MAID

Q: All of the following drugs are part of the protocol recommended by the American Clinicians Academy on Medical Aid in Dying (ACAMAID) for patients who qualify for Medical Aid in Dying (MAID), EXCEPT? (select one)

A) Diazepam 

B) Digoxin 

C) Morphine 

D) Amitriptyline

E) Succinylcholine 

Answer: E

MAID is a very restrictive legal process and is available in very few states in the United States. Once all the legal requirements are fulfilled, a patient can be eligible for help. American Clinicians Academy on Medical Aid in Dying (ACAMAID) recommends a combination of drugs abbreviated as DDMAPh.

• Diazepam 1 g
• Digoxin 100 mg
• Amitriptyline 8 g
• Morphine 15 g
• Phenobarbital 5 g

It may surprise many that the intravenous (IV) route in MAID is not part of the protocol. All medications must be sourced as powder, not crushed tablets. Crushing of tablets is discouraged as they may contain a large amount of filler material. Specific pharmacies provide a compounded powder. If powder can be administrated orally, the rectal route should be considered.

Said all of the above, only certified and legible physicians should take care of such patients - again - once all legal, moral, and ethical requirements are satisfied.

#palliative-care

References:

1. American Clinicians Academy on Medical Aid in Dying. Instructions for mixing aid-in-dying medications. https://www.acamaid.org/mixinginstructions/.

2. Data on Rectal Self-Administration of Aid-in-Dying Medications. American Clinicians Academy on Medical Aid in Dying. Available at: https://www.acamaid.org/rectaldata/ 

3. American Clinicians Academy on Medical Aid in Dying. Available at: https://www.acamaid.org/pharmacologyinfoupdates/ 

(Above sites last accessed on January 21, 2024).