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Design and Participants: This study (among adults receiving care at a Washington, DC not-for-profit, 912-bed academic and research hospital) assessed whether MAID legalization undermines patient trust, with considerations of potential trust and demographic correlations in marginalized and minority populations. Two versions of the five-question abbreviated Wake Forest Trust Scale survey were used, each distributed to half of participants: one included notification that MAID (in this study, defined as “doctors…prescrib[ing] lethal doses of drugs requested by a terminally ill patient, which the patient could use themselves to end their own life”) had been legalized, and the other omitted this information (control). Multiple linear regression and ANOVA were used.
Results: Of those who completed the survey (N=494; 63% completion rate), 32% were aged 18-40 years old, 33% 41-60, and 35% 61 or older; 60% were female; 70% were Black and 18% White; 33% were physically or mentally disabled; 34% had received a high school education or less; and 26% earned less than $20,000 per year. Additionally, 93% of participants not notified of legalization were unaware of this fact. When excluding the controls who correctly identified the legal status (n=18), such that the intervention group of those informed that MAID was legal was compared only to those controls who did not know or believe MAID was illegal (n=220), no difference in trust score was found. Overall, 42% approved of legalization, 32% disapproved, and 26% were undecided, while 40% agreed MAID is morally acceptable, 30% felt MAID is morally wrong, and 30% did not know. Patients who were notified MAID was legal were likelier (vs control) to report approval of legalization (46% vs 37%; P=0.0410) but showed no difference in score for trust in their physicians.
Commentary: This study surveyed patients who were mostly Black, mostly young (<60 yrs) who self-described as having good quality of life and good physical and mental health (with a third endorsing a mental or physical disability). There was no difference in measures of trust for the physicians within the patients’ hospital system after patients were informed that MAID was legal (which most patients did not know). This study challenges concerns that simply the legality of MAID would broadly increase mistrust in the medical profession. Importantly, they did not study how individual discussions about MAID between patients and physicians might impact trust (previous studies have indicated discussing euthanasia and physician-assisted suicide would decrease some patients’ trust).4 It also did not specifically study MAID-eligible or palliative care patient populations, which is more relevant to our clinical practice as we strive to build trust with seriously ill patients and their families.
Bottom Line: This study challenges concerns that legalizing MAID would broadly increase mistrust in the medical profession among a general patient population.
Reviewer: Brittany R. Gatta, MD, Vanderbilt University Medical Center, Nashville, TN
References:
- Emanuel EJ. The history of euthanasia debates in the United States and Britain. Ann Intern Med. 1994;121(10):793-802; doi:10.7326/0003-4819-121-10-199411150-00010.
- Quill TE, Sussman B. Medical aid-in-dying. The Hastings Center for Bioethics. Published June 30, 2023. Accessed April 16, 2025. https://www.thehastingscenter.org/briefingbook/physician-assisted-death.
- Abelson R. Aid in dying becomes legal in New Jersey, but the practice remains controversial. The New York Times. 2023.
- Emanuel EJ, Fairclough DL, Daniels ER, Clarridge BR. Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. Lancet. 1996;347(9018):1805-1810. doi:10.1016/s0140-6736(96)91621-9.
Source: Anderson JB, Cacciapuoti M, Day H, Hashemzadeh T, Krohmal BJ. The Impact of Legalizing Medical Aid in Dying on Patient Trust: A Randomized Controlled Survey Study. J Palliat Med. 2024;27(11):1459-1466. doi:10.1089/jpm.2023.0706.
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