Navigating End-of-Life Decisions: A Comprehensive Guide to Medical Aid in Dying (MAID)

Facing a terminal illness is an incredibly challenging experience that can take a toll on both physical and mental well-being. As individuals grapple with the reality of their situation, they may consider various end-of-life options, including Medical Aid in Dying (MAID). MAID is a process that allows terminally ill, mentally competent adults to request and receive a prescription for life-ending medication (Dugdale et al., 2019). This article aims to provide a comprehensive overview of MAID, its impact on mental health, and the steps involved in accessing this option.

The Impact of Life-Threatening and Terminal Illnesses on Mental Health

Receiving a terminal diagnosis can trigger a wide range of emotional responses, including shock, fear, anger, and sadness (Kübler-Ross & Kessler, 2014). As individuals process the news, they may experience mental health challenges such as:

• Depression: Persistent feelings of sadness, hopelessness, and loss of interest in activities (Rodin et al., 2009).
• Anxiety: Excessive worry, restlessness, and difficulty sleeping (Wilson et al., 2007).
• Existential distress: Grappling with questions of meaning, purpose, and the finality of death (Kissane, 2012).
• Adjustment disorders: Difficulty coping with the emotional and practical aspects of the illness (Mitchell et al., 2011).
• Post-traumatic stress disorder (PTSD): Intrusive thoughts, avoidance, and heightened arousal related to the illness or treatment (Kangas et al., 2002).

Addressing mental health concerns is crucial for individuals facing terminal illnesses. Healthcare professionals, including hospice counselors, social workers, and nurses, play a vital role in assessing and supporting patients' emotional well-being (National Institute on Aging, 2021). Support systems, such as family, friends, and support groups, can provide comfort and help patients cope with the challenges they face (American Cancer Society, 2021).

Symptoms and Signs to Be Aware Of

As terminal illnesses progress, patients may experience various physical symptoms, such as pain, fatigue, breathlessness, and loss of appetite (National Institute on Aging, 2021). These symptoms can significantly impact quality of life and contribute to psychological distress (Temel et al., 2010). Healthcare professionals should be vigilant for signs that a patient may be considering MAID, such as expressing a desire to hasten death, feeling like a burden to others, or experiencing unrelenting suffering (Oregon Health Authority, 2021).

The State of MAID in the US and Europe

In the United States, MAID is currently legal in several states, including California, Colorado, District of Columbia, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, and Washington (Death with Dignity National Center, 2021). Each state has its own specific requirements and processes for accessing MAID, but generally, patients must be adult residents with a terminal illness, have a prognosis of six months or less, and possess the mental capacity to make informed decisions (Ganzini, 2015).

In Europe, MAID is legal in several countries, including Belgium, Luxembourg, the Netherlands, and Spain (Emanuel et al., 2016). Switzerland allows assisted suicide but not MAID specifically (Hurst & Mauron, 2003). The eligibility criteria and processes vary by country, but generally involve a terminal illness, unbearable suffering, and repeated, voluntary requests (Emanuel et al., 2016).

Healthcare Professionals Involved in the MAID Process

Several healthcare professionals may be involved in the decision-making and assessment process for MAID:

• Primary care physicians: Provide information about end-of-life options, assess eligibility, and make referrals to specialists (Death with Dignity National Center, 2021).
• Hospice and palliative care teams: Offer support, symptom management, and guidance throughout the end-of-life journey (National Hospice and Palliative Care Organization, 2021).
• Psychiatrists and psychologists: Assess mental competence, screen for mental health conditions, and provide emotional support (American Psychological Association, 2017).
• Social workers: Assist with practical concerns, provide counseling, and connect patients and families with resources (National Association of Social Workers, 2021).
• Pharmacists: Dispense the prescribed life-ending medication and provide information on its use (Death with Dignity National Center, 2021).
• Nurses: Offer emotional support, monitor symptoms, and assist with the administration of the medication if requested (American Nurses Association, 2019).

Each healthcare professional plays a unique and essential role in ensuring that patients receive comprehensive, compassionate care and support throughout the MAID process.

Understanding Medical Aid in Dying (MAID)

MAID is currently legal in several U.S. states and a few countries worldwide (Dugdale et al., 2019). Eligibility criteria typically include being an adult resident of the jurisdiction, having a terminal illness with a prognosis of six months or less, and possessing the mental capacity to make informed decisions (Oregon Health Authority, 2021). The MAID process involves making multiple requests, both verbal and written, and waiting a specified period between requests (Ganzini, 2015). Patients must be evaluated by two physicians to ensure they meet eligibility requirements (California Department of Public Health, 2021).

Steps to Access MAID

Accessing MAID begins with consulting healthcare professionals, such as primary care physicians or hospice teams, to discuss end-of-life options (Death with Dignity National Center, 2021). Patients must ensure they meet eligibility criteria and complete necessary documentation, including written requests and physician assessments (California Department of Public Health, 2021). Engaging family members and loved ones in the decision-making process can provide support and help address any concerns or questions they may have (Death with Dignity National Center, 2021).

Questions to Consider When Contemplating MAID

When contemplating MAID, individuals should reflect on their personal values, beliefs, and quality of life considerations (American Psychological Association, 2017). They may also explore potential alternatives to MAID, such as hospice care or palliative sedation (National Hospice and Palliative Care Organization, 2021). It is essential to consider the impact of the decision on family and loved ones, as well as any legal and financial implications (Death with Dignity National Center, 2021).

Conclusion

Medical Aid in Dying (MAID) is a complex and deeply personal end-of-life option that requires careful consideration and informed decision-making. As individuals face the challenges of terminal illnesses, it is essential to prioritize mental health support, open communication, and access to comprehensive information. Healthcare professionals, along with family and loved ones, play a vital role in providing guidance and support throughout the end-of-life journey. By fostering open dialogue and ensuring access to resources, we can empower individuals to make choices that align with their values and priorities, ultimately promoting dignity and compassion at the end of life.

References:

• American Cancer Society. (2021). Coping with advanced cancer. https://www.cancer.org/treatment/end-of-life-care/nearing-the-end-of-life/coping.html
• American Nurses Association. (2019). The nurse's role when a patient requests medical aid in dying. https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/medical-aid-in-dying-position-statement-june-2019.pdf
• American Psychological Association. (2017). End-of-life issues and care. https://www.apa.org/topics/end-life-issues-care
• California Department of Public Health. (2021). End of Life Option Act. https://www.cdph.ca.gov/Programs/CHSI/Pages/End-of-Life-Option-Act.aspx
• Death with Dignity National Center. (2021). How to access death with dignity laws. https://www.deathwithdignity.org/learn/access/
• Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Pros and cons of physician aid in dying. Yale Journal of Biology and Medicine, 92(4), 747-750. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913818/
• Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA, 316(1), 79-90. https://doi.org/10.1001/jama.2016.8499
• Ganzini, L. (2015). Legalizing physician-assisted death. New England Journal of Medicine, 372(16), 1499-1501. https://doi.org/10.1056/NEJMp1501623
• Hurst, S. A., & Mauron, A. (2003). Assisted suicide and euthanasia in Switzerland: Allowing a role for non-physicians. BMJ, 326(7383), 271-273. https://doi.org/10.1136/bmj.326.7383.271
• Kangas, M., Henry, J. L., & Bryant, R. A. (2002). Posttraumatic stress disorder following cancer: A conceptual and empirical review. Clinical Psychology Review, 22(4), 499-524. https://doi.org/10.1016/s0272-7358(01)00118-0
• Kissane, D. W. (2012). The relief of existential suffering. Archives of Internal Medicine, 172(19), 1501-1505. https://doi.org/10.1001/archinternmed.2012.3633
• Kübler-Ross, E., & Kessler, D. (2014). On grief and grieving: Finding the meaning of grief through the five stages of loss. Simon & Schuster.
• Mitchell, A. J., Chan, M., Bhatti, H., Halton, M., Grassi, L., Johansen, C., & Meader, N. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies. The Lancet Oncology, 12(2), 160-174. https://doi.org/10.1016/S1470-2045(11)70002-X
• National Association of Social Workers. (2021). NASW standards for palliative and end of life care. https://www.socialworkers.org/LinkClick.aspx?fileticket=xBMd58VwEhk%3D&portalid=0
• National Hospice and Palliative Care Organization. (2021). Palliative sedation. https://www.nhpco.org/hospice-care-overview/end-of-life-care/palliative-sedation/
• National Institute on Aging. (2021). End-of-life care. https://www.nia.nih.gov/health/end-of-life-care
• Oregon Health Authority. (2021). Death with Dignity Act. https://www.oregon.gov/oha/PH/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx
• Rodin, G., Lo, C., Mikulincer, M., Donner, A., Gagliese, L., & Zimmermann, C. (2009). Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients. Social Science & Medicine, 68(3), 562-569. https://doi.org/10.1016/j.socscimed.2008.10.037
• Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., Dahlin, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., Billings, J. A., & Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363(8), 733-742. https://doi.org/10.1056/NEJMoa1000678
• Wilson, K. G., Chochinov, H. M., McPherson, C. J., LeMay, K., Allard, P., Chary, S., Gagnon, P. R., Macmillan, K., De Luca, M., O'Shea, F., Kuhl, D., & Fainsinger, R. L. (2007). Suffering with advanced cancer. Journal of Clinical Oncology, 25(13), 1691-1697. https://doi.org/10.1200/JCO.2006.08.6801

About the Author: Marigold Groot, MA, is a digital copywriter specializing in mental health issues. She is a retired psychotherapist and integrates her passion for mental health into her writing. If you liked this article and are interested in working with her, please contact her at [email protected].