Medical Assistance in Dying (MAiD) regulations vary across different countries, with Belgium, New Zealand, Spain, Canada and certain U.S. states allowing MAiD under certain circumstances. In recent years, Canada has allowed MAiD for those with irremediable illnesses causing lasting physical or psychological impairment, even if death isn’t foreseeable. In the U.S., access to MAiD is more restricted and only legal in a few states; to be eligible to qualify, patients must be diagnosed with a terminal illness expected to result in death within six months.

Dr. Charles D. Blanke, M.D., F.A.C.P., F.A.S.C.O., Chair of the SWOG Cancer Research Network and Professor of Medicine at the Knight Cancer Institute in Portland, Oregon, and Patrick Baillie, Ph.D., L.L.B., Psychologist and Lawyer for the Calgary Police Service in Calgary, Alberta, share Canadian and U.S. regulations, global trends surrounding medical assistance in dying and ways employers can assist employees who may choose MAiD.

Here are the eight key takeaways from Medical Assistance in Dying (MAiD)—A Global Perspective presented at the 2024 Mental Health in the Workplace Virtual Conference.

What Are the Acceptable Terms When Addressing MAiD?

• Acceptable ways to address MAiD:
  • Physician-assisted death or dying
  • Physician-hastened death/dying
  • Physician or medical aid in dying (MAiD)
  • Death with dignity (DWD)
  • Lawful physician-hastened death (LPHD)
• Incorrect ways to address MAiD:
  • Doctor- or physician-assisted suicide
  • Euthanasia
  • Mercy killing

Summary of MAiD Legislation in the U.S.

• Patients do not have a constitutional right to MAiD.
• The federal government cannot prevent states from making MAiD legal through regulation of prescriptions.
• The legality of MAiD continues to be decided at the state level.
• Twenty-six states have recently considered MAiD implementation.

Restrictions in the U.S. Around MAiD.

• In California, for example, the applicant for MAiD:
  • Must be a resident
  • Must have mental capacity to make the decision
  • Must have a disease that cannot be cured or reversed and that is likely to cause death within six months
  • Must be physically able to take the medication
  • Must make the request three times.
• In Oregon and Vermont, the residency requirement has been removed.

Oregon Death With Dignity Rules and Regulations Include:

• The patient must be 18 years or older with a life expectancy of six months or less. The prescriber must be an M.D. or D.O. and licensed in Oregon. (They do not have to be a specialist.)
• Patients must be capable of making and communicating health care decisions by themselves.
• The physician must inform patient of alternatives including comfort care, hospice and adequate pain control.
• Patients must make three separate requests for lethal medication.
• Patients must be mentally competent when script is written.
• No one may administer a lethal IV injection to another person.

Two-thirds of those given prescriptions for lethal medication fill the prescription and ingest the drug. While the number of prescriptions written annually has generally increased, MAiD deaths make up a very small fraction of overall U.S. mortality. The major end of life concerns prompting physician-aided dying are loss of autonomy, inability to enjoy life and loss of dignity.

Two Tracks to MAiD in Canada

In 2020, the Government of Canada established two paths to MAiD, with one that does not require death to be “reasonably foreseeable,” and stipulated that a mental illness is not considered to be an illness, disease or disability. Later, the Senate introduced a “sunset clause” regarding mental illness.

• Track 1: For “a person whose natural death is reasonably foreseeable”
  • Documentary requirements (written request; witness; another independent medical practitioner provides opinion on criteria)
  • Opportunity to withdraw consent, express consent at time of MAiD, or “final consent waiver” or self-administered
  • No waiting period.
• Track 2: For “a person whose natural death is not reasonably foreseeable”
  • Documentary requirements (written request; witness; another independent medical practitioner with expertise in the illness provides opinion on criteria)
  • Ensure person is informed of means available to relieve suffering and is offered consultations and person has given serious consideration to those means
  • Ninety-day waiting period unless loss of capacity is imminent.

What Is Considered a Mental Illness in Canada?

• Mental illness includes “medical conditions that are primarily treated within the domain of psychiatry, such as depression and personality disorders.”
• Mental illness does not include “neurocognitive and neurodevelopmental disorders, or other conditions that may affect cognitive abilities such as dementias, autism spectrum disorders or intellectual disabilities.”

Where Is MAiD Available for Mental Illness?

• In Belgium, the Netherlands, Luxembourg, Switzerland and Spain, MAiD is available for individuals whose sole diagnosis is a mental illness.
• Utilization rates are low (e.g., ~2% of all requests for MAiD), but are increasing.
• One clinic in Switzerland does not require any diagnosis for access to MAiD.

Are There Any Countries Where the Legislation Addresses Anorexia Nervosa?

• Very few countries. Anorexia as a diagnosis may not qualify for MAiD. The medical issues because of anorexia can be a basis for MAiD in Canada. This is not the case in the U.S.

As more employees grapple with mental well-being, organizations are challenged with implementing new solutions to support mental health in the workplace. Mental Health and Substance Use Disorder Benefits: 2024 Survey Results reveals the prevalence of various mental health challenges among workers and their families.