Factors Leading to Medical Aid in Dying for Young Adults With Cancer

For young adults with cancer who consider medical aid in dying, psychological distress and loss of autonomy often precede the request more than physical symptoms alone, according to a new analysis published in the Journal of Clinical Oncology.

The study, conducted by researchers at Dana-Farber Cancer Institute and Harvard Medical School, reviewed clinical records and palliative care consultations from 112 patients aged 18 to 39 with advanced cancer who requested medical aid in dying in jurisdictions where It’s legal, including Oregon, Washington, and California, between 2016 and 2023.

While physical deterioration was present in nearly all cases, the researchers found that 78 percent of patients cited loss of independence — such as the inability to perform basic self-care or continue meaningful activities — as a central factor in their decision. Similarly, 72 percent reported persistent psychological suffering, including feelings of being a burden on family or loss of dignity, even when pain and other physical symptoms were adequately managed.

“We often assume that requests for aid in dying are driven primarily by uncontrolled pain or nausea,” said Dr. Laura Johnson, lead author and palliative care specialist at Dana-Farber. “But in this younger cohort, existential distress and the erosion of personal agency emerged as equally, if not more, influential.”

The average age of patients in the study was 34, with the most common diagnoses being metastatic colorectal cancer (24 percent), glioblastoma (19 percent), and pancreatic cancer (16 percent). Most had received multiple lines of systemic therapy and were enrolled in hospice care at the time of their request.

Importantly, the study found that depression, as diagnosed by clinical criteria, was present in only 22 percent of those who proceeded with aid in dying — suggesting that while mood disorders may contribute, they are not the primary driver in most cases. Instead, researchers emphasized the role of demoralization, a sense of futility, and the perception that life no longer holds meaning or purpose.

These findings align with earlier research from the Netherlands and Belgium, where aid in dying is also permitted, which showed that younger patients with cancer often express concerns about losing control over their bodies and futures, particularly when facing treatments with low likelihood of long-term survival.

Experts caution that the study reflects experiences in regions with established aid-in-dying laws and may not be generalizable to areas where such options are not available. They also note that the data rely on clinician documentation rather than direct patient interviews, which could affect the nuance of reported motivations.

Nonetheless, the researchers argue that understanding the psychosocial precursors to aid-in-dying requests is essential for improving palliative care. They recommend routine screening for existential distress and loss of autonomy — alongside physical symptom assessment — in young adult oncology patients with advanced disease.

“Our goal isn’t to predict who will request aid in dying,” Dr. Johnson said. “It’s to ensure that when these conversations arise, they stem from informed, reflective decision-making rather than unmet psychological or supportive care needs.”

The study was funded by the National Cancer Institute and the Arnold P. Gold Foundation. No conflicts of interest were reported by the authors.