Few Californians take advantage of MAiD - End of Life Choices California

Why do so few Californians take advantage of Medical Aid in Dying?

California vs. Canada – MAiD Awareness Comparison.

Medical Aid in Dying (MAiD) is a well-accepted practice in ten countries around the world, in California, nine other US States, and the District of Columbia. However, as the graph below shows, the number of people taking advantage of MAiD varies widely. Why is there such a big variation – are other countries too liberal with MAiD or are Californians somehow missing out?

Commonalities

Trying to understand such differences between countries is usually very difficult because so many other factors are also different. But, as it happens, California and Canada are easy to compare:

Both started allowing MAiD in 2016
Both have large diverse populations of a similar size (39 and 35 million respectively)
Both have populations who mostly speak English
Both share the same North American popular culture
Both have government-provided Medicare for everyone 65 and older, the people who are most likely to use MAiD; the big difference between the US and Canada is that everyone in Canada gets Medicare, not just older people like in the US
Both have a healthcare system staffed primarily by independent physicians free to choose their own patients and free to provide only those medical services they feel are personally acceptable; in other words no physician in California or Canada is forced to offer MAiD

The Question

This question intrigued Adrian Byram, an EOLCCA Board director, and his colleague Peter Reiner, a professor in the Psychiatry Department at the University of British Columbia. Byram & Reiner looked at the statistics; they looked at the laws; they looked at the healthcare systems; they asked 556 randomly selected older people in California and Canada about their attitudes and intentions. Their results have been published in the peer-reviewed scientific journal Mortality – if you want to read all the details just click on the link, the paper is freely available. If you don’t, here’s a summary of what they found.

Findings

There’s no difference between California and Canada if you look at :

People’s belief about moral acceptability: slightly more Californians (70%) believe MAiD is morally acceptable than Canadians (65%), no matter whether MAiD has to be self-administered like in California or can be physician-administered like in Canada.
People’s willingness to use MAiD themselves: just about 50% of both Californians and Canadians say they would definitely or probably choose MAiD if they were suffering from a long and painful disease like cancer. Again, whether MAiD would be self- or physician-administered made no difference to people’s willingness to use it.
Availability of palliative and hospice care: inability to get palliative care doesn’t seem to mean you are more likely to choose MAiD. In 2023 more Canadians (58%) had palliative or hospice care at the time of their death than did Californians (42%).
Why people choose MAiD: about 65% of the people choosing MAiD in both Canada and California have cancer;
most of the others had similarly intractable diseases like ALS or COPD.
The restrictiveness of the respective laws: except for allowing medical practitioners to provide MAiD by injection, the Canadian law is more restrictive, with tougher eligibility guardrails and a requirement for the medical practitioner to obtain the patient’s consent one last time immediately before administering MAiD.

Noticeable Differences

There are two big differences between California and Canada:

Only 25% of Californians know MAiD is even available let alone that it is their legal right, while 67% of Canadians know MAID is their legal right.
All Canadian healthcare institutions let everyone know that MAiD is available. They list MAID along with all the other services they offer, and make professionally-staffed MAID.

Care Coordination teams available to everyone. In California, healthcare institutions similarly use their websites to describe their many treatment and wellness services, but mention MAiD (if at all) on pages accessible only by diligent searching. Only one big healthcare institution – Kaiser Permanente – is an exception, and even so, it’s not immediately obvious how to find about MAiD on their website.

Outcomes

Canadians are choosing MAiD 16 times more often to escape the very same diseases that cause grievous suffering for Californians. It seems clear that the only reasons why Californians are missing out is because:

Californians don’t know that MAiD is one of their legal rights, and
California’s healthcare institutions do not make it easy to access MAiD.

Californians should not miss out on one of their most fundamental legal rights – the ability to control the time, place, and conditions of their inevitable death from a terminal disease.

EOLCCA’s Goal

End of Life Choices California is doing everything within our power to ensure all Californians know that MAiD is their legal right and that California’s healthcare institutions make accessing MAiD easy and straightforward.