Medical Aid in Dying: suicide by another name?
Updated: Jul 15, 2022
What should we call it when we let a terminally ill person control the time and manner of their death? Currently, ten states and the District of Columbia allow an adult who is terminally ill to request a prescription for lethal drugs they can take to end their life before their illness ends it for them.
These laws are controversial. Those who support and oppose laws that allow gravely ill people to end their lives use different terms. Those who favor them call this “Medical Aid in Dying” or MAID. Those who oppose them call this “physician-assisted suicide.”
How we label things matters. The debate over reproductive rights is an excellent example of the effective use of naming to advance a cause. Those who oppose abortion rights won the battle of labels. Anti-abortion groups began to call themselves “pro-life” shortly after Roe v. Wade was decided, thereby labeling those who support choice as somehow against life itself. Anti-abortion groups also labeled a rarely used medical procedure “partial-birth abortion,” which is not a medical term but became a label that horrified many who support abortion in some cases. While many factors led to the ultimate reversal of Roe v. Wade, effective marketing by anti-abortion groups certainly played a part.
Terminology in the debate around MAID reflects value judgments. In 1994, when Oregon became the first state to permit MAID, it called its statute the “Death with Dignity Act” and medical aid in dying was typically called “physician-assisted suicide.” The word suicide is loaded. Historically, suicide was considered a felony in many states, barring the survivors of those who committed suicide from recovering the proceeds of life insurance policies. While most states have decriminalized suicide, as recently as 2018 a person who attempted suicide in Maryland was criminally prosecuted. Suicide among people who are physically healthy but facing mental health challenges is a serious public health issue. Using the word “suicide” to describe a gravely ill person’s informed choice to end their suffering conflates two very different types of death.
Among jurisdictions that adopted MAID statutes after Oregon, three (Washington, District of Columbia, Maine) use Oregon’s “death with dignity” language and five (Vermont, California, Colorado, Hawaii, New Mexico) use the words “choice” and “end of life options.” Colorado, which passed an MAID statute in 2016, appears to be the first US jurisdiction to use the words “Medical Aid-in-Dying,” perhaps inspired by language in a 2016 Canadian law that legalized “Medical Assistance in Dying.” New Jersey's law has MAID in its title (Medical Aid in Dying for the Terminally Ill Act). In Montana, where MAID was legalized by the state supreme court in 2009, the court described the practice as “physician aid in dying.”
The medical community is divided about the wisdom of MAID and the language used by different medical groups reflects that conflict. In 2018, the American Medical Association decided that the term “physician-assisted suicide” was more accurate than “medical aid in dying.” But other medical associations, including The American Academy of Hospice and Palliative Medicine and American Academy of Family Physicians, have adopted policies opposing the use of the terms “suicide” and “assisted suicide” to describe the medical practice of aid in dying.
It’s important to distinguish MAID from euthanasia. MAID requires the individual seeking to end their life to self-administer lethal medication when certain conditions are met. Euthanasia is when someone hastens another’s death. Euthanasia is not legal in any state. The requirement that MAID is self-administered is currently being challenged by a disability rights group that claims MAID is not available to some disabled people.
MAID involves difficult moral questions and people of goodwill have strongly different views about whether it is ever right to let a person take his or her own life. Some palliative care physicians believe strongly that MAID would not be necessary if all patients had access to quality hospice and palliative care. Others believe that it is a basic human right to be able to assert one’s autonomy to decide when and how to die when faced with a diagnosis that will result in certain death.
To have a respectful, meaningful debate about these issues, it is important to use terminology that is both descriptive and value-neutral. MAID, or Medical Aid in Dying, is legally and medically different from the tragedy of suicide and is the best way to describe laws that enable terminally ill people to control the time and manner of their death.