Medical Aid in Dying: What Oncology Providers Need to Know

Resources for Providers

Dr Blanke moved to Oregon about 1 year after the state passed its MAID law. Soon after, he wrote a prescription for medication to end a patient’s life. 

“I didn’t know anything about the rules underlying the law, so I had to do a little bit of homework, and I think that’s probably true for most doctors,” he said. 

At that time, Dr Blanke had to get a hard copy of the law to read. These days, there are more easily accessible resources on MAID.

The advocacy organizations Death with Dignity³ and Compassion & Choices¹ have resource pages that break down the details of each state’s laws. The American Clinicians Academy on Medical Aid in Dying (ACAMAID) offers resources for clinicians, including newsletters, advice regarding complicated MAID cases (such as patients who have pacemakers), and continuing medical education.⁷ 

Although all MAID laws were modeled on Oregon’s legislation, there are important differences for health care providers to be aware of, Dr Sandeen noted. For example, states vary in the number and duration of waiting periods required between a patient requesting MAID and receiving the prescription.⁸ In addition, Oregon is the only state that allows non-residents to travel there to receive MAID.⁹

One of the best ways to learn about MAID is to work with a provider who has helped a patient use it, according to Dr Sandeen. She noted that states with MAID laws have nonprofit organizations, such as End of Life Choices Oregon¹⁰ and End of Life Washington,¹¹ with physicians on staff who can advise providers about MAID. These organizations also have volunteers who can help patients and their families navigate the MAID process.

Another potential resource is an upcoming conference on MAID, scheduled to take place in February 2023.¹² The conference is open to clinicians, students, and others who want to learn about standard care, ethics, bereavement, and other issues related to MAID. 

Medical journals can also be a great way to share information about MAID among health care professionals, according to Dr Blanke. In 2019, he and his colleagues published a study describing MAID trends in Oregon and Washington.¹³ 

The study showed that the most common underlying illness among MAID recipients was cancer (76.4%), and the most common reasons patients requested MAID were loss of autonomy (87.4%), poor quality of life (86.1%), and loss of dignity (68.6%). The study also showed that the rate of complications among evaluable patients was low, at 4%. The most common complication was difficulty swallowing the medication or regurgitating it.  

There are also resources for health care professionals who would like to help patients pursue MAID but do not feel comfortable providing MAID themselves. Providers can reach out to ACAMAID if they would like to find physicians in their area who provide MAID.¹⁴ 

The Future of MAID

The Death with Dignity organization advocates for expanding MAID laws across the US. Dr Sandeen said the organization is currently focusing its political campaigns for the next legislative cycle on 4 states: Arizona, Massachusetts, New York, and Nevada. The efforts include working with state advocacy groups, sharing stories online and in local media, and engaging with state and local elected officials.

“Those political campaigns are really built around people in those states coming together to share their stories and really wanting to establish this policy through the state legislature,” Dr Sandeen said. 

In addition to states potentially passing new legislation, there is activity in states that legalized MAID to make the option more accessible. An amendment to California’s law, which took effect this year, reduced the waiting period for residents who request MAID, among other changes.¹⁵ In Vermont, a new amendment allows residents to request MAID by telemedicine and reduces the delay for a prescription for MAID medications.¹⁶ 

Disclosures: Dr Blanke reported involvement in writing a bill to amend Oregon’s MAID law to make it more accessible to patients who are not able to self-ingest the medications and testified before the state House and Senate on the topic. He continues to work with End of Life Oregon and Compassion & Choices to advance this legislation, and he serves as an expert witness for public defenders who wish to use MAID drugs in capital punishment cases. Dr Sandeen and Dr Brown reported no conflicts of interest.

References

1. States where medical aid in dying is authorized. Compassion & Choices. Accessed October 6, 2022. 

2. In your state. Death With Dignity. Updated August 25, 2022. Accessed October 6, 2022. 

3. Jones JM. Prevalence of living wills in U.S. up slightly. Gallup. Published June 22, 2020. Accessed October 6, 2022. 

4. Medical aid in dying. Compassion & Choices. Accessed October 6, 2022. 

5. Kozlov E, Nowels M, Gusmano M, Habib M, Duberstein P. Aggregating 23 years of data on medical aid in dying in the United States. J Am Geriatr Soc. Published online June 16, 2022. doi:10.111/jgs.17925

6. Brown AJ, duPont N, Alvarez RD, et al. MAID ready for primetime?: A survey of SGO members regarding medical aid in dying (MAID). Gynecol Oncol Rep. 2021;37:100829. doi:10.1016/j.gore.2021.100829

7. Clinicians’ information. American Clinicians Academy on Medical Aid in Dying. Accessed October 6, 2022. 

8. Comparison of provisions in S.74 to other state MAID laws. Vermont legislature. Updated January 6, 2022. Accessed October 6, 2022. 

9. Out-of-state information regarding Oregon’s Death with Dignity Act. End of Life Choices Oregon. Accessed October 6, 2022. 

10. Medical professionals. Introduction to Oregon’s Death with Dignity (DWD). End of Life Choices Oregon. Accessed October 6, 2022. 

11. Death With Dignity Act (DWD) for medical providers. End of Life Washington. Accessed October 6, 2022. 

12. National Clinicians Conference on Medical Aid In Dying 2023. Accessed October 6, 2022. 

13. Al Rabadi L, LeBlanc M, Bucy T, et al. Trends in medical aid in dying in Oregon and Washington. JAMA Netw Open. 2019;2(8):e198648. doi:10.1001/jamanetworkopen.2019.8648

14. Contact the academy. American Clinicians Academy on Medical Aid in Dying. Accessed October 6, 2022. 

15. California bill summary: SB 380. Compassion & Choices. Accessed October 6, 2022. 

16. Robinson R. Scott signs bill to allow telemedicine in medical aid in dying. VT Digger. Published April 27, 2022. Accessed October 6, 2022.

This article originally appeared on Cancer Therapy Advisor