Physicians and Medical Aid in Dying: A multimethod study of physicians who do and don't provide MAiD

PROJECT SUMMARY ABSTRACT Patients with terminal illnesses face many complex decisions regarding their care at the end of life. Options range from aggressive life-prolonging care to those that aim to minimize suffering and include palliative care (which can occur simultaneously with life-prolonging care) and interdisciplinary hospice care. Enter into this already complicated decisional context a legal option for patients to voluntarily end their lives before their illness advances further: Medical Aid in Dying (MAiD). In 1997, the “Death with Dignity Act” was passed, legalizing MAiD in Oregon. Since that time, 10 states and the District of Columbia have passed MAiD laws, and 8-9 states are considering similar legislation as of 2021-22. Yet, despite growing widespread access to MAiD, there is a paucity of research about physicians' participation in MAiD. There are no national data to understand the epidemiology of MAiD from the physician perspective. Further, there are no data on the role that ethical and patients' quality-of-life (QOL) considerations do or don't not play in physicians' participation in MAiD activities. To address these large knowledge gaps, we propose to conduct the first ever national study of physician participation in MAiD. The specific aims are: Aim 1: to create a claims-based MAiD-targeted sample of doctors practicing in states where MAiD is legal; Aim 2: To conduct a national survey of doctors practicing in states where MAiD is legal regarding the nature, extent, and consequences of their participation in MAiD; and Aim 3: To explore the unique role that ethical principles and physician assessments of the quality of life patients have on physicians' attitudes towards and participation in MAiD activities. Given MAiD appears to be expanding across the US, the data provided by this study will be critical to inform MAiD discussions and evidence-based policies and practices of physicians in the US.