Doctors' Conscience-Based Barriers to Medical Aid in Dying

Author: University of Colorado Anschutz Medical Campus
Published: 31 May 2024 - Updated: 8 Nov 2026
Publication Details: Peer-Reviewed | Data and Statistical Analysis

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This research from the University of Colorado Anschutz Medical Campus, published in May 2024 in the peer-reviewed Journal of General Internal Medicine, surveyed 300 Colorado physicians likely to care for patients eligible for medical aid in dying (MAiD), a legal option in the state since 2016 for terminally ill adults with decision-making capacity. It found that 26 percent reported large ethical or religious barriers to taking part, more often among physicians with longer careers and those identifying as non-white. These barriers did not reduce willingness to discuss MAiD or refer patients, but they sharply limited direct roles: 5 percent served as consulting physicians and none as attending physicians, compared with 31 and 21 percent of colleagues without such barriers. The study matters to patients, families, clinicians and lawmakers balancing physician conscience with patient access.*

At a Glance

1 - Colorado legalized medical aid in dying in 2016.
2 - Two physicians must confirm that a patient has less than six months to live.
3 - Researchers began with data on the 554 patients who received a MAiD prescription in Colorado from 2017 to 2020.
4 - The authors suggest formal referral pathways so objecting physicians can take part in early steps while others handle direct roles.

Topic Definition

Medical Aid in Dying: Medical aid in dying (MAiD) is a practice, legal in a number of US states and some other countries, in which a terminally ill adult with decision-making capacity can request and receive a prescription for medication that they may choose to take to end their life peacefully. Laws usually require a prognosis of six months or less confirmed by two physicians, repeated requests, waiting periods and the ability of the patient to take the medication themselves.

Overview

Research published in May 2024 and led by the University of Colorado Anschutz Medical Campus examined the prevalence - and impact - of physicians' ethical or religious barriers to their involvement in medical aid in dying (MAiD), a multi-step process where a physician provides a terminally ill adult with decision-making capacity with a lethal dose of medication to end their life.

The research article, "Conscience-Based Barriers to Medical Aid in Dying: A Survey of Colorado Physicians," was published in May 2024 in the Journal of General Internal Medicine. It shows that 26% of physician survey respondents reported large ethical and/or religious barriers to their involvement in MAiD.

Despite these barriers, the research suggests these conscience-based barriers do not appear to affect these physicians' willingness to discuss medical aid in dying with their patients. However, they are much less likely to have any direct participation in it - being significantly less likely to serve as a consulting or attending physician - compared to physicians without these barriers.

Informing Public Policy

As legislators and health leaders across the nation continue to debate policies related to medical aid in dying, research like this is vital to making informed decisions.

"Medical aid in dying is under consideration in a number of states, and it comes up every legislative session. You cannot make policy around things that are not well understood, and so it was critical to gather data to better understand what's going on," says Mika Hamer, PhD, MPH, the first author on the paper and a post-doctoral research fellow with the CU Center for Bioethics and Humanities. "It is important to look at the actual behaviors of physicians. This research offers essentially the first look into what is happening on the ground in a previously hidden and difficult-to-study population."

For Hillary Lum, MD, PhD, a co-author of the paper and associate professor in the CU Division of Geriatric Medicine, getting involved in this research was important to her as a geriatrician and palliative medicine physician, given that questions about MAiD may arise when caring for older adults with serious illnesses.

"Medical aid-in-dying was legalized in 2016 in Colorado, but physician experiences providing care for patients seeking MAiD was under-studied," Lum says.

A reason for the lack of data is because there are extensive protections in place for physician and patient privacy. As a result, the vast majority of data that exists are from qualitative studies or surveys of the general physician population.

"There is a long-standing debate around MAiD - the legality, the ethical appropriateness, the morality - and people have extremely strong opinions about it. But when we let those really strong opinions drive policy, rather than empirical data, we run the risk of implementing misguided policy that is more amenable to the cultural sentiment or social context at the time," Hamer says.

To gather data about this important issue, researchers used anonymized, aggregate information on the 554 patients known to have received a MAiD prescription in Colorado from 2017 to 2020 and then identified the clinical conditions most prominent in this patient population. The research team then determined which physicians in Colorado were providing care to patients likely to qualify for MAiD based on their clinical conditions and sent them an anonymous survey regarding their willingness to provide MAiD and actual prior participation in MAiD. Ultimately, 300 physicians responded.

Since then, researchers have published several papers about the study, including:

A scientific report about the research methodology.
An analysis of physicians' attitudes and experiences.
An examination of their perspectives on disclosure, presence, and eligibility.
The use and influence of medical aid in dying service on physician experiences.

"We felt there was an opportunity to look at this untapped aspect of the survey research. We had a hunch that there was something about ethical or religious barriers that may be different than other types of barriers physicians faced, like lack of time or fear of stigma," Hamer says.

"We wanted to understand what these physicians have actually done when faced with these decisions, and we had a unique opportunity to measure that and lend some empirical data into what is a very contentious topic - but one that's really quite understudied as far as hard data goes," she adds.

Lum agrees with Hamer, saying:

"In the absence of data, it's easy to make assumptions - either that there are many physicians who have a conscientious objection to MAiD, or that there are few. Thus, this study was important to actually measure the percentage of physicians who have a religious or ethical reason for not participating in MAiD activities."

What The Research Shows

Out of the 300 survey respondents, 26% of physicians likely to care for MAiD-eligible patients in Colorado reported large ethical and/or religious barriers to participating in MAiD activities.

The survey also shows physicians with a longer time in practice and those identifying as non-white were more likely to report these conscience-based barriers.

Hamer said she was surprised that the survey data shows the physicians with these conscience-based barriers are still willing to participate in some aspects of the MAiD process. Specifically, when comparing physicians with and without these barriers, there was no difference in ancillary participation, meaning having discussions about MAiD or referring patients to other providers.

However, there were significant differences regarding direct participation in MAiD. To be eligible for MAiD, a patient must have decision-making capacity and a prognosis of less than six months to live. This prognosis must be independently verified by two physicians - an attending and consulting physician.

The survey found that only 5% of physicians with conscience-based barriers had served as a MAiD consultant, as compared to 31% of physicians without conscience-based barriers. When it came to serving as a MAiD attending, no physicians with conscience-based barriers had served in this role compared to 21% of physicians without these barriers.

"Participation looks different for different people. As far as consulting or attending, which are much more active roles that may involve writing prescriptions or doing evaluations - that's where we start to see those barriers really show up in terms of changes in behavior," Hamer says.

Lum says:

"I think this emphasizes the importance of the relationship between physicians and patients. Whether a physician is willing to discuss, refer, serve as a consulting physician, or serve as a MAID attending physician is likely to vary. And there may be different reasons and situations related to the individual patient."

Both Hamer and Lum noted that this study was limited in its sample size, highlighting the need for further research. With regard to conscience-based barriers, Hamer says it is important to distinguish that these "are not necessarily barriers to be overcome in the traditional sense of barriers."

"We really see this as a space where physicians need accommodation - not intervention to help change their mind around this barrier," Hamer says. "It calls for continued protection of physician rights to conscientiously object or not participate in a service to which they have deeply held, conflicting beliefs."

There is also a need to better understand what support systems and processes need to be in place in clinics or hospitals to help support those physicians who have religious or ethical barriers. For instance, perhaps a formal referral process could be created so that physicians with these barriers can be involved in the beginning stages of MAiD, but when it comes to the more active roles, there is an established team the patient can be referred to.

"We must have protections in place and processes to support these physicians while ensuring patients are able to get the care they desire," Hamer says. "It is something that needs to be considered especially as the legality of MAiD potentially expands. We need a balance between protecting physicians' rights and preserving patient access."

Related Information

Physicians Face Ethical Conflicts with Religious Hospitals: Primary care physicians nationwide face clinical ethical conflicts with religious hospitals.
Why We Believe in Gods: Religious Beliefs Not Linked to Intuition or Rational Thinking: Studies have suggested people who hold strong religious beliefs are more intuitive and less analytical, and when they think more analytically their religious beliefs decrease.
Disability and Religion: Studies and Overview: Information and disability studies that reference religion and disabilities, includes religious beliefs, purpose, and treatment regarding the disabled.
The Delusional World of Man Made Deities: Paper examines the delusional world of man-made Gods, the uselessness of prayer, and the primitive barbaric legends in the Bible.
My Own Decision Making - All My Life: Oped by Dr. Seth Morgan advocating for autonomy to make end-of-life decisions, including the ability for all people to choose medical aid in dying.
Proposed Changes to Medical Assistance in Dying Legislation : Canadian Government: Medical Assistance In Dying (MAID) is a complex and deeply personal issue. Article outlines reintroduced proposed changes to Canada's Criminal Code provisions on MAID.
Bill to Charge Doctors with Homicide for Providing Aid in Dying Defeated: Bipartisan group of legislators voted 51 to 49 to reject bill HB328, which opponents call The Physician Imprisonment Act.
Loss of Faith and Family Struggles when Relative Dying: Examining family struggles with anger and forgiveness when relative is dying including relationships with God and faith.
Faith Communities and Respite Care Fact Sheet: Faith communities often have resources such as respite facilities volunteers and expertise in education and healthcare.

More on this topic: Palliative Care Publications - Medical Publications - Religion Publications

Frequently Asked Questions

NOTE: Researched FAQs by Disabled World (DW)

Which US states allow medical aid in dying?

As of 2024, medical aid in dying was legal in about ten states and Washington DC, including Oregon, Washington, California, Colorado, Vermont, Maine and New Mexico. Laws continue to change.

Is medical aid in dying the same as euthanasia?

No, in US aid in dying laws the patient must take the medication themselves. In euthanasia, a clinician gives the medication directly, which is not legal in the United States.

Can a doctor refuse to take part in medical aid in dying?

Yes, state laws allow physicians and other health workers to decline on grounds of conscience, though rules on informing or referring patients vary.

Who is eligible for medical aid in dying in Colorado?

An adult Colorado resident with a terminal illness and a prognosis of six months or less, who has decision-making capacity and can take the medication on their own.

Why are some disability groups concerned about these laws?

Some disability advocates worry that people may feel pressure to choose death because of poor support, costs or negative views of disability, and call for strong safeguards and better care.

What is the role of hospice in end-of-life care?

Hospice provides comfort-focused care for people with a terminal illness, managing pain and symptoms and supporting families, whether or not a patient considers aid in dying.

How can patients find a physician willing to discuss aid in dying?

Patients can ask their own doctor for information or a referral, contact hospice providers, or ask local patient advocacy organizations for guidance.

What is conscientious objection in medicine?

Conscientious objection is a health worker refusing to provide a legal service because it conflicts with their moral or religious beliefs, usually with a duty to ensure patients can get care elsewhere.

Insights, Analysis, and Developments

Editorial Note: Debates about medical aid in dying often focus on whether it should be legal, but this study looks at a quieter question: who actually provides it once it is. A quarter of the physicians most likely to see eligible patients have conscience-based objections, which can leave patients in some areas, especially rural ones, with few willing doctors. The finding that most objecting physicians will still talk about the option and refer patients is encouraging for patient access, but it depends on clear referral systems. Disability advocates also follow these laws closely, raising concerns about safeguards and pressure on people who lack good care, so balanced data like this is useful on all sides.*

Attribution/Source(s): This peer-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally issued as a press release by University of Colorado Anschutz Medical Campus and published on 31 May 2024. Last updated on 8 Nov 2026. This content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.