Examining public stigma and expectations of grief following medical aid and dying in the US: A vignette-based experiment

Abstract

Objectives Families bereaved following Medical Aid in Dying (MAID)-related death express concerns about public stigma. As access to MAID expands, research examining MAID is needed, including understanding stigma toward family members. This study examines if stigmatization exists toward bereaved individuals whose family member utilized MAID at differing ages and assess if expectations of grief differ between bereaved individuals whose family member utilized MAID compared to bereaved individuals whose family member died of an illness. Methods This study utilized a randomized, between-groups, vignette-based experiment to test the effects of cause of death (MAID vs. illness-related death) and age (28, 38, 70, and 80 years) of the deceased on indicators of public stigma. Participants (N = 428) were recruited from mTURK (Mage = 42.54; SDage = 16.50). Results Analyses showed a statistically significant interaction between age and the mode of death (F(7, 400), p = 0.001, $\eta _{\rm p}^2$ = 0.06) and the main effect for age (F(5, 401), p = 0.004, $\eta _{\rm p}^2$ = 0.04) on expectations of grief, whereas emotional reactions and wanting social distance were not significant (p > 0.05). Participants expected more maladaptive grief among family members of 28- and 70-year-olds who died of illness compared to 28- or 38-year-olds who utilized MAID [28-year-old (M = 44.12, SD = 12.03) or 70-year-old (M = 44.32, SD = 10.29) illness-related death vs. 28-year-old (M = 39.3, SD = 11.56; p = 0.01) or 38-year-old (M = 38.71, SD = 11.56; p = 0.007) MAID-related death]. Significance of results Findings suggest that direct stigma does not exist toward family members of individuals engaging in MAID. The American public may expect that family members of young individuals who utilize MAID are accepting of the death and expect them to experience fewer maladaptive grief symptoms. Future research should investigate differences in bereavement outcomes based on age of bereaved caregivers of individuals engaging in MAID.

An examination and proposed theoretical model of risk and protective factors for bereavement outcomes for family members of individuals who engaged in medical aid in dying: A systematic review

“… 29 More specifically, participants reported they were trying to take care of their family/friend while also grieving as they knew they were going to die soon resulting in an emotional burden and grief before the death. 13 …”

“…prolonged grief disorder). 38 , 39 Research has aimed to understand stigma related to Medical Aid in Dying, 13 but more research is needed to identify if perceived public stigma, and self-stigma, exist and their effects on bereavement outcomes for family members of individuals who experienced a Medical Aid in Dying related death.…”

“…pre-death grief) that occur after the patient is diagnosed with a terminal illness. 10 – 12 Moreover, Medical Aid in Dying is often associated with increased stigma related to a patient’s or family member’s perceived morality of Medical Aid in Dying, 13 which could both happen before (i.e. decision-making surrounding Medical Aid in Dying) and after the death (i.e.…”