Nearly 75% of those who used medical aid in dying had cancer
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Key takeaways:
- The vast majority of patients who died with medical aid were non-Hispanic white individuals.
- Most chose to die at home and a similarly high majority discussed their plans with their families.
- Cost and physician reluctance to provide medical aid in dying may be barriers to patients who seek the service.
Well-educated, white patients with cancer used medical aid in dying more than any other demographic, according to a study published in Journal of the American Geriatrics Society.
Non-Hispanic white patients made up more than 95% of patients who died with medical aid. In addition, more than 72% had some college education and nearly three-quarters 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,” Elissa Kozlov, PhD, study author and instructor at Rutgers School of Public Health, said in a press release. “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.”
For the study, Rutgers researchers reviewed published reports on Medical Aid In Dying (MAID) from nine jurisdictions with legal MAID. They developed a data abstraction guide and calculated rates of death using MAID using CDC WONDER data.
They found that over 23 years, 5,329 individuals died by MAID and 8,451 received a prescription. Median age of MAID death was 74 years.
More men died by MAID than women (53.1% vs. 46.9%) and more non-Hispanic white individuals died by MAID than other racial group (95.6% vs. 4.4%). The majority of MAID users (72.2%) had attained some college education and most (74%) had been diagnosed with cancer.
Similarly, most recipients of a MAID prescription (88.6%) were non-Hispanic white and 43.3% were aged 65 years or older. Almost three-fourths (71.6%) of prescription recipients had some college education, and most (69.3%) had been diagnosed with cancer.
Cost represents a major barrier to the use of MAID among financially challenged and underserved populations, according to the press release. MAID is currently permitted by eight states and Washington, D.C., but the federal Medicare program, which is the main insurer of Americans aged 65 and older, does not pay any costs related to MAID. States that allow MAID generally require certification that the patient will die within 6 months. Additionally, the cost of the medications — which often are not covered by insurance and can cost up to $3,000 — may be prohibitive.
Physicians may also be reluctant to provide MAID, thus presenting another barrier to patients who might seek this service.
“Many doctors will not participate in MAID, and many who will do not necessarily advertise the fact,” Kozlov said in the press release. “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 and colleagues found that although many MAID users had previously received hospice care, 90% chose to die at home, and a similarly high majority (88%) discussed their plans with their families.
“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 said.
References :
- Kozlov E, et al. J Am Geriatr Soc. 2022;doi:10.1111/jgs/17925.
- Medical aid in dying (MAID) mostly used by well-educated, white patients with cancer (press release). Available at: academichealth.rutgers.edu/news/medical-aid-dying-maid-mostly-used-well-educated-white-patients-cancer. Published July 18, 2022. Accessed July 31, 2022.
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