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End of Life Choices California Board Director Adrian Byram co-authors study evaluating disparities in public awareness and institutional support from healthcare systems

Dear EOLCCA Blog Readers,

We are pleased to share with you today’s press release about an important new study co-authored by one of our esteemed board members, Adrian Byram. This study confirms our experience that terminally-ill Californians are woefully uninformed about our state’s compassionate medical aid in dying law.  They – and their loved ones – are needlessly suffering as a result.  Please help us expand pubic awareness by supporting our outreach and education work with a donation today. Please contact our Speakers Bureau if you would like to host a presentation for your community group, hospice, church or synagogue, retirement community or local library, or take the next step and become more involved as a volunteer.  Thank you!

Californians nearly 16 times less likely than Canadians to choose Medical Aid in Dying

SAN DIEGO, CA, April 23, 2024 End of Life Choices California (EOLCCA) today announced a new study co-authored by EOLCCA Board Director Adrian Byram, illuminating the gap in public awareness and institutional support from healthcare systems in California. Byram and his colleague Peter Reiner, a professor in the Psychiatry Department at the University of British Columbia, found only 25% of Californians are aware of their options for MAiD as compared to 67% of Canadians who are aware of their legal right to MAiD. 

MAiD has been legalized in over 10 countries, 10 U.S. states and the District of Columbia; yet, medically assisted deaths vary significantly by region. While typically challenging to understand the differences in medically aided deaths between countries, California and Canada have similar populations and both introduced MAiD in 2016. They also both have government-provided Medicare for adults age 65 and older and a healthcare system staffed primarily by independent physicians free to choose their patients and the medical services they provide. However, Californians are nearly 16 times less likely than Canadians to choose MAiD.

Insights from the research illustrate that California and Canada are nearly identical in the following areas:

  • Moral acceptability of MAID: 70% of Californians and 65% of Canadians believe MAiD is morally acceptable, regardless of whether it is self-administered in California or physician-administered in Canada.
  • Willingness to use MAiD: Approximately 47% of both Californians and Canadians indicated they would “definitely” or “probably” utilize MAiD to avoid suffering from a long and painful disease like cancer.
  • Availability of palliative and hospice care: Inability to get palliative care doesn’t indicate a higher likelihood to choose MAiD. In 2023, more Canadians (58%) than Californians (42%) had palliative or hospice care at their time of death.
  • Reason for choosing MAiD: Approximately two-thirds of Canadians and Californians who choose MAiD have been diagnosed with cancer. The remaining had similarly intractable diseases, such as ALS or COPD.
  • Restrictiveness of respective laws: With the exception of allowing medical practitioners to provide MAiD by injection, Canadian law is notably more restrictive with more guardrails and requiring a medical practitioner to obtain the patient’s consent a final time immediately before administering MAiD.

“We observed Californians choose MAiD far less frequently than Canadians, even though the two jurisdictions are similar in many ways. This enabled us to ask why in a scientifically valid manner,” said Byram. “Our findings clearly show two major differences between California and Canada. First, 75% of Californians are simply unaware they have a legal right to MAiD. Second, unlike in Canada where all healthcare institutions let patients know MAiD is available, listing it on their websites alongside all their other medical services, in California almost no healthcare institutions mention MAiD on their websites, or only if the patient is able to make a diligent search. I hope this research increases Californians’ awareness of one of their fundamental legal rights.”

“Nearly a decade after MAiD was first introduced with the California End of Life Act, it’s disappointing to see that only a quarter of Californians are aware of their fundamental legal rights,” said EOLCCA Board President Robert V. Brody, M.D. “Through our compassionate end-of-life support services, we frequently find that residents don’t have the information needed to navigate their options. EOLCCA is committed to helping all Californians explore their options and approach the end of their lives with dignity, autonomy and peace.” 


A demographically representative and statistically sound group of more than 500 adults aged 60 and older in California and Canada were surveyed about their attitudes and intentions related to MAiD. The full results of the study have been published in the peer-reviewed scientific journal Mortality

About End of Life Choices California

End of Life Choices California (EOLCCA) provides all Californians with the necessary information to effectively navigate their rightful end-of-life options and provide the support required to honor their choices. The organization offers trained client volunteers to work with Californians who are seriously or terminally ill, as well as individuals thinking ahead and planning for the future. Through compassionate end-of-life support, EOLCCA empowers individuals and families with the knowledge needed during one of life’s most challenging transitions. For more information, please visit



End of life choices California

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