For Medical Professionals

Planned Deaths

The Death with Dignity Act allows patients to decide if they want to take the MAID medication, who they want to attend their planned death, and when they want to take the MAID medication. EOCLOR strongly recommends experienced EOLCOR volunteers and, if possible, a hospice nurse attends the planned death for medical and emotional support. One other person must be present to report time to sleep, time to death, and any complications, as required on the Attending Physician Follow-up Formthat must be submitted to OHA.

Time to Death

It is suggested the planned death occurs mid to late morning because the dying process may take several hours. Patients and caregivers should be counseled that time-to-death varies. Eighty percent of patients with the standard MAID Rx die within 2 hours,16% in 2-5 hours, and 5% in more than 5 hours.

Before Oral Ingestion

  • Automatic Implantable Cardioverter-Defibrillators should be turned off before ingestion. However, pacemakers can be left on and will not interfere with or prolong the death.

  • The patient must be able to ingest 2-3 oz of liquid within 2 minutes, to ingest the entire MAID medication before becoming unconscious. If their ability to swallow 2-3 oz at this rate is in question, they should practice for several days beforehand.

  • The patient should not eat solid food, especially anything containing high fat, high protein, or dairy for 4 hours before ingestion. 

  • Pain medications should be continued as needed. 

  • One hour before the MAID medication, the patient takes the premedications.

  • The patient should be sitting comfortably in a supported fashion such as in a recliner or in bed with pillows.

Mixing the Meds

  • The MAID medication is mixed with 2-3 oz of water, clear juice, or simple syrup immediately before ingesting.

  • It should not be mixed with high-protein, fatty, or dairy drinks because they can delay gastric emptying. 

  • Alcohol, carbonated beverages and stomach coating medicines (e.g., Pepto-Bismol, sucralfate) are not recommended because they may cause vomiting or interfere with absorption. 

Ingestion

  • The MAID medication can be ingested directly from the medication bottle or poured into a small glass. 

  • It is recommended the patient uses a large bore straw to bypass tastebuds.

  • If the MAID medication is not ingested immediately, it can be refrigerated for up to two weeks. 

  • Patients should be warned that the cocktail will be bitter and may burn. A small amount of clear juice, water, popsicle, or sorbet (which is non-dairy)  may be taken immediately before and after ingestion to soothe the bitterness and burning.

Rectal and PEG Tube Administration

If oral intake is impaired on the day of the planned death by neuromuscular weakness, esophageal obstruction or dysfunction, or intractable nausea and vomiting, self-administration may be done rectally or through a PEG Tube. Self-administration must be deliberate and volitional and must include the patient pressing the plunger on one or two syringes containing the MAID medication or opening a clamp or valve to allow the MAID medication to flow from a gravity bag into the feeding tube or rectal catheter.

Coma

  • Patients fall asleep in 5-15 minutes after ingestions and then go into a coma. 

  • If the patient is on oxygen and if the family is comfortable, the oxygen may be discontinued after the patient falls asleep. 

  • The patient should remain in an upright position for at least 20 minutes for gastric emptying, then they may be lowered to a semi-recumbent position.

Seizures

Terminal seizures are rare and more likely in patients with a history of brain insult (tumor, trauma, or stroke) or a history of seizure disorder, but can also occur from hypoxia immediately preceding death. Although terminal seizures are not common, people attending the death should be aware they are possible and be assured that they will be self-limited and the patient will be unaware and not suffer.

Death Certificate and Insurance

The Death with Dignity Act requires the manner of death to be listed as “natural” and the cause of death as the individual’s underlying illness.

Using MAID does not affect life insurance. 

For Patients Not Enrolled in Hospice

Advise your patients and their caregivers who are not in hospice that the mortuary will need to be notified of the date and time of the expected death and who to contact to sign the death certificate before the day of the planned death. If this is not done, the nonemergency number must be called, generating responses from the fire department, who must pronounce the death, and the police department, who must investigate the death on behalf of county Medical Examiners. This adds distress to an already emotional event.