Assessment of willingness to provide medical aid in dying

From the Loggers and Shen labs, Clinical Research Division

As of today, 11 US jurisdictions, including Washington state, have legalized medical aid in dying, where patients with terminal illness and life expectancy of less than 6 months may request a prescription from their physician for self-administered oral medication to end their life. In Washington state, the Death with Dignity Act has allowed physicians to provide medical aid in dying since 2009. In 2021, New Mexico became the first state to allow physician assistants and nurses licensed in advanced practice to prescribe and consult on medical aid in dying. Dr. Jonathan Singer, an assistant professor of Psychological Sciences at Texas Tech University and Fred Hutch affiliate investigator, led a study published in JAMA Network Open that examined advanced practice professionals’ knowledge, comfort, and willingness regarding medical aid in dying. Dr. Elizabeth Loggers, an associate professor at the Fred Hutch Clinical Research Division and the senior author on the study, says, “This article is one of the first to investigate the attitudes toward and willingness to participate in medical aid in dying among advanced practice professionals.”

The authors surveyed 77 advanced practice professionals, a collective term that includes physician assistants and nurse practitioners, at Fred Hutch in fall 2021. In addition to sociodemographic data, clinical backgrounds, and prior experience with medical aid in dying, the survey assessed 3 key aspects related to participation in medical aid in dying: willingness to participate, knowledge about the process, and comfort with participation. Of the 77 participants, 51% reported that they would be willing to prescribe or consult for medical aid in dying, and 43% reported they would be comfortable participating in medical aid in dying. However, only 27% of the respondents stated that they were knowledgeable about medical aid in dying. The authors found a positive association between knowledge or comfort regarding medical aid in dying and willingness to participate in the procedure. Dr. Loggers explains that the study “demonstrates that there likely is a group of advanced practice professionals who are willing to participate in medical aid in dying, and that education and training would be necessary if the law were to change in Washington State to allow advanced practice professional participation.”

Advanced practice professionals willing to participate in medical aid in dying reported greater knowledge regarding aspects of the process compared to colleagues who are unwilling or unsure about participation.
Advanced practice professionals willing to participate in medical aid in dying reported greater knowledge regarding aspects of the process compared to colleagues who are unwilling or unsure about participation. Image taken from article

Dr. Loggers says, “Based on these results, we have conducted a state-wide survey of advanced practice professionals on the same topic to understand how attitudes and willingness to participate might vary by important characteristics like experience with terminally ill individuals, geography and socio-demographics. We are analyzing those data now.” Pursuing these additional questions is especially relevant as representatives in the Washington state legistlature introduced a bill in 2021 to increase acess to the Death with Dignity Act, including expanding medical aid in dying participation to advanced practice professionals (HB1141). Dr. Loggers explains, “One of the goals of expanding prescribing authority is to increase access to medical aid in dying; however, it is unclear to what extent this expansion would achieve those goals here in Washington State where hospital policies may be affecting clinician ability to participate. This would be an area of future research along with a longitudinal study of the New Mexico experience.” Resources at the Fred Hutch and the wider scientific community in Seattle supported this study. Dr. Loggers says, “Our team is grateful for the support of the Cancer Consortium Collaboration including the IRB and RedCAP for enabling this research.”

This work was supported by the biostatistical shared resource of the Fred Hutchinson/University of Washington Cancer Consortium.

The Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium members Drs. Elizabeth Loggers and Megan Shen contributed to this work.

Singer J, Daum C, Shen MJ, Zecha G, Kaplan L, Plakovic K, Blazey M, Arnold M, Silko B, Baker K, and Loggers ET. 2022. Assessment of Oncology Advanced Practice Professional Willingness to Participate in Medical Aid in Dying. JAMA Network Open. 5(10):e2239068.