Loose Ends: The Status Of Medical Aid In Dying (MAID) In The US

Despite the controversy that surrounds its availability and use, Medical Aid in Dying (MAID) appears to be gaining ground in the US in terms of public support, legal availability, and use by those at the end of their lives. A recent poll by the Pew Research Center found that about 6 in 10 US adults surveyed believe that it’s acceptable for persons with a terminal illness to end their lives with the help of a physician: about 34% found that the procedure was morally acceptable, and about 29% did not have a moral issue with a person utilizing the option. 35% of those polled by Pew responded that Medical Aid in Dying is morally wrong. Responses to this survey were often split along political party lines, and some religious leaders condemn the practice, although in certain cases, a majority of respondents who identify with the religion (Catholicism, for example) support the concept. It should be noted that there is sensitivity about the language used to refer to the process of a physician helping a terminally ill patient take life-ending medication, even when the patient has decisional capacity to ask for the procedure and physical capacity to ingest the medication on his/her own. Some use the term “physician-assisted suicide” or just “assisted suicide” to label the process. But as one physician who does this work has made clear, “Suicide is a tragedy — when somebody takes their life during a time when they have the option to live on, that’s a suicide. The patients we work with, sadly, don’t have that option. They’re not choosing to die. In fact, I see my patients have tremendous resistance to the idea that they are going to die — but eventually they acknowledge it. And so patients who have no choice about whether they will die are choosing the way they die, not whether they will die. In a suicide, there is the option to live on. Those are very important to distinguish.”

Not only is there public support behind Medical Aid in Dying, but more and more states are beginning to legalize its availability. As The New Old Age writer Paula Span recently commented, by September, nearly ⅓ of Americans will live in a state that has legalized Medical Aid in Dying. While the regulations may vary slightly from state to state, essentially, what that means is that persons with a terminal diagnosis of 6 months or less to live, through both written and/or oral requests, with a confirmation by a physician that they have decision-making capacity, may ask their physician to prescribe a life-ending medication which they will take on their own. States may have a waiting period between requests to physicians (which can often be waived or shortened depending on the patient’s condition) and may have a residency requirement (although Vermont and Oregon do not). Each state is responsible for its own requirements and limitations on the process. To find out the legal availability in your state, click here.

Many disability, religious, and medical organizations oppose this practice, on moral grounds among other reasons. Disability groups fear that vulnerable individuals will be pressured into asking for the procedure rather than being given the support and care they need to continue their lives. National physician groups object to placing physicians in the position of helping to end a life, though some medical organizations have a neutral position, and some state-level organizations are even supportive. But there are decades of history regarding Medical Aid In Dying laws in multiple states. The data collected from these histories reflect a very limited use of the procedure (usually less than 1% of deaths in those states) and a select group of patients who usually request the procedure (often college-educated white individuals with terminal cancer diagnoses). For example, in a recent 3-part series about New Jersey’s Medical Aid in Dying law, it was found that the law exists in theory but is rarely used, as very few physicians and pharmacies have been willing to participate. Moreover, since insurance does not cover this procedure, patients and families may struggle to come up with the thousands of dollars that may be necessary to cover the costs of the medication and the participating physicians.

Evidence from California and Oregon, which have had their laws on the books for many more years than New Jersey, is somewhat different, though still reflects a limited use of Medical Aid in Dying. In a recent forum in California, for example, panelists remarked that many patients who utilize medical aid in dying are already in hospice at the time the request is made. Further, they cited the lack of any evidence that patients were pressured into the procedure. In fact, the opposite was cited: family members often pressure patients against using the procedure. Oregon, which passed its Medical Aid in Dying legislation about 30 years ago, has seen a small but steady uptick in its use over the years, as there is greater awareness of the law and more acceptance of the concept of end-of-life planning. Commentators have stated that over the years, there has been no indication of abuse or coercion, with no reported compliance issues or violations of the law. In theory, in every state, a failure to follow the exact requirements of the state law could create civil or possibly even criminal charges against patients, families, or physicians. For further information about possible legal concerns related to MAID, including estate planning and life insurance issues, click here.

Outside of the United States, physician involvement in ending the life of a patient appears more widespread and socially accepted. For example, in countries like Canada, Belgium, and the Netherlands, doctors have the option of administering a life-ending drug, rather than the legal limitation that only the patient can self-administer the medication, though to be eligible, patients must be facing unremitting suffering with no hope of improvement. In Canada, in fact, approximately 5-6% of all deaths are the result of Medical Aid in Dying, and next year Canada may expand the legal availability of the procedure to include patients with mental illness rather than terminal physical illness, an expansion causing great concern. Given the mixed reception these laws have received in the US, such an expansion is extremely unlikely for the foreseeable future in this country. Advocacy and support groups are currently just trying to expand awareness of the legality of the procedure in the many states that allow it, and expand the legal option in states that have not yet permitted MAID. To learn more about MAID, the issues involved, and the availability of this procedure in your area, take a look at community and advocacy groups (here, here, and here) working to advance this cause.