tell you or a loved one they have to die at any particular time. Participation in MAID must be requested by you. No patient is ever required to use it, and no physician is mandated to provide it. It is illegal to force someone to request or use aid-in-dying medication.
Q: What safeguards are included in medical aid-in-dying laws?
A: The laws include strict eligibility criteria and over a dozen safeguards, such as:
The patient must make multiple requests, both oral and written.
The patient must take the drugs themselves. In the US, neither caretakers nor doctors can directly give the drugs to the patient.
Two physicians must confirm the terminal diagnosis and 6-month prognosis .
If either doctor suspects the patient's judgment is impaired, they must refer them for a psychological evaluation.
Two independent witnesses must attest the request is being made voluntarily without coercion.
There is a waiting period after getting doctor approval to qualify of up to 2 weeks.
The patient can rescind the request at any time.
Physicians must report each prescription to the state.
Q: How difficult is it to qualify for MAID?
A: Laws differ by state so it is important to do a Web search to find out the qualifications needed in your state. However, in most states:
The patient must make multiple requests, both oral and written
The patient must be able to take the drugs themselves. In the US, neither caretakers nor doctors can directly give the drugs to the patient.
Two physicians must confirm the terminal diagnosis and 6-month prognosis
If either doctor suspects the patient's judgment is impaired, they must refer them for a psychological evaluation
Two independent witnesses must attest the request is being made voluntarily without coercion
There is a waiting period after getting doctor approval to qualify that may be up to 2 weeks
The patient can rescind the request at any time
Physicians must report each prescription to the state
For more information, go to the Death with Dignity website or the Compassion and Choices website.
Q: How many people use medical aid-in-dying laws? Is it safe?
A: Aid-in-dying laws have been in place in some states for over 20 years. State reports show that only a small number of qualified terminally ill patients (less than 1%) choose to obtain aid-in-dying prescriptions, and one quarter to one third never take the medication. In over 40 combined years of experience across authorized states, there has not been a single substantiated case of abuse or coercion. The laws are working as intended with no evidence of misuse.
Q: Assuming I live in a state where MAID Is legal, how do I find a doctor who is willing to prescribe MAID drugs?
A: Go to the A.C.A.MAID website. You can find their link on the Fully Informed Conversations website. They can assist you. Alternatively, search for the End-of-Life organization in your state. For example, End-of-Life Washington, End-of-Life Oregon etc.
For more information, go to the Death with Dignity website or the Compassion and Choices website.
Also, a death doula can help navigate the health system for you.
Q: What if I can’t find a participating physician?
A: Go to the A.C.A.MAID website. They can assist you. Alternatively, search for the End-of-Life organization in your state. For example, End-of-Life Washington, End-of-Life Oregon etc.
For more information, go to the Death with Dignity website or the Compassion and Choices website.
Also, a death doula can help navigate the health system for you.
Q: Can I apply for hospice and also MAID
A: Yes. You can either apply for MAID and then ask for hospice help or you can get into a hospice and then apply for MAID. Either way, you’ll want to talk to hospice up front and make sure they will support your MAID decision.
Q: Where can I take the medications?
A: Over 90% of people take the medications at home. They can also be taken in an assisted living facility or nursing home or hospice. You should NOT take it in a public place. You should not take it out of the state in which it was prescribed.
Q: What if I decide not to take the medications once I have them?
A: Giving the medications to another person is illegal. Dispose of them in a legal manner such as flushing them down the toilet. Your state may have specific instructions about disposal. In most cases hospice is involved and can tell you what to do.
Q: Can my Representative or other family member request MAID for me?
A: No. you must be able to request it for yourself
Q: Can I write that I want MAID in my Living Will for use if I later become incompetent or unable to take the medications myself.
A: No. You must be competent to make the requests and to give the medication to yourself at the time you undertake MAID.
Q: How long does it take to die after the medications are swallowed?
A: In about 85% of cases, it takes 2 hours or less. Rarely does it take more than 5 hours. You would get drugs to induce coma that act before the drugs that suppress lung and heart function. So you are calm first, then comatose and only after do your muscles and breathing and heart stop. So for the vast majority of people it is a peaceful death.
Q: What if the medications don’t work OR What are the complications?
A: Possible complications are: reawakening after drug ingestion, difficulty getting medications down, vomiting, prolonged death and seizures. Recent data show that with the most modern protocols, almost no patients had reawakening. Only about 3% took more than 5 hours to die and in almost all of these cases it was because they had known problems with gut motility. Having a healthcare provider or death doula or trained support volunteer present while the patient takes the medications can be useful to suppress side effects and provide reassurance.
Q: What if I can’t swallow?
A: You can take the medications via rectal suppository and these work even faster than taking them by mouth.
Q: What are the medications used and what do they do?
A: Protocols may differ slightly by state but doctors typically give a pre-packaged set of medications that includes more than one medication to quickly induce coma and suppress breathing and two medications that stop heart function. Typical drug combinations are: diazepam, digoxin, morphine, amitriptyline and phenobarbitol. Patients are typically told to mix the medication powders in apple juice and then to suck on a popsicle or sorbet to offset the bitter taste while the sedatives take effect.
Q: What is the process for obtaining aid-in-dying medication?
A: You must live in a state where MAID is legal. If you do:
You must make two verbal requests to a physician willing to participate in the process at least 15 days apart, although some states are considering shorter waiting periods.
Once the physician considers you eligible, you must make a written request signed by two witnesses. The attending physician and a consulting physician must confirm that you meet all eligibility criteria. If either physician suspects that your judgment is impaired by a psychiatric disorder, they will refer you for an evaluation.
When all these requirements are met, the attending physician may prescribe the medication, which you must be able to self-administer.
To find a participating physician, go to the A.C.A.MAID website. Or consult a death doula who typically can help navigate the health system for you. Or go to the Death with Dignity website or the Compassion and Choices website.
Q: Can family members or healthcare proxies request aid-in-dying medication on behalf of a patient?
A: No. The request must be made directly by the patient. It cannot be made through an Advance Directive or by a family member, friend, or healthcare proxy. At the time of the request, the patient must be capable of making their own medical decisions.
Q: Will using an aid-in-dying law affect my insurance?
A: No. The laws specify that choosing medical aid in dying is not suicide. Therefore, it has no effect on life, health, or accident insurance or annuity policies. However, the federal government does not allow federal funds to be used for medical aid in dying, including through Medicare or Medicaid.
Q: What are the residency requirements?
A: You must be able to prove current residency in a state where medical aid in dying is authorized. The places where aid-in-dying is legal are: Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, New Jersey, Maine, New Mexico, and Washington DC.
You may move to an authorized state or city to establish residency in order to access the law, but you must be able to prove residency to the attending physician. Simply traveling to an authorized state is not sufficient.
Q: How do these laws impact end-of-life care more broadly?
A: Evidence shows medical aid-in-dying laws improve end-of-life care across the board, not just for those who use them. Authorized states have among the best palliative and hospice care in the country, and physicians have improved at discussing all end-of-life options with patients. The laws help foster open conversations between doctors and terminally ill patients about end-of-life preferences. Just having the option of medical aid in dying provides many dying people peace of mind, even if they never choose to use the medication.
Q: What do doctors think about medical aid in dying?
A: Surveys show a majority (55-57%) of U.S. physicians support medical aid in dying, with support growing over the past decade. However, individual physicians can choose whether to participate. A number of professional medical societies have endorsed or taken a neutral stance on the practice.
Q: How much public support is there for medical aid in dying?
A: Polls consistently show that about 70% of Americans across a wide range of demographic groups support giving terminally ill patients the option of medical aid in dying. This strong majority support exists among people from different political parties, ideological views, religious affiliations, races, and ethnicities. Overall support has nearly doubled since the 1940s.
Q: Where is medical aid in dying authorized?
A: Eleven U.S. jurisdictions currently authorize medical aid in dying: Oregon (1994), Washington (2008), Montana (2009), Vermont (2013), California (2015), Colorado (2016), the District of Columbia (2016), Hawai'i (2018), New Jersey (2019), Maine (2019) and New Mexico (2021).
