Abstract
Background: Nearly 9 in 10 patients in the United States who use medical aid in dying (MAID) are enrolled in hospice. Jurisdictions have increasingly mandated that health organizations publicly report their MAID participation policies. Yet comprehensive examination of the prevalence and characteristics of public-facing MAID policies in U.S. hospice providers is lacking. Objective: The objective of this study was to comprehensively characterize the availability and content of hospices' public-facing MAID participation policies in the 11 U.S. jurisdictions where MAID is legal. Design: We adopted a cross-sectional design. Setting/Subjects: We used the Centers for Medicare & Medicaid Services' Hospice - General Information data set to identify Medicare-certified hospices in all 11 U.S. jurisdictions where MAID is legal. Measurements: Policy availability was assessed via the presence or absence of online hospice MAID participation policies. Policy content was extracted to identify and subsequently categorize clinical domains of MAID participation. Results: Only 39 of 724 hospices (5.4%) published a public-facing MAID participation policy. Policy availability was low even within the two jurisdictions mandating hospice online publication (0 of 52 from New Mexico [0.0%]; 14 of 389 from California [3.6%]). Moreover, even when published, policy content was highly variable and often too vague to discern which MAID-related activities were permitted. For instance, 18 of 39 policies (46.2%) did not report whether or not physicians were permitted to prescribe MAID medication. Conclusions: The lack of availability and specificity in hospices' public-facing MAID participation policies may jeopardize patient access to legal end-of-life care options. Irrespective of jurisdictional mandates, greater organizational transparency is needed to support informed decision making.