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Nontraditional End-Of-Life Care

Nontraditional End-Of-Life Care, Medical Aid in Dying, MAID, Voluntarily Stopping Eating and Drinking, VSED, Palliative Sedation

Patient self-administers a cocktail of medications that result in a humane death
1. Intended to avert a more inhumane death (e.g. rapidly progressive ALS)
2. Patient must physically take the medication themselves
Not considered Suicide (by law) and does not invalidate life insurance
1. Cause of death listed as the terminal illness from which they suffer
Laws in U.S. (vary by state) and internationally (vary by country) allow for MAID
Eligibility Criteria
1. Two independent physician assessments (including decision making capacity)
2. Adult age >=18 years old
3. U.S. State resident (where the MAID law applies, exceptions: Vermont, Oregon)
4. Life Expectancy <=6 months
Medical safeguards
1. Other specialties are consulted (e.g. hematology and oncology, Palliative Care)
2. Patient must demonstrate decision making capacity at all evaluation visits
3. Process is 100% voluntary and must be understood as such by patient and all involved
4. Requires a signed consent with 2 witnesses

Patient chooses to not eat or drink
1. Considered legal in all U.S. states
2. Alternatively, forced feeding, may be considered battery
Typically results in death within 7-10 days
1. Duration varies by underlying comorbidity and health status
Requires additional support (e.g. Hospice)
1. Some symptoms of initial Dehydration are initially distressing
Timeline of findings
1. Day 0-1: Patient is awake and interacts with others
2. Day 2-3: Generalized weakness and Light Headedness
3. Day 4-6: Progressive Somnolence to coma

Occurs in ICU or inpatient Hospice
Continuous sedating medications (e.g. Anxiolytics, Opioids) are used to maximize patient comfort and ease suffering
Comfort is the key focus and require a deeper sedation to achieve relief
1. Medications are not intended to end life