For most patients with dementia, by the time they have a prognosis of 6 months or less, they lack the capacity to make medical decisions. This means they do not meet the criteria under the End of Life Options Act (EOLOA).

Many patients wonder if they can complete the eligibility process for MAID while they are still relatively healthy and have decision making capacity. Under current California law, patients are not eligible until they have six months or less to live.

The law in California does not permit any eligibility determination or prescription of the aid in dying medication prior to that time.

MediCal will cover MAID medications. Some hospice services, such as one of their physicians serving as the second (consulting) physician needed to determine MAID eligibility, may be covered.

Medical Aid in Dying (MAID) and palliative care are both approaches to end-of-life care, but they serve distinct purposes. MAID involves providing eligible patients with the means to end their own life, under specific circumstances and criteria. Palliative care focuses on improving the quality of life for patients with serious illnesses, aiming to relieve symptoms, pain, and stress without attempting to cure the underlying condition. While MAID directly addresses the choice to end life, palliative care seeks to make the patient’s remaining time as comfortable and meaningful as possible

Medical Aid in Dying (MAID) directly facilitates a patient’s choice to end their life, while hospice care is about making the patient’s remaining time as comfortable, dignified, and meaningful as possible in their preferred setting, often at home.

MAID and hospice care offer distinct but complementary end-of-life options. Hospice care provides a comprehensive, holistic approach to supporting patients with terminal illnesses.

Once a patient has decided to no longer pursue medical treatment, hospice care centers on pain management, symptom relief, emotional support, and enhancing overall quality of life during a patient’s final stages.

Hospice care is often home-based, allowing patients to remain in a familiar and comforting environment surrounded by loved ones. This home-based approach ensures that patients receive personalized care tailored to their unique needs and wishes. The hospice team, which may include doctors, nurses, social workers, therapists, and volunteers, collaboratively works to provide medical, emotional, and spiritual support not just to the patient, but also to the family.

Enrollment in hospice does not automatically qualify you for Medical Aid in Dying (MAID) in California. The California End of Life Option Act, governing MAID, sets forth specific criteria, including a terminal illness prognosis of six months or less to live, mental competence to make informed healthcare decisions, and the capability to self-administer the prescribed medications.

Hospice care in California is designed for patients with a prognosis of six months or less, taking into account the specific diagnosis, disease progression, and other associated medical complications. While both hospice and MAID consider the severity and trajectory of an illness, the specifics of how these criteria are applied can differ.

For instance, someone with advanced dementia might qualify for hospice based on the combined effects and complications of the disease but is likely not eligible for MAID due to lacking the required cognitive capacity to make an informed decision.

While there’s overlap in consideration of life expectancy, hospice and MAID have distinct eligibility criteria, and eligibility for one does not automatically imply eligibility for the other.

VSED is a conscious decision by an individual to stop eating and drinking with the intention of hastening death. This approach leads to a natural death over a period of days to weeks. While VSED doesn’t require medical intervention, healthcare professionals can be involved to provide comfort care during the process to ensure patients making this choice do not suffer.

VSED is legal in the United States and no specific legal criteria exists for eligibility. Central Valley Hospice Palliative Medicine licensed professionals can discuss VSED with you and help you decide if it is the right option for you.

Medical Aid in Dying is a direct medical intervention and requires the participation of a physician to determine eligibility and prescribe the aid in dying medication.

Central Valley Hospice Palliative Medicine requires that patients enroll in hospice care before obtaining a prescription for aid-in-dying medication. Fortunately, hospice care is a complimentary benefit under Medicare.

This service offers extensive support both before and following death. Enrolling in hospice ensures that both patients and their families have access to the essential resources and assistance they need.

Moreover, it significantly alleviates the responsibilities and pressures faced by family members and caregivers.

The process can happen quickly if you meet the eligibility requirements. There are a few additional factors that impact how long it takes. California law requires 48 hours between a patient’s first request for the aid in dying medication and their second.

It can take a week or two to review a patient’s medical records, for the patient to see the second (consulting) physician, and to receive the prescription medication which is delivered by courier.

Central Valley Hospice Palliative Medicine will work with patients and other medical providers to ensure that the process to get the medication happens as quickly as possible.

At any point in the process, a patient can decide they no longer wish to seek aid in dying. Once the medication has been received by the patient, the patient should keep the medication in a secure place.

The aid in dying medication comes from the pharmacy in powder form. Right before taking the medication, a qualified licensed health care provider or someone else of your choosing will mix the powder with a small amount of water or other pleasant tasting liquid, such as apple juice.

The majority of patients take the medication by drinking it. For patients who cannot swallow or have other objections to taking the medication orally, the aid in dying medication can be taken rectally or through an existing feeding tube.

Under California law, the aid in dying medication must be self-administered. During the eligibility determination process, licensed healthcare providers will assess your ability to self-administer the medication and help you choose the appropriate ingestion method for your particular needs.

The aid in dying medication is bitter. We recommend mixing the powered aid in dying medication with a pleasant tasting liquid, such as apple juice, to help make it more palatable.

When mixed, the medication is only two to four ounces, so there is not a large amount that you will need to drink.

Having a popsicle, some sorbet, or another favorite easy to eat food on hand that you can eat immediately following taking the medication helps make drinking the medication more pleasant.

It is not painful to die from taking the aid in dying medication. The combination of drugs used in the aid in dying medication provide powerful pain relief and deep sedation. They slow and eventually stop the heart and lungs.

Once you take the aid in dying medication, you will fall asleep quickly. We recommend you find a comfortable place to take the medication. Many patients like to take it in bed, in a favorite chair, or even outside in their garden. Patients drink the medication sitting up and then can lay down if they choose. We can help you make a plan for how you will take the medication, such as who will be with you, what time of day you prefer, if you would like music or aromatherapy, and will help to ensure that all your needs are met.

The decision to take the aid in dying medication is yours alone and you can decide at any time not to take the medication. Central Valley Hospice Palliative Medicine is here to support and guide you in whatever decisions you make.

The aid in dying medication prescribed to eligible patients is a combination of a number of powerful drugs, including morphine. Taken properly, the aid in dying medication always leads to the patient falling asleep and dying.

For family members, caregivers, or anyone else present when a patient takes the aid in dying medication, it is helpful to understand what happens after the medication is taken. Within just a few minutes, the patient will fall into a deep sleep.

Once the patient is asleep, they will not experience any pain or other discomfort. Their breathing and heart rate will slow and soon both will stop. Depending on a number of factors, the amount of time it takes for a patient to die can vary widely. The majority of patients will pass within 1 or 2 hours.

Less commonly, it can take a number of hours before the patient’s heart and breathing completely stops. The patient will not wake during this time and there is nothing additional that needs to be done for the patient. The patient will pass when their body is ready.

Your medical information and records are private. HIPAA and other patient privacy laws apply to Medical Aid in Dying in the same way they do for any conversations you have with a doctor or any medical treatment you receive.


We recommend, and the law encourages, you to share your choice with a family member or caregiver so you can be supported, but that choice is yours to make.

In California, the cause of death listed on your death certificate will be your terminal diagnosis, such as cancer. Using MAID will not affect your life insurance, and it is not considered suicide.

For statistical purposes and to ensure that the law is being followed, the paperwork you and your physicians complete when determining your eligibility will be sent to the state. This information is anonymized. If you are interested in learning more about the statistics California keeps on the use of Medical Aid Dying, you can visit the California Department of Health website.