What Is a Terminal Disease? Hidden Expansion of Medically Assisted Death in the United States

Medically assisted death (MAD) in the United States is legally restricted to adults with a terminal disease. When these laws were debated and adopted, the term “terminal disease” was used by lawmakers and the public with a common sense understanding: an incurable disease that would inevitably cause death in the near term, regardless of treatment. Since then, published case reports, government correspondence, annual report data, and professional discussions indicate that some clinicians now apply the terminal disease criterion to cases where death is expected primarily because the person refuses or cannot access food, water, or standard medical care. This constitutes a de facto expansion of MAD eligibility, likely enabled by excessive clinician discretion and weak state oversight, with significant implications for the legal, ethical, and democratic foundations of terminal illness-based MAD regimes.