What to Know About Medical Aid in Dying
A plain language guide for patients and the people who love them
If you or someone you love is considering medical aid in dying, it is normal to have questions. This guide walks through what it is, who qualifies, and what the process actually looks like, in plain language.
What MAID Is
Medical aid in dying, often called MAID, is an end of life option for someone with a terminal or hospice appropriate diagnosis who still has the ability to make their own medical decisions. It allows a person to ask a doctor for medication that they will take themselves, on their own terms, to bring about a peaceful death.
The heart of MAID is agency. It gives someone the ability to decide when and whether to take the medication, so that the end of their life is not defined by symptoms they find unbearable, such as pain, difficulty breathing, swelling, or losing the ability to move or communicate.
Why People Choose MAID Alongside Hospice
Hospice offers a full team of support: a physician, a nurse, a chaplain, a social worker, and a hospice aide, all focused on comfort and symptom control. What hospice cannot do is reverse the underlying illness or guarantee a specific death experience. For people who find the possibility of losing control at the end of life unacceptable, MAID offers another layer of choice alongside that hospice support, not instead of it.
Who Qualifies
To be eligible for MAID, a person generally needs to meet all of the following:
Be an adult
Have a terminal diagnosis or a hospice appropriate, life limiting illness
Have the mental capacity to make medical decisions, understand the risks and benefits, and be free from any outside pressure or coercion
Be physically able to take the medication on their own, whether by swallowing it, or by self administering it through a gastrostomy (G) tube or rectal tube
Two physicians must evaluate the patient on two different occasions, at least 48 hours apart, to confirm these criteria are met. Only after both evaluations confirm eligibility can a doctor prescribe the medication. This built in waiting period and second opinion exist to make sure the decision is well informed and truly voluntary.
What MAID Is Not
It is not euthanasia. Euthanasia means another person ends someone's life. MAID is different: the patient must take the medication themselves. The physician's role is limited to prescribing it.
It is not suicide. On the death certificate, the cause of death listed is the underlying terminal illness, such as a neurodegenerative disease, cancer, or a cardiac condition, not the medication itself.
Choosing MAID is not giving up. It is a way of holding on to control when so much else feels out of your hands.
How the Medication Works
The medication is specially prepared by a compounding pharmacy. It is designed to bring on sedation, relieve pain, and gently stop the heart, so that a peaceful sleep is followed by death.
When the patient is ready to proceed, the medication is mixed with water, often apple juice is used to help with the taste, right before it is taken. Once the first swallow happens, the full dose needs to be finished within two to three minutes so the ingredients work together as intended.
Once the pharmacy dispenses the medication, it stays effective for about six months. It should be stored safely and securely in the home the entire time, to prevent accidental use.
What the Day Can Look Like
There is no single right way to do this, in the same way there is no single right way to give birth or to celebrate a milestone. Some people choose a celebratory gathering, surrounded by loved ones sharing stories and saying goodbye. Others prefer a quiet, intimate setting with only one or two people present. Some choose to have no one else in the room at all.
Who is present is entirely up to the patient. Options include:
Family and friends
A hospice nurse, who can offer support even though hospice staff are typically not directly involved in the act itself
A death doula, trained to offer companionship and comfort throughout the dying process
A MAID physician expert, for extra support if wanted
A death doula or MAID physician expert is usually not covered by hospice, though some hospices are beginning to expand what they offer. If you are not enrolled in hospice, you can still move forward with MAID. It is worth telling loved ones ahead of time so the day does not come as a surprise to anyone.
A note on control: Whatever the medication does not decide, you do. The date, the setting, who is in the room, and the atmosphere in it are entirely up to you.
Getting Started
If you think MAID might be right for you or someone you love, here is a general roadmap:
Talk with your doctor about whether you meet the eligibility criteria. You can also connect with me here at Pontis Health.
Schedule the two required physician evaluations, at least 48 hours apart
Confirm you are able to self administer it
Arrange for the medication to be compounded and plan for safe storage at home
Choose a date and think through the setting you want, including who you would like present
Talk with the people close to you about your plans
Decide whether you would like a hospice team member, a death doula, or a MAID physician expert involved, and ask about any costs outside of hospice coverage
Medical aid in dying is deeply personal, and there is no wrong way to approach it. If you have questions or want to talk through whether it might be right for you or someone you love, we are here to help.
