Support for Physician-Assisted Death High Across Ethnicities

Most respondents to a Stanford University School of Medicine survey conducted in California and Hawaii supported physician-assisted death, whatever their ethnicity. Among the 1095 responses from California and 819 from Hawaii, the majority supported physician-assisted death: 72.5% of California respondents and 76.5% of Hawaiians. Even among respondents who said religion or spirituality was very important to them, a majority supported physician-assisted death. Older people were more likely than younger people to believe physicians should be able to prescribe life-ending medications to terminally ill patients who request them.

A law allowing physician-assisted death took effect in California on June 9, 2016. However, physician-assisted death is illegal in Hawaii. The survey was conducted between July and October 2015 and was published in the Journal of Palliative Medicine. It is the first study to compare multiethnic attitudes in Hawaii and California toward physician-assisted death.

The study authors noted that California is the first minority-majority state where the aid-in-dying law has been implemented and, thus, is quite different in ethnic makeup than Oregon, Washington, and Vermont, where physician-assisted death is also legal.

The new study found that even though the most religious or spiritual people were the least supportive of physician-assisted death, 52% of self-identified religious/spiritual people were still in support of the idea. Furthermore, in both California and Hawaii, both genders and all racial/ethnic groups in both states were equally in support of physician-assisted death. Those taking the survey identified their ethnicities as African American, Latino, white, Native Hawaiian/Pacific Islander, or Asian.

Lead author VJ Periyakoil, MD, clinical associate professor of medicine at Stanford University Medical School and director of the Stanford Palliative Care Education and Training Program, said that it’s important for physicians in California to prepare for the new law by training in end-of-life conversations and being aware of cultural differences. In particular, she recommended that physicians be honest with patients, acknowledge that it’s a hard topic to discuss, and be aware that it takes a great deal of courage for patients to ask questions about the end of life at such a vulnerable time in their lives.

“How the doctor responds initially to the patient’s question is very important and will set the tone for the rest of the interaction about this sensitive issue,” Periyakoil said in a statement.

The investigators conclude that even in ethnically diverse states like California and Hawaii, faith/religion/spirituality and age are major influencers of attitudes toward physician-assisted death and not ethnicity and gender.

“Even in the subgroups leas supportive of physician-assisted death, the majority supports physician-assisted death,” they wrote.

Larger, more generalizable studies are needed to confirm the attitudinal patterns shown in this new study, as well as longitudinal studies to follow respondents as they age and have more life experiences involving death and dying.