Summary
Medical assistance in dying (MAID) is a process where cognitively competent adults, suffering from a terminal illness, yet alive in the final six months of life expectancy and capable of making their own healthcare decisions, may choose to end their lives with assistance from their doctors. In the first of two commentaries, Dan Cohen, an international consultant in patient safety and clinical risk management, and a Trustee for Patient Safety Learning, considers whether MAID aligns with the goals of healthcare and the foundational principles of biomedical ethics.
*Content warning* Some of the themes included in this blog people might find upsetting.
Content
The Terminally Ill Adults (End of Life) Bill in Parliament
Recently, the House of Commons failed to pass the Terminally Ill Adults (End of Life) Bill.[1] This legislation would have allowed “adults who are terminally ill, subject to safeguards and protections, to request and be provided medical assistance to end their own life.” The bill would not apply to patients who are disabled or mentally ill but are not suffering from a terminal illness.
The legislation would have allowed patients suffering with a terminal illness, whose life expectancy is six months or less and who are cognitively competent and capable of making their healthcare decisions, to request medical assistance in dying (MAID) to “bring about their end of life accordingly on their own terms and at a time of their choosing.”
Two doctors would be required to confirm the terminal illness diagnosis and prognosis and to affirm the patients’ cognitive competency to make their own medical decisions. The legislation also includes protections against patient coercion to request MAID. Doctors willing to participate would prescribe a combination of oral medications, which would then be ingested by patients, thus resulting in ending their life. Similar legislation now exists in 14 countries and in 13 states in the USA, plus its capital, Washington, DC (a separate legislative jurisdiction under the US Constitution)*.
Doctors are not required to participate in any aspects of providing MAID, either during the patient assessment phase or by providing prescriptions for oral medications. Some doctors hold religious beliefs or other moral perspectives that they will not violate. Participating doctors are not generally present when the patients ingest the prescribed medications.
The ending of life remains a private process exclusively controlled by the patients.
In USA states, where the legislation has been passed, about 35-39%of patients who have received prescriptions for the lethal combination of medications do not actually take these medications to end their lives.[2]
Does MAID align with the goals of healthcare?
The practice of medicine is fundamentally viewed as providing diagnostic and therapeutic services designed to maintain health, diagnose illnesses and provide interventions to treat illnesses, improve wellbeing and sustain health. These services ordinarily include professional advice, medications, surgery, physio and occupational therapies, etc. Optimal outcomes are to be under the direction of doctors (and by using this term I am referring to all categories of medical and surgical doctors) and other healthcare professionals, including nurses, various kinds of therapists, etc. These professionals work together collaboratively with patients to implement therapeutic plans that suits each patient’s needs and wants. Even in situations where we may not be able to cure an individual’s illness (e.g., hypertension), we can hope to control their illness, prevent progression and lessen the likelihood of complications or associated comorbidities.
Prevention of illness, limitation of illness progression and potential cures are the goals in the provision of all healthcare services. But what is the apparent goal when patients have a terminal illness, when they cannot be cured and are suffering with pain, disability and even elements of humiliation—for example, in instances where they are experiencing loss of bodily control functions and are sustaining considerable hygiene issues?
Most importantly, what is the goal when a patient’s life expectancy is less than six months, and they want to end their suffering on their own terms and at a time of their choosing?
Providing comfort measures, physical and psychological support most assuredly are important and helpful interventions; however, for some patients, ending their life on their own terms and under their control and timing is what matters most.
So, the conundrum is: does not a doctor’s role and moral obligation include providing these patients what they desperately want and need?
The physician’s moral imperative
The provision of healthcare is driven by an abiding moral imperative. Healthcare must be provided collaboratively in a way that ensures patients receive what they need, based upon prudent assessments of their health concerns and application of commonly accepted standards of healthcare. Healthcare should be provided with empathy and compassion for all patients, while acknowledging varying life circumstances, and working collaboratively with patients to achieve their goals for improvements in health and functionality. How patients define improvements and best outcomes may vary considerably depending on unique diagnoses, prognoses and individual life perspectives.[3]
Consider a patient who has a terminal illness, alive in the last six months of life and suffering from pain, disability and even humiliation in circumstances where bodily functions have been compromised thus resulting in hygiene issues. Should this change our perspectives on that patient’s needs and wants? Can we provide collaborative care when the patient’s goals and our professional perspectives may not align? Who are we serving, if not the patients and their needs and wants?
Where biomedical ethics comes in
Physicians satisfy their abiding moral imperative by aligning the care they provide with the four foundational Principles of Biomedical Ethics: respect for patient autonomy, beneficence, nonmaleficence and justice.[4] In my view, these principles are designed to encompass treatment planning for patients across life’s complete spectrum of health and illness, including the provision of care for those with a terminal illness who cannot be healed or cured.
Principle #1: Respect for patient autonomy
The provision of healthcare services should be a collaborative process, with physicians and patients working together to achieve optimal outcomes. How patients define these outcomes is a very important aspect affecting their choices and respecting their autonomy. Patients’ needs, wants and expectations are what should matter most in collaborative therapeutic planning. Although returning to normal function and curing an illness may not be possible, the goals for improvements should be well thought-out and agreed upon. Each patient’s concerns should be addressed completely and compassionately.
Presume for a moment that your patient has an illness that is incurable, one that will most assuredly cause that patient’s death. Also, presume for a moment that the patient’s prognosis is for death within six months, and the patient is suffering greatly with pain, disability and possibly even humiliation. Finally, suppose what your patient wants is to control the end of their life, accordingly, on their own terms and at a time of their choosing. Should not respect for patient autonomy and choice apply also to this aspect of life? I would posit that it most assuredly does, and that the provision of MAID for these patients complies with the first principle of biomedical ethics.
Principle #2: Beneficence
Physicians are ethically obliged to provide care that is beneficial for patients. But benefit is not limited to improvements in health or cure. When providing care to terminally ill patients, beneficence, from the patient’s perspective, may be the end of suffering from pain, disability and hygiene humiliation. Beneficence, when caring for terminally ill patients, should include the provision of MAID if requested by patients. To deny this care would possibly prolong the process of dying and suffering and would not benefit these patients. Providing MAID thus aligns with the second principle of biomedical ethics.
Principle #3: Nonmaleficence
Nonmaleficence means “do no harm” or at least attempt to avoid preventable harm when possible. For patients with terminal illnesses nearing the end of life, suffering with pain, disability and hygiene issues are often prominent burdens. These may be effectively managed to some extent, but when patients wish to end their suffering on their terms, to deny them MAID could prolong the process of their dying and create the very harms doctors are supposed to seek to avoid. Providing MAID for these patients would avoid continued pain and suffering and thus aligns with the third principle of biomedical ethics.
Principle #4: Justice
The principle of justice requires that all patients be treated equally, without reference to race or ethnicity, religion, socioeconomic background, gender or gender identity.[5] It would be unethical to deny MAID to patients based on discriminatory factors. Providing MAID to all patients who request it thus aligns with the fourth principle of biomedical ethics.
Conclusion
The provision of MAID, when in compliance with requirements of established legislation, aligns with the foundational principles of biomedical ethics**.
In his second opinion piece, Dan explains why, in his view, providing MAID to patients with terminal illnesses is not “assisted suicide".
References
Terminally Ill Adults (End of Life) Bill. The House of Commons, 17 June 2026.
Compassion and Choices. Medical Aid in Dying Utilization Report, 2026.
*The parameters discussed in this post relating to the processes of providing medical assistance in dying represents a compilation of requirements as commonly portrayed in various forms of international legislation and may not be applicable in all countries.
**The opinions expressed above are those of the author. Others may agree or disagree.
About the author
Daniel L Cohen is an international consultant in patient safety and clinical risk management, senior healthcare executive with extensive leadership experience, former US Department of Defense (DoD) physician executive with career culminating as Chief Medical Officer/Executive Medical Director for the DoD TRICARE health plan currently providing healthcare to over 9 million beneficiaries worldwide. Most recently served as Chief Medical Officer for Datix where he championed the company’s comprehensive patient safety thought leader efforts internationally through innumerable conference presentations, publications and commentaries.
Further reading on the hub from Dan:
Late night reflections on patient safety: commentaries from the frontline (2014)
Patient safe care as a moral imperative: The mandate of medical ethics
Diagnostic errors and delays: why quality investigations are key
Patient Safety Spotlight Interview with Dr Dan Cohen, Patient Safety Learning Trustee
Structures, processes and outcomes for better or worse: Personal responsibility in patient safe care
Providing patient-safe care begins with asking and listening... really listening!
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