Clinical practice and pharmacology decisions of medical aid-in-dying providers in the United States.

objectivesComprehensive understanding of the technical aspects of medical aid-in-dying (MAiD) including candidate selection, clinician prescribing decisions, and complications in the USA has been absent from clinical literature. This is due to limited scholarship and highly fractured data reporting methods across states. This study seeks to characterise the current landscape of MAiD practice and management by American providers to assess whether and how national standards of care are emerging across jurisdictions.

methodsA digital survey tool recorded a series of quantitative and qualitative questions from 126 respondents practising in 10 jurisdictions and gathered 682 deidentified case reports of their patients who self-administered a MAiD prescription.

resultsRespondents had cared for an average of 102 patients and 73% reported an increase in patient volume over time. Providers declined 9% of MAiD requests. More than half had changed pharmacological regimens, but lacked consistent clinical justification for these changes. The drug combination known as DDMAPh is the current predominant prescribed MAiD regimen. More than half use alternate MAiD regimens, change dosages, or add agents like macrolide antibiotics, indicating DDMAPh functions as a backbone rather than a standard order set. Unanticipated complications occurred in 7% of cases. The addition of sweeteners did not reduce burning or bitter taste.

conclusionsAlthough there are general trends among MAiD practice, primarily offered by two national organisations, US providers continue to pursue significant individual practice variation.