How Oncologists Can Navigate Patient Requests for Medical Aid in Dying

In this episode of Oncology On the Go, Daniel C. McFarland, DO, spoke with Yesne Alici, MD, who oversees Memorial Sloan Kettering Cancer Center (MSKCC)’s medical aid in dying (MAID) program. Together, they explored what MAID means for oncology practice now that it is legal in New York State.

Alici defined MAID as the legal practice in which a terminally ill, capacitated adult with a life expectancy of less than 6 months may request a prescription that they self-administer to hasten death. Self-administration, she noted, is the main distinction between MAID and euthanasia, which is not legal anywhere in the US. MAID is currently legal in 14 states and Washington, DC, giving roughly 1 in 3 US adults access, according to Alici. Even so, it accounts for less than 1% of all deaths in states where it is legal, and not every patient who inquires goes on to pursue it.

Drawing on MSKCC’s experience fielding inquiries from patients in New Jersey since 2019, Alici described a population that was mostly older and predominantly female, with about one-third of patients having early-stage cancer when they asked and most still receiving treatment. Nationally, the top reasons patients inquire are loss of dignity, loss of control, and loss of ability to enjoy activities, rather than physical symptoms like pain or shortness of breath.

The conversation also walked through New York’s safeguards, including multiple requests, 2 neutral adult witnesses, a decision-making capacity assessment, and a mandatory psychiatrist or psychologist evaluation, a requirement shared only with Hawaii. Alici argued that these assessments should be psycho-oncology informed and stressed the importance of approaching each request with neutrality, cautioning that conflating MAID with suicidal ideation risks alienating patients.

McFarland shared a challenging case involving voluntarily stopping eating and drinking, reflecting on clinicians’ own moral discomfort and on broader philosophical concerns about the romanticization of death. The pair also discussed the need for more research, the role of palliative care, and conscientious objection. Alici closed by urging oncologists who object to MAID to ensure that patients still have a path to discuss their inquiry, noting that New York law mandates offering a palliative care referral.

McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer, in addition to being the psycho-oncology editorial advisory board member for the journal ONCOLOGY®. Alici is vice chair of clinical operations in the Department of Psychiatry and Behavioral Services, clinical director, associate attending psychiatrist, and medical director of the Biobehavioral Health Clinic at MSKCC.