End-of-Life Care: Medical Aid in Dying

Medical aid in dying (MAID) is a practice in which a physician provides a competent adult with a terminal illness with a prescription for a lethal dose of a drug at the request of the patient, which the patient intends to use to end his or her life. MAID currently is legal in nine states and the District of Columbia. The most common concerns leading to requests for MAID include loss of autonomy, loss of ability to participate in activities that make life enjoyable, and loss of dignity. MAID remains controversial. Physicians can choose not to participate in MAID and many are prohibited from participating by their employers. Family physicians should have the knowledge and skills to respond to inquiries about MAID in a compassionate, patient-centered manner. Clinicians should be familiar with the legal status of MAID in the state in which they practice, understand eligibility requirements for participation, have access to resources to support patients and clinicians, and be able to apply various communication strategies to MAID discussions. A thoughtful exploration of what led the patient to inquire about MAID will allow the physician to better understand and respond to patient concerns regarding the final months of life.