Patients that have received terminal diagnoses, such as cancer, frequently worry about end-of-life care and options. An option that is becoming permitted in states such as Oregon, Washington, Vermont, Colorado, California, Hawaii, Maine and New Jersey is physician assisted suicide or Medical Aid in Dying (MAID). Physicians and patients in Massachusetts are challenging their right to be able to use this practice as an option of end-of-life care in Kliger v. Healey.

What are current options that terminally ill patients currently have?

The most common option the terminally ill have are to be administered strong narcotics that are provided to help with pain and suffering, but have side effects of deceased mental alertness, and are not always strong enough.

When relieving the pain with narcotics is not effective, there is a process available called “terminal sedation,” or “palliative sedation,” where the patient is sedated to unconsciousness and the physician withholds hydration and nutrition to hasten their death. This practice is legal and accepted in the state of Massachusetts.

The withdrawal of life-sustaining treatment is not considered “suicide” under current Massachusetts law and physicians who offer this treatment cannot be charged with manslaughter. The petitioners in the case draw comparisons to this practice and MAID, arguing that MAID should be protected as well.

How does MAID work?

The first step in MAID would be describing MAID as an end-of-life care option to the patient by the physician. The Massachusetts appeals court ruled that barring a physician to discuss these options with their patients would violate the right to freedom of speech under the First Amendment because it impedes a doctor’s ability to discuss medically appropriate end-of-life treatment options.

The next step in MAID would be for a doctor to write the prescription for the patient who elects to have MAID as an option for their care. The patient must have been given a timeline of 6 months or less to be eligible. The doctor has the ability to refuse writing the prescription of the patient if they believe the patient had “suicidal tendencies,” because the patient would, therefore, not apply for MAID. A patient must be competent to qualify for MAID, and this includes mental health evaluation. In Colorado, the law requires the physician refers the patient to another doctor for a second opinion before prescribing the medication.

The final step in MAID would be the patient filling and self-administering the prescription. The physician does not administer the medication, and the patient must do it themselves. Many patients chose not to fill the prescription, but have the peace of mind knowing that is an option for themselves.

So, can a physician be charged with manslaughter for writing a prescription for a terminally ill patient under MAID?

As of right now, no physicians have been charged with manslaughter for prescribing a medication under MAID, but the Massachusetts Appeals Court ruled that a physician could be. The petitioners in the case going up to the SJC are arguing that physicians should be protected from these charges. Hopefully the Supreme Judicial Court finds for the petitioner and expands on end-of-life options for terminally ill patients.