Medical Aid in Dying Isn't Suicide.
Here's the Difference (and Why It Matters).
If you're old enough to remember Jack Kevorkian (aka "Dr. Death"), there's a good chance that's still the picture in your head when someone says "medical aid in dying."
But it's not the right one. And the gap between what people assume and what the law actually says is exactly where this conversation lives.
I had an insightful conversation with Bernadette Nunley, Chief of Legal Advocacy at Compassion & Choices, to get to the bottom of what “medical aid in dying” actually is. How is it different from euthanasia and assisted suicide, and why is that difference not just legal hairsplitting but the entire point?
What Is Medical Aid in Dying, Actually?
Medical aid in dying (MAID) is a medical practice, defined in state law, available to a mentally capable, terminally ill adult with a prognosis of six months or less. That person can request a prescription from their healthcare provider — a prescription they must then self-administer, on their own, to die peacefully.
Every word of those two sentences is load-bearing and must be true for MAID to take place.
Mentally capable. The patient has to be able to make their own healthcare decisions.
Terminally ill, six months or less. This is the same window that qualifies someone for hospice.
Self-administered. No one else — not a family member, not a doctor — can administer the medication. The patient brings it into their own body, every time.
As of my podcast with Bernadette, medical aid in dying is authorized in 13 states and Washington, D.C.: California, Colorado, Delaware, Hawaii, Illinois, Maine, Montana, New Jersey, New Mexico, New York, Oregon (the first state to adopt the law), Vermont, and Washington State.
What It's Not: Euthanasia, Assisted Suicide, or Kevorkian
This is where most confusion lives, so it's worth being precise.
Euthanasia:
Euthanasia is when a healthcare provider administers a lethal drug directly to the patient.
That's illegal everywhere in the United States. Medical aid in dying laws are written specifically to distinguish the practice from euthanasia. The key difference is that the patient must self-administer, full stop.
Assisted suicide:
Assisted suicide is typically a felony, and it's kept legally and conceptually separate from MAID on purpose.
The distinction matters because if someone is expressing suicidal ideation, that's a death advocates want to prevent. The person needs support, not suicidal assistance.
Medical aid in dying describes something structurally different: a patient walking through a deliberate process with their healthcare provider, often with loved ones part of the conversation, inside the healthcare system, tied to an already-terminal prognosis.
The line between MAID and these isn't semantic. It's the difference between preventing a death and supporting a dying person's autonomy over a death that is medically certain.
How does the process actually work?
It starts with the patient. The request has to be voluntary, and it has to originate from the person themselves.
Not a healthcare provider suggesting it.
Not a spouse.
And critically, not a medical power of attorney or healthcare proxy, even if that person is otherwise authorized to make decisions on the patient's behalf. If a patient loses capacity, no one can request MAID for them.
After the voluntary decision is made by the patient, these are the steps that follow:
The patient makes a request (written and/or oral, depending on the state) to their attending healthcare provider.
The provider evaluates and documents the patient's capacity throughout, confirming the terminal prognosis and mental competence at every stage.
A prescription is written and sent to a compounding pharmacy, which combines the medications into a single dose.
At the time the patient chooses, the medication is mixed with liquid so it can be self-ingested, often through a straw, sometimes with a cup held for them. That kind of physical support is legal. What has to remain the patient's own act is the actual ingestion.
And it's not a one-way door. At any point, a patient can decide not to move forward, even after the prescription is filled and sitting in their home.
Most people who choose MAID do it at home. Some choose to be outside. Some are in residential care facilities or hospitals, though not every facility supports it — some states require institutions to be transparent about whether they do.
But if the patient has dementia?
This is where the conversation gets harder, and more complicated.
Because MAID requires ongoing mental capacity, it is not available to someone in the terminal stages of dementia. By definition, the capacity requirement can't be met once the disease has progressed that far. That surprises a lot of people who assume a diagnosis alone would qualify them.
But "not eligible for MAID" doesn't mean "no options." It means the planning has to happen earlier, and it looks different:
Advance directives can specify exactly what kind of care a person wants at each stage — not just "keep me on machines or not," but far more granular choices. Someone might specify: if I no longer recognize my family and I have a heart attack, I want comfort care only, which means no resuscitation, no emergency room.
If a person has a co-occurring terminal illness (cancer, for example, alongside dementia), they can still make decisions to stop curative treatment for that illness — meaning their dying process becomes tied to the terminal diagnosis rather than the dementia itself.
VSED — voluntarily stopping eating and drinking — is a legal option some people choose while they still have capacity, specifically to avoid progressing into advanced dementia. It's not something a person does alone; it requires palliative support (pain management, moistening lips for dryness) to keep the person comfortable as their body naturally shuts down.
It's worth naming the cultural weight here directly: food is often equated with love and care, and the idea of "stopping eating and drinking" can sound like abandonment or suffering.
But advocates draw a sharp distinction between a healthy person skipping meals and a dying body that is naturally beginning to shut down. In this case, a body that, at a certain stage, isn't absorbing nutrition the way it once did.
The goal of supportive care is to make sure it doesn't feel like suffering.
The Bigger Picture: Values First
Medical aid in dying is just one option inside a much larger system of advanced care planning, palliative care, hospice, and the ongoing work of getting healthcare providers—most of whom receive little to no formal training on end-of-life care—equipped to have these conversations at all.
The advice for where to start isn't just legal; it's personal:
"What's important to me? How do I want to spend my time? Who do I want to spend it with?"
This isn’t a one-time exercise. As health changes, the answer changes.
What matters at diagnosis isn't necessarily what matters after treatment stops working. The recommendation is to keep returning to that question, both with yourself and in conversations with the people you love, long before a crisis makes the conversation urgent.
Compassion & Choices offers free planning tools, including an end-of-life decision toolkit and a dementia-specific care planning tool, on its website. If this blog raised questions about what's legally available where you live, that's the place to start.
🎙️ Listen to this episode of Life Is Legal wherever you get your podcasts. If you found it helpful, leave a review, subscribe, and share it with someone who needs to know this stuff.
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This post is for educational purposes only and does not constitute legal advice. Laws vary by state and situation. For advice specific to your circumstances, consult a licensed attorney in your area.
