Medical Aid in Dying: What Oncology Providers Need to Know

In recent years, there has been an uptick in the number of US states with medical aid in dying (MAID) laws, which allow patients with a terminal illness to request prescription medication to hasten death.¹ 

Oregon and Washington State were the first states to legalize MAID in 1994 and 2008, respectively. Now, there are MAID laws in California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Montana, Vermont, and Washington, DC.¹ Bills on MAID are currently pending in Pennsylvania.²

“I think this increase [in MAID laws] is definitely going to continue because this is a social movement with a ton of momentum and public support,” said Peg Sandeen, PhD, executive director of Death with Dignity, an advocacy organization based in Portland, Oregon. 

In a 2020 Gallup poll, 74% of Americans surveyed said they favored allowing physicians to end the life of a patient with an incurable illness if the patient and family request it.³ 

The Role of Oncology Providers

Patients in states with MAID laws are eligible for MAID if they are 18 years of age or older, have any illness that gives them 6 months or less to live, are capable of making their own health care decisions, and are able to ingest the medication on their own.⁴ 

Though patients with any terminal illness may be eligible for MAID, the vast majority of patients who choose it are those with cancer. A recent study showed that 74% of MAID users in the United States between 1998 and 2020 had cancer.⁵

However, data have suggested that oncologists may not feel familiar with MAID or prepared to support patients who ask about it. In a 2021 survey of US gynecologic oncologists, 18% of respondents said they did not know if their state had legalized MAID.⁶ Of the respondents who lived in states where MAID is legal but chose not to provide it, 36% said they did not provide MAID because they had limited knowledge about it. 

“Many physicians in this survey support the option but don’t have the education to provide it in states where it is legal,” said Alaina Brown, MD, an assistant professor of obstetrics and gynecology at Vanderbilt University Medical Center in Nashville, Tennessee, who led the survey. 

Physicians who are opposed to MAID because of ethical concerns, religious reasons, or professional views — such as a preference for palliative care instead — have the right not to provide MAID, said Charles Blanke, MD, a professor of medicine at the Oregon Health & Science University Knight Cancer Institute in Portland. 

“But if it’s legal and medically feasible, I do think there is a medical, ethical obligation to refer patients” to another physician, Dr Blanke said. 

He added that physicians don’t have to wait for patients to raise the topic of MAID. In fact, he recommends that doctors who feel comfortable doing so — and live in a place where MAID is legal — should mention MAID as an option when talking to patients with terminal illnesses. 

If a patient brings up the topic of MAID, health care providers in states where MAID is legal should be prepared to explain how the law works, who is eligible for it, and what it is like for patients, Dr Blanke said.

This article originally appeared on Cancer Therapy Advisor