End-of-Life Options in the United States

There are many different end-of-life options that are available to patients who are seriously ill and approaching the end of life. Patients may qualify for different end-of-life options depending on their terminal prognosis, discomfort level, decision-making capacity, and other factors. To learn more about each of these options, we encourage patients to reach out to their primary care physician or another licensed healthcare provider.

Declining Treatment

Patients are always allowed to decline treatment or stop medical treatment at any time, even when a certain treatment might prolong their life. Treatments could include cardiopulmonary resuscitation (CPR), ventilators, feeding tubes, IV drips, antibiotics, chemotherapy, dialysis, and other types of medical intervention. When someone decides not to pursue certain treatments, their care team can focus on providing comfort to them, including options that help ease pain or distress.

Because a person might one day be unable to communicate their healthcare wishes, it can be helpful to complete an advance directive. Advance directives are legal documents that allow individuals to outline the types of medical care they want (or don’t want) to receive in the future, ensuring their preferences are known and respected.

Palliative Care

Palliative care is a type of supportive medical care that focuses on comfort, quality of life, and relief from the stress of living with a serious illness. Palliative care specialists work with patients to address physical, emotional, and practical challenges related to their illness, and can be provided in hospitals, clinics, assisted living facilities, or at home. Palliative care can be used in conjunction with other treatment plans. For example, patients receiving treatment for cancer, kidney disease, or dementia may also receive palliative support to help improve their overall wellbeing. A healthcare provider can offer information about whether a palliative care consultation may be appropriate for a person’s situation and needs.

To learn more about palliative care, Get Palliative Care offers helpful information for considering this option.

Hospice

Hospice focuses on improving the quality of life of terminally ill patients who have been given a prognosis of six months or less to live. Hospice offers services such as symptom relief, nursing care, emotional support, and spiritual or psychological guidance. Many programs also extend support to loved ones and caregivers.

Hospice services can be provided in many settings, including a patient’s home, in a hospital, a hospice residence, or in an assisted living facility. Because hospice is centered on comfort rather than curative interventions, patients who enroll generally shift away from treatments aimed at reversing or stopping their underlying condition.

For more information, a great place to start is to visit Hospice Foundation of America.

Voluntarily Stopping Eating and Drinking (VSED)

Patients have the right to voluntarily choose to stop eating and drinking, and some patients may choose this route as a way to hasten a natural death. The experience and timeline vary from person to person, depending on overall health, underlying conditions, and circumstance. People who choose this option will often require increasing support as they become weaker, and it is always recommended that patients and their loved ones work with a licensed medical provider to help manage any discomfort during the dying process, either through medications, keeping the lips moisturized, or other comfort measures.

You can learn more about VSED at Compassion and Choices.

Palliative Sedation

Palliative sedation is a type of care that patients may utilize at the very end of life who are experiencing severe distress or symptoms that are difficult to manage. It involves the use of medications to render a patient unconscious to relieve them from extreme suffering. Palliative sedation is typically only for extreme cases and must be overseen by a licensed medical provider.

To learn more about palliative sedation, visit the Center to Advance Palliative Care.

Medical Aid in Dying

Medical aid in dying (MAID) allows qualified, terminally ill patients to request prescribed medications to die at the time and place of their choosing. In the United States, MAID is legal in only certain jurisdictions. Depending on the jurisdiction, the qualification requirements and the prescription process can vary. However, two independent, licensed healthcare providers must confirm that patients requesting MAID meet each of the following qualifications:

Terminally ill, with a diagnosis of six months or less to live
Mentally capable of making and communicating healthcare decisions
Physically capable of self-administering and ingesting the medication
Physically in a jurisdiction with an existing MAID law*
At least 18 years old

*Most jurisdictions with existing MAID laws require patients to be residents. However, there are some jurisdictions that allow qualified patients to come and use MAID, as long as they are working with licensed healthcare providers in the jurisdiction where they will be receiving MAID. For more information about the eligibility criteria and MAID status in each jurisdiction, visit our MAID Map.

Patients need to ingest the medications on their own, without help from anyone else. After the patient takes the medications, they will soon enter a state of sleep. Once they’re asleep, they will usually die within 1-2 hours, but there are rare moments when this timeline is extended. The time it takes for the medications to work can vary depending on the underlying health conditions of the patient.

For more information on MAID, view our MAID Fact Sheet.

The Completed Life Initiative does not provide direct patient healthcare or legal services. We help individuals navigate their end-of-life choices with dignity and autonomy, in consultation with each patient’s licensed healthcare team.