As advocates, we know that medical aid in dying (MAID) is about much more than the act of a terminally ill person requesting a prescription for life-ending medication and taking that medication at a chosen time and place. Death with Dignity is about having a choice at the end of life; it’s about peace of mind.
Exploring the Impact of Knowledge and Access Surrounding Death with Dignity
Each state with an assisted-dying statute issues an annual report on usage of MAID, so we have an understanding about the numbers of individuals who qualify for Death with Dignity each year and the numbers of individuals who ingest the medication to end their lives.
But, those numbers do not help us understand the impact of having more options, nor do they give us more than a glimmer toward understanding peace of mind. A new research article in the online JAMA Network Open, published in February, 2025, explores these concepts, albeit obliquely, while primarily examining knowledge about the availability of Death with Dignity among the general population.
It is rare that we see data from a national sample published on our issue, making this article, “Knowledge of and Preferences for Medical Aid in Dying” an important contribution to the body of scholarship around Death with Dignity. The data were derived from an online sample of 3,227 respondents from all 50 states, plus the District of Columbia. The authors note that they oversampled individuals living in states with Death with Dignity, those over 60, and people of color. Oversampling means the researchers attempt to find enough people in those categories so that statistical conclusions can be drawn, a common research strategy.
Public Knowledge of Medical Aid in Dying for Increasing End-of-Life Options
Interestingly, on the main research question, “What is the level of public knowledge about the legality of medical aid in dying (MAID) in the U.S,” the researchers found 51.3% of respondents did not know whether MAID was legal anywhere in the U.S. Similarly, 50.8% did not know whether MAID was legal in their home state. As you would expect, there was a difference between individuals living in states where MAID is legal as compared to those in non-MAID states. People living in MAID states were more likely to know Death with Dignity was legal than non-MAID state respondents.
Language Matters: Why Neutrality in Research is Critical
It’s important to note that the researchers used appropriately neutral language in their survey. When researchers biased against Death with Dignity construct surveys, they use pejorative language like assisted suicide and euthanasia, both illegal in the United States. In contrast, the researchers here defined MAID in this accurate and direct manner: “laws that permit physicians to assist in ending an individual’s life by prescribing medicines that are intended to cause death. In some countries, MAID is legal and available to patients who have less than 6 months to live due to a serious illness.”
Researchers also explored interest in accessing or considering MAID in the hypothetical situation where the respondents were terminally ill. Nearly 45% of study participants indicated they would “definitely” or “probably” consider MAID if they received a terminal diagnosis. This is the most important finding in the study. It demonstrates that MAID impacts a much larger population of individuals than just the people who choose to ingest the medication to end their life.
The Role of Death with Dignity in End-of-Life Care
It also underscores the importance of offering terminally ill individuals a range of options as they undergo their end-of-life care process. We know that very few of them will choose Death with Dignity—in fact, a fraction of one percent of all deaths in MAID states—but having this option provides peace of mind to nearly a majority of individuals who are dying, if these findings can be generalized to the general public.
Exploring Racial Disparities in the Use of Medical Aid in Dying
The authors draw conclusions about the lack of usage of MAID among people of color who are terminally ill, speculating that lack of awareness or knowledge about the availability might be contributing factors as to why there is a difference in MAID usage between white terminally ill individuals and their Black, Latino, Asian, American Indian and Pacific Islander, and mulitracial counterparts. While this may be true, the researchers did not directly ask the “why” questions to the participants.
The why question—why did you choose to use the law or not—could also be posed as “What factors contribute to your decision-making about your end-of-life options?” These questions are beyond the scope of the researchers’ inquiry for this study, but research is a process of constantly peeling back the layers of a complex issue. The next pieces of research could dive into this important question directly, so that our movement could better support people of color who are dying.
Overall, this is an important contribution to the body of research about MAID, and we look forward to seeing more studies like this.
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