When physician-assisted death mandates were passed in states like Oregon, Washington, and California, guidelines were established for practitioners as part of election mandates. However, in states like Montana and Vermont, the legalization of assisted death went through the legislature without process and practice guidelines. Therefore, practitioners have little or no framework to implement the process of medical aid in dying.

Despite groundbreaking treatments, novel medications, fast-tracked drug approvals, and cutting-edge science, a terminal diagnosis is still a reality for many patients with cancer. Having end-of-life discussions with patients and their family members is a difficult part of oncology nursing, but it’s necessary to provide the highest quality of care and education possible. With more news reports emerging about states introducing—and passing—medical aid in dying legislation, oncology nurses will face questions about the process from patients and caregivers.

Daniel is a 55-year-old male diagnosed with stage III nasopharyngeal cancer. He lives with Jon, his partner of 4 years. One day, he is taken by ambulance to the ED where it is determined he had an ischemic stroke. He has no advanced directives or living relatives. What would you do?