Researchers analyzed data from each of the 5,329 patients across the United States who used medical aid in dying in the 23 years after Oregon became the first state to legalize the practice (in 1997) and found one demographic dominates the group: well-educated, White patients with cancer. These findings were published by Kozlov et al in the Journal of the American Geriatrics Society.
Of the approximately 5,300 patients included in the analysis, more than 72% 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, PhD, the study's lead author and an instructor at Rutgers School of Public Health in Piscataway, New Jersey. “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.”
Further Findings
The sexes were relatively evenly represented—53% male, 47% female—but medical aid in dying users naturally skewed much older than the population at large. Nearly 60% of the people who died with medical aid were between the ages of 65 and 84. Another 16% were aged 85 years or older, while 8% were 54 or younger.
Many users of medical aid in dying 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.
Barriers Identified: Cost and Providers
One major barrier to many would-be users is cost. Medical aid in dying is now permitted by eight states and Washington, DC, but the federal Medicare program, which is the primary insurer of Americans 65 and older, doesn’t pay any costs associated with medical aid in dying.
Those costs can be considerable, Dr. Kozlov said. States that allow medical aid in dying typically require two doctors to certify the patient will die within 6 months. There’s also the expense of buying the medications prescribed for medical aid in dying, which are often not covered by insurance and can cost up to $3,000.
Another major barrier is finding a doctor who will provide the service. “Many doctors will not participate in medical aid in dying and many who won’t necessarily advertise the fact,” Dr. Kozlov said. “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.”
“Further research in this area is necessary, because although medical aid in dying 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,” concluded Dr. Kozlov.
Disclosure: For full disclosures of the study authors, visit agsjournals.onlinelibrary.wiley.com.
