Aid in dying
Aid in dying is an overarching term that the WFRtDS uses to include all kinds of help at the end of life. It may include palliative care (which is caring for a dying person) and respecting the wish to end treatment (the person dies from the disease). However, normally we use the term more specific. Then it means 1) the distribution of lethal medication to a person for to self-administration and 2) the direct administration of lethal medication, in both cases causing the death. When aid in dying is given by medical practitioners, it is called medical aid in dying (MAiD).
Legality of aid in dying
To be legal, the request for assistance to die must be voluntary. Legal aid in dying requires assessment by one or two medical practitioners (depending on the jurisdiction), and if the person meets the criteria listed in the law of that jurisdiction, a physician or nurse practitioner can prescribe the lethal medication. In some jurisdictions the person is only able to request administration by a health professional if they are no longer able to self administer. The choice of physician administration is not available in the USA. In Switzerland, the law does not require the intervention of a doctor in order to be legally allowed to assist in the death, but in most cases a physician plays a role in prescribing the medication.
There are different terms used to describe aid in dying:
- Medical Assistance in Dying (MAiD): The term used in Canada, where legislation states that MAiD is not the same as assisted suicide. MAiD includes both the help to self administration by a health professional as direct administration by this professional. In Canada the majority of patients rely on physician or nurse practitioner administration rather than self administration.
- Medical Aid in Dying (MAiD): The term used by some parties in the USA.
- Death with Dignity: The term commonly used in the USA. The website of Death With Dignity says the following about it:
“Death with dignity is an end-of-life option, governed by state legislation, that allows certain people with terminal illness to voluntarily and legally request and receive a prescription medication from their physician to hasten their death in a peaceful, humane, and dignified manner. / Death with dignity is a term originating in the title of the Oregon statute governing the prescribing of life-ending medications to eligible people with terminal illness; because our founders authored the Oregon law, our family of organizations bears its name and it’s our preferred term for the practice.“
- Physician Assisted Suicide (PAS): A term previously used in the USA.
- Assisted Suicide: The term used to describe physician administration of a drug to cause the death of a person who is suffering intolerably and meets the legal eligibility criteria. The term is used in Switzerland, Austria and the Netherlands.
- Voluntary Assisted Dying (VAD): The term used in Australia, where legislation states that VAD is not suicide and where assisting a suicide is illegal. VAD is the provision of medical assistance to a terminally ill person for self administration of a drug which will cause their death; if the person can no longer self administer, a doctor can administer the drug. VAD is understood and defined in law differently from suicide. Suicide is seen as an act which is usually carried out alone, sometimes impulsively, and often violently, with society making every effort to prevent it; VAD is an enduring and carefully considered decision of a person with a terminal illness, associated with a gentle, peaceful death, with the person usually surrounded by loved ones.
- Assisted Dying: The term used in New Zealand.
- Dignity in dying: A term used in the UK.
- Euthanasia: The direct administration of lethal medication. The term is used in the Netherlands, Belgium and Luxembourg.
- Aid to die: The term used in Spain.
MAiD and VAD include both the help to self administration and administration by a health professional, such as a doctor or nurse practitioner. Euthanasia is commonly used to define the administration of lethal medication by a physician, but can also include the help of a physician to self administration.