[Skip to Navigation]
On the Brain
August 24, 2020

Medical Aid in Living

Author Affiliations
  • 1Department of Neurology, University of Rochester Medical Center, Rochester, New York
  • 2Department of Medicine, University of Rochester Medical Center, Rochester, New York
JAMA Neurol. 2020;77(11):1349-1350. doi:10.1001/jamaneurol.2020.2915

In November 2016, Colorado voters passed Proposition 106, the Colorado End of Life Options Act, by a nearly 2-to-1 margin.1 Colorado thus became the fourth US state to have a medical aid in dying (MAID) law. As with other MAID laws, the Colorado law allows an “eligible terminally ill individual with a prognosis of six months or less to request and self-administer medical aid-in-dying medication in order to voluntarily end his or her life”2; allows physicians to prescribe these medications2; and provides additional regulations, such as the process of determining eligibility (eg, a determination must be made by 2 physicians or include an assessment of capacity).

Add or change institution
2 Comments for this article
MAID as an End of Life Option
Michael McAleer, PhD(Econometrics),Queen's | Asia University, Taiwan
The sensitive message from a caring neurologist on medical aid in living is reminiscent of the final words of The Last Samurai, where the Emperor Meiji asks Nathan Algren about the warrior Katsumoto: "Tell me how he died", to which the response is: "I will tell you how he lived".

The medical aid-in-dying (MAID) law enables terminally ill patients with a prognosis of six months or less to request medication to voluntarily end their lives as an end of life option.

Some terminal illnesses may provide clear indications of longevity, but others might be more opaque about the
expected time to the end of life.

How accurate is the prognosis of six months for all illnesses and all patients, especially regarding the possible feedback effect of admission to a MAID program on the prognosis?
Prognosis and MAID
Benzi Kluger, MD, MS | University of Rochester
Dear Dr. McAleer,
I appreciate your comments and question. Prognosis, particularly for neurologic illness, is certainly not an exact science. There have been a few studies of physicians ability to prognosticate using either general gestalt or scales (e.g. CHESS) and have shown accuracy around 70%. These studies did not include patients with MAID so I do not believe there is a risk of a self-fulfilling prophecy. In my experience with neurodegenerative illnesses, dysphagia (especially for liquids), weight loss, accelerating progression and recurrent infections all have high predictive value.
I think the 6-month prognosis aspect of MAID laws in the US
is a reasonable requirement from a practical perspective in that it also enables physicians to get these patients and their families hospice support. I would also raise the question, for both hospice and MAID, as to whether prognostic estimates are really the best or most relevant criteria for acceptance into these programs.