Takeaway
When a patient asks about medical assistance in dying, prioritize deep listening and exploration of fears and hopes over immediate procedural responses. This can help reassure them that you’ll accompany them to the end.
Lifelong Learning in Clinical Excellence | April 8, 2025 | 3 min read
By Carolyn Rennels, MD, University of San Francisco
A patient inquiry about medical aid in dying (MAID) can be an opportunity for clinicians to learn more about their concerns, values, and goals. It can also help establish a trusting patient-doctor partnership through the illness journey.
I recently met Mr. S, who had just been diagnosed with metastatic pancreatic cancer. His life recently had been a whirlwind of ED visits, imaging and labs, and meetings with oncologists. The oncologist had referred him to my outpatient palliative care clinic, hoping that we could help with symptom management and advance care planning. I asked Mr. S what he wanted to focus on during this visit.
He worried about his pain, losing his independence, and the future caregiving burden on his wife and kids. Then he paused, looking down and then back up at me—he worried about the end, about what would happen if things got really bad. He asked, “Is it true that if I ask you to, you can give me medicines to end my life?”
Medical aid in dying, or MAID, allows a terminally ill person to request and receive medications to end their life. MAID is legal in 10 states and Washington D.C. To qualify for MAID, one must be an adult resident of a state where MAID is legal, have a terminal illness with a prognosis of six months or less, have the capacity to make the decision for oneself, and be able to self-administer the medication.
I let the silence sit and then met his eyes. “Thank you for sharing this question. We care for many people who ask about medical aid in dying, and people ask about it for many different reasons. Could I ask you what leads you to ask about it today?” He took a deep breath, visibly relieved that I was willing to engage in the topic and began to speak.
Many clinicians might feel uncertain, ethically conflicted, or even frightened when a patient asks about medical aid in dying. Here are some lessons I’ve learned about addressing patient inquiries:
1. Slow down and explore.
Resist the temptation to go straight into describing the details of your state’s MAID process. MAID is legal in my state, and upon hearing an inquiry I might be tempted to jump into outlining the steps to access the medications. If MAID isn’t legal in your area, you might be tempted to quickly shut the conversation down. Either response misses the chance to hear your patient’s worries and hopes regarding the end of their life.
I remind myself that my patient has shared something vulnerable and there’s a reason behind the inquiry. Are they afraid of losing control? Of pain? Of burdening others? This inquiry isn’t so different from any expression of distress. I ask open-ended questions to encourage them to share their concerns, values, and hopes. Some phrases I often use are: “As you look to the future, what are you worried about? And what are you hoping for?”
2. Reassure the patient that there are multiple ways to address suffering.
Most patients who ask about MAID don’t go on to complete the process. It’s our job to inform people about the likelihood of the forms of suffering they fear and use medications and other interventions with interdisciplinary support to alleviate suffering in any ways possible. Consider more aggressive symptom control and discuss available programs like hospice. It’s possible that patients will no longer be interested in MAID if symptoms and other sources of distress are addressed thoroughly. If not, there’s time to consider legal and logistical next steps.
3. Tell your patient that you’ll accompany them, no matter what.
Whether or not MAID is an eventual possibility, a promise we can keep is to remain available to patients throughout their illness, supporting their physical and emotional needs to the best of our ability. This in and of itself often goes a long way to relieve fears.
A patient asking you about medical aid in dying may initially seem overwhelming. But remaining open to learning more about this request is a chance to display your commitment to walk with patients through their journey of illness.
Finally, here are some additional resources:
“Medical Aid in Dying,” “American Family Physician.”
“Responding to a Request for Hastening Death,” Palliative Care Network of Wisconsin.
“Evaluations a Request for Hastening Death,” Palliative Care Network of Wisconsin.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.