Academic medical centers implementing new Medical Aid in Dying (MAiD) laws: challenges and solutions

Abstract New York and additional jurisdictions are now joining others in legalizing Medical Aid in Dying (MAiD), but academic medical centers and clinicians are, consequently, confronting dilemmas regarding whether to provide it, and if so, how. Institutions must decide what processes to establish if patients inquire about MAiD, which specific clinicians within an institution should evaluate patients for eligibility and capacity, and prescribe MAiD medications, how to communicate about the new law with patients and local communities, how to educate medical and other students and staff appropriately, and how to make these decisions. The contexts of state laws, hospital, clinicians, patients and local communities all vary in ways that can affect these new institutional practices and policies. Though a few jurisdictions have addressed MAiD in the past, use has been increasing and attitudes changing, and the contexts of different states and their relevant laws vary considerably. For example, though some states require that patients alone, not clinicians, raise the topic of MAiD, others allow clinicians to broach the topic as well, posing challenges. These issues have critical implications for governmental and institutional policies, practice, research and education. This paper provides suggestions for how institutions should address these challenges—by establishing as early as possible a multidisciplinary working group, including providers (e.g., from palliative care, psychiatry, nursing and social work), compliance, other administrative, legal, and ethics stakeholders. Hospitals should establish and disseminate clear step-by-step policies and procedures, including standardized electronic health record templates, and develop research protocols to assess the effects of implementation. Institutions should also provide and organize structured “debriefs” after initial cases (to examine what went well or not) and/or periodic case conferences among clinicians performing MAiD, and mentorship in providing and prescribing MAiD, offering support, in part due to moral distress and other concerns that can emerge.