Medical assistance in dying (MAID) is a practice in which a physician helps a terminally ill person end their life, either by directly administering life-ending medications or by prescribing medications the patient takes themselves. It is legal in a growing number of jurisdictions worldwide, though the specific rules, terminology, and eligibility requirements vary significantly depending on where you live.
Two Forms of Medical Assistance in Dying
There are two distinct ways MAID can happen, and the legal and practical differences between them matter. In the first form, sometimes called voluntary active euthanasia, a physician directly administers life-ending drugs to the patient, typically through an intravenous line. In the second form, often called physician-assisted dying or aid in dying, a doctor writes a prescription for lethal medication that the patient picks up and takes on their own, at a time and place of their choosing.
The key distinction is who performs the final act. In clinician-administered MAID, the doctor pushes the medication. In self-administered MAID, the patient swallows it. Both require the patient’s voluntary, competent request. In the United States, only self-administered aid in dying is legal. Canada and several European countries permit both forms.
Who Is Eligible
Eligibility criteria share a common core across most jurisdictions: the person must be a mentally competent adult with a serious, incurable medical condition. Beyond that baseline, the specifics diverge.
In U.S. states where aid in dying is legal, the patient must have a terminal illness expected to cause death within six months. They must be a resident of the state, be at least 18, and possess the mental capacity to make major medical decisions. If a physician suspects a mental health condition is impairing the patient’s judgment, a referral to a psychiatrist or psychologist for evaluation is required before proceeding.
Canada’s criteria are broader. Eligibility extends to people with a “grievous and irremediable medical condition,” which does not necessarily require a six-month prognosis. The person must be at least 18, mentally competent, and eligible for publicly funded health services in a Canadian province or territory. Visitors to Canada are generally not eligible. Notably, people whose only medical condition is a mental illness are currently not eligible for MAID in Canada until at least March 2027, after multiple delays of a planned expansion.
Where It Is Legal
In the United States, MAID is legal in nine states and Washington, D.C. Oregon was the first in 1994, and the list has grown slowly since: Washington state (2008), Vermont (2013), California (2015), Colorado (2016), Washington, D.C. (2016), Hawaii (2018), Maine (2019), New Jersey (2019), and New Mexico (2021). No additional state has enacted an aid-in-dying law since 2021. Montana occupies a unique position: its Supreme Court ruled in 2009 that a terminally ill patient’s consent to physician aid in dying serves as a legal defense against homicide charges, but the state has no formal statute regulating the practice.
Internationally, Canada legalized MAID in 2016 and has expanded eligibility since then. The Netherlands, Belgium, Luxembourg, Colombia, Spain, and several other nations also permit some form of the practice. The United Kingdom recently voted to extend this right to its citizens as well.
What the Process Looks Like
The process is deliberately slow and structured to ensure the decision is voluntary and well-considered. In U.S. states, a patient typically must make two verbal requests to their physician spaced at least 15 days apart. In California in 2020, for example, 662 people started this process by making their first verbal request. Additional safeguards vary by state but generally include a written request, confirmation of the diagnosis and prognosis by a second independent physician, and verification of mental capacity.
For self-administered aid in dying (the U.S. model), the patient receives a prescription, fills it at a pharmacy, and decides when and whether to take it. Many people who obtain the prescription never use it. Having the medication provides a sense of control, which for some patients is enough.
In clinician-administered MAID (common in Canada), the process involves a sequence of intravenous medications. First, a sedative calms the patient. Next, an anesthetic puts them into a deep, unconscious sleep. Then a medication stops breathing. In some protocols, a final drug stops the heart. The patient is unconscious before any of the life-ending medications take effect. The median time from the start of the procedure to death is about 9 minutes, though it can range from as short as 1 minute to, in rare cases, over 2 hours.
Why Patients Choose MAID
The reasons people request MAID are more varied than many assume. Pain and physical suffering are significant, but they are not always the primary driver. Data from British Columbia found that about 60% of patients cited illness-related suffering (pain, nausea, and similar symptoms) as one of their top two reasons. Nearly as many, around 53%, pointed to loss of control and independence. About 49% cited losing the ability to do activities that made life enjoyable and meaningful. And roughly 24% were motivated by fear of future suffering rather than what they were currently experiencing.
These numbers reveal that MAID requests are often about quality of life and autonomy as much as they are about physical pain. For many patients, the prospect of progressive dependence, loss of dignity, or losing the ability to engage in life on their own terms weighs as heavily as any symptom.
Healthcare Providers Can Decline
No physician is forced to participate in MAID. Conscientious objection is recognized across jurisdictions, meaning doctors and other healthcare workers can refuse involvement based on personal, moral, or religious beliefs. Some providers also decline due to concerns about legal ambiguity or fear of litigation, particularly in situations where a patient’s family members might disagree with the decision.
Refusal to participate does not mean abandoning the patient. When a provider declines, the expectation in most legal frameworks is that they refer the patient to another clinician willing to assess or provide MAID, so that the patient’s access is not blocked. The balance these laws try to strike is protecting the conscience of individual providers while ensuring patients can still exercise their legal rights.
Cost and Coverage
In self-administered aid in dying, the primary cost is the prescription medication itself. Out-of-pocket costs for the lethal dose vary but are generally in the range of a few hundred to around $3,000, depending on the specific drug combination prescribed and local pharmacy pricing. Some states have seen significant price increases for commonly used medications. Insurance coverage is inconsistent: some private insurers and state Medicaid programs cover the prescription, while others do not. Medicare does not explicitly cover aid-in-dying prescriptions, though hospice benefits that often accompany end-of-life care are covered.
In Canada, where MAID is clinician-administered and part of the public healthcare system, there is no direct cost to the patient. The medications and the clinician’s time are covered through provincial health insurance.