Public understanding of medical aid in dying (MAID) in the United States is often clouded by both misinformation and uncertainty, but these aren’t simply two sides of the same coin. New research from Rutgers Health reveals that the roots of these misunderstandings differ significantly, with ideology driving incorrect beliefs and structural barriers fueling a lack of knowledge.
The study, published in the Journal of General Internal Medicine, highlights a crucial distinction: being wrong about the legality of MAID often stems from pre-existing beliefs, while simply not knowing reflects challenges like limited access to education or financial insecurity. This finding challenges the assumption that a lack of information is the sole driver of public misunderstanding.
Treating MAID knowledge as a single ‘informed versus uninformed’ issue would be a big miss. Our findings show that being wrong may reflect belief-protecting reasoning, not simply a lack of information.
Elissa Kozlov, assistant professor, Rutgers School of Public Health and study’s lead author
Medical aid in dying, a practice currently legal in 13 states and Washington, D.C., allows terminally ill, mentally capable adults the option to self-administer medication to hasten their death. This means roughly one in four Americans live in a jurisdiction where MAID is permitted. Despite this growing availability, public understanding remains uneven.
Researchers analyzed survey responses from over 3,200 U.S. Adults, comparing those who incorrectly stated MAID’s legality with those who admitted they didn’t know. The results showed a clear pattern: individuals with strong ideological stances – those who oppose MAID on moral or religious grounds, or who actively participate in religious activities – were significantly more likely to hold incorrect beliefs about its legal status.
This suggests that misinformation surrounding MAID isn’t simply a result of a lack of access to facts, but rather a tendency towards “motivated reasoning,” where individuals interpret information in a way that confirms their existing beliefs. People may be selectively processing information to align with their values.
Conversely, respondents with lower levels of educational attainment or those facing financial hardship were more likely to respond “don’t know” when asked about MAID’s legality. This indicates that uncertainty is often linked to systemic barriers to information and access. As Kozlov explains, “People who don’t know may benefit from straightforward education, but people who are misinformed may need tailored approaches that acknowledge their values while presenting accurate information.”
The study’s findings have important implications for public health education efforts. As more states consider legalizing MAID, simply increasing awareness isn’t enough. A two-pronged approach is needed: traditional health literacy strategies to address uncertainty, and values-aligned messaging delivered by trusted sources to counter misinformation. This means recognizing that different audiences require different communication strategies.
The researchers acknowledge that further investigation is needed. Future studies will explore the level of confidence individuals have in their answers, where they obtain information about MAID, and the strength of their related beliefs. They also plan to test communication-based interventions to determine their effectiveness in improving understanding of MAID, regardless of an individual’s moral viewpoint.
The evolving legal landscape surrounding MAID underscores the importance of ongoing research and nuanced public health messaging. Addressing both misinformation and uncertainty is crucial to ensuring that individuals have access to accurate information and can make informed decisions about their end-of-life care options.
