
Planning, Preparing, and The Aid-in-Dying Day
Once you are eligible for medical aid in dying, new needs and questions arise.
Please stay in close touch with your prescribing provider and hospice or palliative care team for support and guidance.
There is a window of opportunity for aid-in-dying. It opens once you are eligible and closes if you permanently lose capacity or the ability to ingest and absorb the medications. It is crucial to understand that no clinician can predict precisely when you might die, but they can provide guidance. Your attending/prescribing provider, in collaboration with your hospice team, should be able to give you this essential guidance.
Your medical or hospice team will want to work with you to ensure that you are as comfortable as possible and don’t proceed due to uncontrolled pain, nausea, breathing problems, or other symptoms that could be controlled or managed.
Ask your team to let you know what their assessments indicate so that you can make a more informed decision about whether and when to proceed. Signs such as becoming weaker and unable to get out of bed, having an extremely low appetite, sleeping most of the day and night, becoming less alert and oriented, changes in vital signs, and increasing pain or other symptoms may indicate that your body is shutting down, and your window of opportunity for aid-in-dying could close soon.
Remember that patients are never obliged to take the medications to die. Many patients are surprised to find their dying process is more acceptable than anticipated, especially with hospice care, and so they never proceed.
Patients must have mental capacity before self-ingesting but can proceed for their own reasons and do not have to explain their thoughts or prove they are suffering.
Please stay in close touch with your prescribing provider and hospice or palliative care team for support and guidance.
Please reach out to your prescriber for detailed instructions.
These are a few Academy recommendations:
It is essential to have detailed contingency plans in case you lose the required mental capacity or the ability to safely proceed with aid-in-dying. Your loved ones and other bedside attendants will need to be fully prepared to step in and provide bedside vigil care, including turning, cleaning, and giving you comfort medications. Ask your hospice team or other provider to help prepare a plan, just in case.
Your hospice team or provider should monitor and manage your condition to optimize your choices, especially your gastrointestinal and cognitive functions. Constipation, diarrhea, nausea, or vomiting should be assertively controlled, ideally using non-sedating medications so you maintain capacity. That said, comfort medication should not be withheld, and any uncomfortable symptoms should be well managed.
For safety, the aid-in-dying medications should be kept at the pharmacy until your plans are clear and the date approaches, usually within a few days. You won’t be charged for these expensive, dangerous medications if they are safely held at the pharmacy. They won’t pose a threat to anyone in your home, and your loved ones won’t be tasked with disposing of them. The medications can typically be promptly delivered.
Once your plans are in place and the medications are delivered, you should practice swallowing two ounces of a slightly thickened liquid, like a smoothy, every day so you know you can swallow on the day of the aid-in-dying. If you will be using a non-oral route, practice depressing the plunger on a 60mL feeding syringe filled with two ounces of water. This practice can help ensure you will be able to self-administer and can help you feel calmer on the aid-in-dying day.
Consider making most of your goodbyes in the days before the aid-in-dying day and having a few of your closest loved ones in attendance so the focus can more easily be on you and yours in your final moments.
Generally, The night before a planned aid-in-dying death, you should stop eating or taking in any food after midnight and have only clear liquids after that. Most patients will not pass stool during or after the procedure, but you may feel more comfortable wearing an incontinence brief so any urine will be contained.
If you decide to take the medication to die, we strongly suggest you have an experienced clinician, such as a hospice nurse, end-of-life doula, or volunteer, at your bedside to help manage the procedure. The aid-in-dying day can be very emotional and stressful. An experienced clinician can take care of the medical details, freeing you and your loved ones to focus on each other. If your hospice staff cannot provide the attentive bedside care you and your family need, privately hired end-of-life doulas or volunteers from various non-profit organizations can offer this essential support.
The Academy can provide referrals for bedside attendants through our website or at this link.
Please reach out to your prescriber for detailed instructions.
The aid-in-dying procedure is generally very peaceful when you and your loved ones know what to expect and are well supported. Having a knowledgeable hospice staff or bedside attendant is essential to ensuring a peaceful process and supporting your loved ones. The Academy can provide referrals for bedside attendants this link.
The medications come in powder form that must be carefully mixed with clear filtered apple juice (see video below). When swallowed, they taste very bitter and can cause a burning sensation, which can be soothed by a non-fat popsicle or a few teaspoons of non-fat sorbet before and after taking them. Sitting upright during swallowing can help prevent coughing, and it is best to remain upright until sedation begins to take effect.
Some patients are unable to swallow but can self-administer the medications by pushing them into their GI tract through a 60mL feeding syringe and tube via PEG, ostomy, or small rectal catheter. Some non-oral routes require significant clinical support. If you need a provider who can manage non-oral routes, please fill out our referral form at this link
After taking the medicines, deep sleep occurs in about five to ten minutes, followed by a coma. Patients typically begin to have very slow, sometimes imperceptible breathing, then may take several sudden deep breaths and stabilize for a few hours. All the typical signs and symptoms of dying will be present, such as changes in color and sometimes slight stiffening and relaxing of body muscles.
The heart and lungs slowly stop, and death typically occurs within two to five hours. Some patients’ illnesses cause medications to be absorbed more slowly, and those deaths can take longer, up to a day. But remember, the patient will be comfortably unconscious during that entire time.
We recommend that loved ones or bedside attendants call hospice or the attending provider once no breaths or neck pulse has been detected for at least ten minutes.
According to law, your death certificate will officially list your underlying medical condition as the cause of death, not medical aid in dying. Notably, life insurance companies are legally prohibited from canceling policies for patients who pursue aid-in-dying.
Generally, families are not at risk of having more complex grief due to their terminally ill loved one having taken lethal medications and died. Hospices and various nonprofits offer specialized grief support for families; contact us for details.
If you need a referral to a provider, or support for non-oral routes, please click here
Find a ProviderIf you need a referral to a bedside attendant, please click here
Find an Aid-in-Dying AttendantA Video Enactment of the Aid-in-Dying Day
Instructions for Mixing Aid-in-Dying Medications
The aid-in-dying medications must be carefully mixed with two ounces of clear filtered apple juice. If hospice staff or bedside attendants are not permitted to help, please proceed cautiously.