In the United States ana average of 74 million people live in a jurisdiction that allows Medical Aid in Dying (MAID), with another 87 million reside in 14 states where MAID is on the legislative agenda.[1] Research looking at MAID in the United States has, so far, focused exclusively on data from the Pacific Northwest, which includes Oregon and Washington. However, theses studies are not really representative of the entire United States.

Researchers at Rutgers School of Public Health, Piscataway, New Jersey, USA and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA, analyzed data from each of the 5,329 patients across the U.S. who died from medical aid in the 23 years after Oregon became the first state to legalize it and found one demographic dominates the group: well-educated, white patients with cancer.

The results of their study were first published on June 16, 2022 in the Journal of the American Geriatrics Society.[1]

More than 72% of patients who died with medical aid had at least some college education, more than 95% were non-Hispanic whites, and nearly 75% had cancer.

“We don’t know if these numbers reflect genuine, underlying differences in group preferences or disparities in how laws are written or services provided,” said Elissa Kozlov, Ph.D., the study’s lead author and an instructor at the Rutgers School of Public Health.

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“But such large differences in utilization are always a red flag that demands further investigation, and if that investigation finds disparities that make it harder for some groups to access desired medical services, we need to correct them.”

The sexes were relatively evenly represented — 53% male, 47% female — but MAID users naturally skewed much older than the population at large. Nearly 60% of the people who died with medical aid were between ages 65 and 84. Another 16% were 85 years old or older, while 8% were 54 years old or younger.

Major barrier
One major barrier to many would-be users is cost. MAID is now permitted by 8 states and Washington, D.C., but the federal Medicare program, which is the primary insurer of Americans 65 years old and older, doesn’t pay any costs associated with MAID.

Those costs can be considerable, Kozlov said. States that allow MAID typically require two doctors to certify the patient will die within six months. There’s also the expense of buying the medications prescribed for MAID, which are often not covered by insurance and can cost up to US $ 3,000.

Another barrier
Another major barrier is finding a doctor who will provide the service.

“Many doctors will not participate in MAID, and many who will don’t necessarily advertise the fact,” Kozlov noted.

“You have to be well connected within a network of doctors or skilled in researching such matters, and that’s one possible explanation of why well-educated people are disproportionately represented in our findings,” Kozlov added.

Many MAID users previously had received hospice care. Still, the overwhelming majority — 90% — chose to die at home, and nearly as many — 88% — told their families of their plans.

“Further research in this area is necessary because although MAID will likely never account for more than a small portion of deaths, it is becoming more common in the states where it is legal, and it’s currently on the legislative agenda of another 14 states,” Kozlov concluded.

[1] Death with Dignity. In Your State. 2022. Online. Last accessed on April 5, 2022.
[2] Kozlov E, Nowels M, Gusmano M, Habib M, Duberstein P. Aggregating 23 years of data on medical aid in dying in the United States. J Am Geriatr Soc. 2022 Jun 16. doi: 10.1111/jgs.17925. Epub ahead of print. PMID: 35708060.

Featured image by Kinga Cichewicz on Unsplash Used with permission.  Image/table: Rates of MAID prescription and MAID death per 1,000 deaths, by state and year.

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