History of Medical Aid in Dying (MAID)
Medical aid in dying (MAID) is also called medical assistance in dying, physician-assisted suicide (PAS), physician-assisted death/dying (PAD), and self-determination in dying. The New York State Bar Association defined MAID as “when a terminally ill, mentally competent adult patient, who is likely to die within six months, takes prescribed medicines, which must be self-administered, to end suffering and achieve a peaceful death.”
MAID differs from euthanasia, which is when a healthcare provider administers a fatal drug, and from passive euthanasia, which is when artificial life support is withheld or stopped (such as feeding tubes and ventilators). Euthanasia is illegal in the United States but legal in some countries, including Belgium, Canada, Luxembourg, the Netherlands, and Spain. Read more history…
[Editor’s Note: We do not recommend or refer specific physicians, counselors, organizations, or other experts on end-of-life issues.]Pro & Con Arguments
Pro 1
MAID allows terminally ill people to choose a “good death.”
The word “euthanasia” comes from the Greek word euthanatos, which means “easy death” or “good death.” [14]
In English, “euthanasia” has meant a good death since Francis Bacon described it as “after the fashion and semblance of a kindly & pleasant sleepe” in the early 17th century. The phrase “good death” has been associated with medical aid in dying ever since. [14]
While individual definitions of a “good death” may vary, a literature review found 94% of reports about what makes for a good death placed “preferences for dying process (94% of reports), pain-free status (81%), and emotional well-being (64%)” at the top of the lists from patients, family members, and healthcare providers. [15]
Many opponents of MAID define the practice as suicide, and thus not a good death. However, the American Association of Suicidology asserted that “suicide and physician aid in dying are conceptually, medically, and legally different phenomena.” [16]
Anita Hannig, Associate Professor of anthropology at Brandeis University, also distinguishes MAID from suicide: “Terminally ill patients who seek an assisted death aren’t suicidal. Absent a terminal prognosis, they have no independent desire to end their life…. Patients who pursue medical aid in dying are no longer looking at an open-ended life span either. To qualify for an assisted death in states with these laws they must already be on the verge of dying – that is, within six months of the end of their life. These patients don’t face a meaningful decision between living and dying, but between one kind of death and another.” [17]
Moreover, because of the waiting periods enforced by MAID laws, the patients have had time to carefully consider their choices for medical care and their own moral or spiritual obligations. Patients who choose medical aid in dying are typically surrounded by family, friends, and other loved ones when they die in a peaceful and comfortable environment. The patients have had time to say goodbye to other people in their lives. [16] [18]
Medical anthropologist Mara Buchbinder has amplified on the benefits of MAID, especially for patients facing a drawn-out physical and mental decline punctuated by incessant medical interventions and a painful and heavily sedated death: “MAID renders not only the time of death but also the broader landscape of death open to human control. MAID allows terminally ill patients to choreograph their own deaths, deciding not only when but where and how and with whom. Part of the appeal is that one must go on living right up until the moment of death. It takes work to engage in all the planning; it keeps one vibrant and busy. There are people to call, papers to file, and scenes to set [turning]… dying into an active extension of life.” [18]
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Pro 2
MAID is a matter of bodily autonomy, a right everyone should have.
Autonomy is “the state or condition of self-governance, or leading one’s life according to reasons, values, or desires that are authentically one’s own.” Bodily autonomy, in turn, is control over one’s physical being. [19]
MAID laws are written “to offer agency and autonomy at the end of life in lieu of suffering, indignity, and shame.” [20]
We should protect the “personal autonomy people should have to decide that they don’t want to continue living to the end of a condition from which they will die after many months, weeks, or days of suffering, both physically and existentially–that is, when there is no longer purpose in their lives,” according to lawyer Lamar W. Hawkins. [21]
“Our own [US] Supreme Court, nearly 30 years ago, found that we all have the right to decide what medical care we are willing to accept,” adds Hawkins. “We should also have a right to decide what suffering we are willing to endure and receive medical assistance necessary to avoid the suffering we want to avoid. Our essential right to take our own lives when faced with unwanted suffering is undeniable–no state prohibits it. What we don’t yet have everywhere is the right to receive assistance in doing so, an omission that discriminates against the too feeble, the too ill, and the too disabled, who nevertheless know their own minds and deserve the assistance necessary to exercise that essential right.” [21]
For many terminally ill patients who are interested in MAID and go through the process to qualify and obtain a prescription, just having the lethal medication on hand relieves anxieties and fears about not only their potentially excruciating deaths but the lives and good moments they have left. [22]
Many find support from family, friends, and medical professionals to continue their lives for a while longer. In fact, many do not take the prescription medication and instead die from the terminal illness itself, but they die more peacefully having had the option of ending their lives and suffering on their own terms. [22]
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Pro 3
MAID ensures thoughtful regulation of the practice.
American death with dignity laws are based on Oregon’s 1994 law, which was the first such American law enacted. The laws all have “stringent eligibility requirements” and “safeguards that [d]ata and studies show… work as intended, protecting patients and preventing misuse.” The safeguards include but are not limited to: being an adult with a terminal illness and fewer than six months to live, mentally competent, and able to self-administer the drugs. Each state requires the patient to make several requests to several doctors in person with witnesses and waiting periods between requests. And the patient may stop the process at any time before taking the lethal medication. [3] [23]
Healthcare providers are under no obligation to participate in MAID but, if they do, they have to stop the process for mental health evaluations if needed or if coercion is suspected. Each state also has strict reporting protocols. [3] [23]
Even Catholic priests have recognized the need for regulated death without agreeing morally with MAID. “And of the two possibilities, assisted suicide is the one [versus euthanasia] that most restricts abuses…. [So] it is a question of seeing which law can limit evil,” argues Father Renzo Pegoraro, Chancellor of the Pontifical Academy for Life. [24]
Many consider medical aid in dying laws a slippery slope to the abuse of vulnerable groups. But as journalist George Will pointed out, “Life is lived on a slippery slope: Taxation can become confiscation, police can become instruments of tyranny, laws can metastasize suffocatingly. However, taxation, police and laws are indispensable. The challenge is to minimize dangers that cannot be entirely eliminated from society…. MAID, enveloped in proper protocols, can and should be a dignity-enhancing response to especially harrowing rendezvous with the inevitable.” [25]
Rather than denying terminally ill people the grace of a good death because the law might go awry, society should work to strengthen protections for vulnerable groups and enforce laws that already make actions such as elder abuse illegal.
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Con 1
MAID dangerously normalizes suicide.
Suicide is “the act of intentionally taking one’s own life.” Medical aid in dying is the act of taking a fatal dose of medication to end one’s own life. [1] [26]
“The more a society becomes pro some suicides, the more normalized suicide will become. Indeed, unless we recognize that the proper answer to suicide ideation is suicide prevention—for everyone, not just some—the ‘right’ to commit suicide could become as fundamental as the right to life,” according to Wesley J. Smith, Chair and Senior Fellow at the Center on Human Exceptionalism. [27]
Legalizing some suicides via medical aid in dying sends the message to those who are not terminally ill but who may be struggling with mental or physical illness, drug addiction, or other hardships that suicide is an acceptable solution available for them. [28]
According to the World Health Organization (WHO), 700,000 people die from suicide every year globally. [29]
In 2020, suicide was the twelfth leading cause of death in the United States, bumped down from the number 10 spot held in 2019 due to COVID-19 deaths and an increase in chronic liver disease and cirrhosis deaths. The overall rate of suicide increased 30% between 2000 and 2020. [30] [31]
Suicide was the second leading cause of death for people aged 10-34 and the fifth for people aged 35-54, making suicide “a major contributor to premature mortality,” according to the Centers for Disease Control (CDC). [30] [31]
In addition to the 45,900 Americans who died by suicide in 2020, some 12.2 million other adults reported serious thoughts of suicide, 3.2 million adults made plans to die by suicide, and 1.2 million adults actually died by suicide. [30]
Steven Wade, Executive Director of the Brain Injury Association of New Hampshire, highlights as well the many “populations, including veterans, teens, people with disabilities, brain injury survivors and the elderly who are ‘pre-disposed’ to suicide for reasons including depression, lack of autonomy and inability to engage in activities that make life enjoyable.” Those populations, he argues, are especially endangered by the “dangerous precedent” of legalizing some suicides, as well as by others who could exploit MAID laws “to steer vulnerable members of our society — who are not necessarily dying — in the direction of death instead of care.” [28]
“A taboo (not stigma) against suicide is an instrumental piece of suicide prevention,” according to psychiatrist Mark Komrad. Thus, instead of promoting any kind of suicide, governments should focus on suicide prevention, effective healthcare, and compassionate palliative care. [32]
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Con 2
MAID endangers vulnerable groups, including people with disabilities, the elderly, and people of color.
Among the dangers of legalizing medical aid in dying is the potential to exploit the laws to kill vulnerable people.
The Center for Disability Rights points to the troubling reality that many disabled people are at the mercy of unscrupulous caregivers, medical providers, and insurance companies. Legal MAID endangers a community “at grave risk of coercion and abuse while creating an opportunity for insurance companies to enhance their bottom line.” [33]
Legalizing MAID “invites coercion,” according to attorney Margaret Dore, because abusive or impatient heirs and caregivers can shepherd the elderly toward suicide by helping them complete the necessary steps, picking up their medication, and potentially even administering the lethal drug because no witnesses are required at the time of death. [34] [42]
“BIPOC [Black Indigenous and People of Color] Disabled people are at greater risk from assisted suicide laws because of racial disparities in health care,” says Ayishetu Salifu Mamudu, Deaf Systems Advocate at the Regional Center for Independent Living. “Although privileged white people present this as a rights issue, the reality is that BIPOC are in the cross hairs of this bad policy. I urge policy makers to recognize that and understand that in establishing this rights [sic] for some people, BIPOC individuals – and others – will die before their time. That is unacceptable.” [33]
Instead of facilitating suicide, palliative care is an effective, compassionate solution that does not imperil vulnerable groups. Zach Garafalo, Manager of Government Affairs at the Center for Disability Rights, points out that “anyone dying in discomfort that is not otherwise relievable, already may legally receive palliative sedation, wherein the patient is sedated to the point that the discomfort is relieved while the dying process takes place. We already have a legal solution to any uncomfortable deaths that does not endanger others the way an assisted suicide law does.” Legal hospice organizations already provide this end-of-life care and comfort. [33]
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Con 3
MAID is a slippery slope to legal euthanasia and worse.
Describing legal MAID as a “moral cliff” rather than a slippery slope, John Stonestreet and Shane Morris, both of the Colson Center for Christian Worldview, highlight the fact that the “patient may request to die, but the doctor is still the one who determines whether the patient is competent and eligible. Small wonder that wherever medical aid in dying has been legalized, doctors and lawmakers have quickly begun asking why they need [a] patient’s permission before exercising ‘compassion’…. Once death is a treatment option, patients can no longer trust their doctors, their insurance companies, or even their families to have their best interests at heart. ‘Terminal illness’ quickly broadens to include ‘intolerable suffering’ which soon broadens to include ‘mental suffering.’” [35]
While the laws may be written with good intent, time chips away at the restrictions that might protect people. For example, in 2022, Oregon eliminated the requirement that patients requesting MAID be state residents. [36]
In 2021, Canada, which legalized MAID and euthanasia simultaneously, removed the criterion that the patient be dying or have a terminal illness; now any patient with a “grievous and irremediable medical condition” may request MAID or euthanasia. [37]
In 2002, Belgium extended euthanasia to children over 12, and recent health ministers have even tried to extend the law to all children. [38] [39] [40]
“As the world’s pioneer, the Netherlands has also discovered that although legalising euthanasia might resolve one ethical conundrum, it opens a can of others – most importantly, where the limits of the practice should be drawn,” says journalist Christopher de Bellaigue. Specifically, “the idea that a measure introduced to provide relief to late-stage cancer patients has expanded to include people who might otherwise live for many years, from sufferers of diseases such as muscular dystrophy to sexagenarians with dementia and even mentally ill young people.” [41]
As MAID becomes more common globally, the ethical and moral concern we should have over issues as serious as doctoring, death, and euthanasia is dangerously weakened.
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