Rutgers research shows misinformation and uncertainty stem from different causes, requiring different public health responses
Public misunderstanding about medical aid in dying in the United States falls into two distinct categories - misinformation and uncertainty - and each is driven by different forces, according to Rutgers Health researchers.
Their study, published in the Journal of General Internal Medicine, found that misinformation about legality of medical aid in dying - a voluntary medical practice for terminally ill adults often abbreviated as MAID - is primarily shaped by ideology, while uncertainty is linked to structural barriers such as education level and financial strain.
"Treating MAID knowledge as a single 'informed versus uninformed' issue would be a big miss," said Elissa Kozlov, assistant professor at the Rutgers School of Public Health and the study's lead author. "Our findings show that being wrong may reflect belief-protecting reasoning, not simply a lack of information."
Our findings show that being wrong may reflect belief-protecting reasoning, not simply a lack of information.
Elissa Kozlov
Assistant Professor, Rutgers School of Public Health
The law allows terminally ill, mentally capable adults to self-administer prescribed medication to hasten death. The practice is legal in 13 states, including New Jersey and Washington, D.C., meaning about 1 in 4 Americans live in a jurisdiction where it is permitted.
Analyzing survey responses from more than 3,200 U.S. adults, researchers compared people who gave incorrect answers about MAID's legality with those who said they didn't know if MAID was legal or not. Individuals with strong ideological positions - those who believe that medical aid in dying shouldn't be legal or those who participate in religious activities - were more likely to be incorrect than uncertain.
The pattern suggests misinformation often reflects motivated reasoning, in which people interpret information in ways that align with their existing beliefs.
In contrast, respondents with lower educational attainment or greater financial insecurity were more likely to answer "don't know" rather than give incorrect responses.
"That distinction matters," Kozlov said. "People who don't know may benefit from straightforward education, but people who are misinformed may need tailored approaches that acknowledge their values while presenting accurate information."
As the practice becomes legal in more jurisdictions, the researchers found that legal availability doesn't immediately translate into informed or equitable access. Their findings suggest public education efforts should use a two-track approach: conventional health literacy strategies to reduce uncertainty and values-aligned messaging delivered by trusted messengers to address misinformation.
Future research will examine how confident people are in their answers, where they obtain information about medical aid in dying and how strongly they hold related beliefs. The researchers also plan to test communication-based interventions to determine whether they improve understanding of MAID regardless of an individual's moral views.
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