Misunderstanding Medical Aid in Dying: Rutgers Study Reveals Different Types of Public Confusion

Americans’ misunderstanding about medical aid in dying falls into two distinct categories requiring different public health approaches, according to a new study by Rutgers Health researchers.

The research, published in the Journal of General Internal Medicine, identifies that public confusion about this end-of-life option manifests as either misinformation or uncertainty, each with different root causes.

“Treating MAID knowledge as a single ‘informed versus uninformed’ issue would be a big miss,” said Elissa Kozlov, assistant professor at the Rutgers School of Public Health and the study’s lead author. “Our findings show that being wrong may reflect belief-protecting reasoning, not simply a lack of information.”

Medical aid in dying (MAID) is a voluntary practice that allows terminally ill, mentally capable adults to self-administer prescribed medication to hasten death. Currently legal in 13 states including New Jersey and Washington, D.C., approximately one in four Americans lives in a jurisdiction where MAID is permitted.

The research team analyzed survey responses from more than 3,200 U.S. adults, comparing those who gave incorrect answers about MAID’s legality with those who admitted uncertainty by responding “don’t know.” The results revealed striking patterns in how these different forms of misunderstanding arise.

People with strong ideological positions—particularly those who believe MAID should be illegal or who participate regularly in religious activities—were more likely to provide definitively incorrect information rather than express uncertainty. This pattern suggests that misinformation often stems from motivated reasoning, where people interpret information in ways that align with their existing beliefs and values.

In contrast, uncertainty about MAID’s legal status was more common among respondents with lower educational attainment or greater financial insecurity. These individuals were more likely to acknowledge their knowledge gap by answering “don’t know” rather than providing incorrect information.

“That distinction matters,” Kozlov emphasized. “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 findings have important implications for public health communication as MAID becomes legal in more jurisdictions across the United States. Legal availability does not automatically translate into informed or equitable access, the researchers note. Based on their findings, they recommend a two-track approach to public education efforts: conventional health literacy strategies to reduce uncertainty, alongside values-aligned messaging delivered by trusted sources to address misinformation.

This research comes at a time when end-of-life options are receiving increased attention in healthcare policy discussions. As America’s population ages and more states consider MAID legislation, ensuring accurate public understanding becomes increasingly important for both policymakers and healthcare providers.

The Rutgers team plans to extend their research by examining how confident people are in their MAID knowledge, where they obtain information about the practice, and how strongly they hold related beliefs. They also intend to test communication-based interventions to determine whether tailored messaging can improve understanding regardless of an individual’s moral views.

This work represents an important step toward developing more effective public health communication strategies that recognize the complex interplay between knowledge, values, and access to information. By distinguishing between misinformation and uncertainty, health communicators can craft more targeted messages that respect diverse viewpoints while ensuring that all Americans have accurate information about their end-of-life options.

For those seeking to understand this issue, the findings highlight the importance of considering not just what people know—or think they know—about medical aid in dying, but also how their values and social circumstances shape their understanding of this sensitive and often controversial practice.