ArticleBMJ open2021
Association of socioeconomic status with medical assistance in dying: a case-control analysis.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Factors That Influence Access to Medical Assistance in Dying Services: An Integrative Review.Health expectations : an international journal of public participation in health care and health policy · 2024Pooled it
- Factors associated with requests for Medical Assistance in Dying (MAiD) referral among patients with amyotrophic lateral sclerosis receiving specialist palliative care.Journal of neurology · 2026Article
- Choice and Death: Analysis of Medical Assistance in Dying for Head and Neck Cancer in Ontario.The Laryngoscope · 2026Article
- Assisted suicide in Germany: a survey on requests for and current practices of assisted suicide.BMC medical ethics · 2026Article
- Co-creating end-of-life choices education: A process description of a program to explore community death-literacy in preparation for voluntary assisted dying.Palliative care and social practice · 2026Article
- Is Assisted Dying Really a Matter for Medical Regulation?The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics · 2025Article
- International Comparison of Underlying Disease Among Recipients of Medical Assistance in Dying.JAMA internal medicine · 2025Article
- Prognosis and risk factor assessment of patients with advanced lung cancer with low socioeconomic status: model development and validation.BMC cancer · 2024Article
- Importance of investigating vulnerabilities in health and social service provision among requestors of medical assistance in dying.Lancet regional health. Americas · 2024Review
- Barriers to connecting with the voluntary assisted dying system in Victoria, Australia: A qualitative mixed method study.Health expectations : an international journal of public participation in health care and health policy · 2023Article
- Contemplating the Impacts of Canadian Healthcare Institutions That Refuse to Provide Medical Assistance in Dying: A Framework-Based Discussion of Potential Health Access Implications.The American journal of hospice & palliative care · 2023Article
- Commentary: Access to Psychedelics for Psychological Suffering at the End of Life - Prioritizing Our Priorities.Healthcare policy = Politiques de sante · 2023Article
- COVID Vaccine Hesitancy and Risk of a Traffic Crash.The American journal of medicine · 2023Article
- Hospice vs Palliative care: A comprehensive review for primary care physician.Journal of family medicine and primary care · 2022Review
- Being a safe place: a qualitative study exploring perceptions as to how a rural community hospice could respond to enactment of voluntary assisted dying legislation.BMC palliative care · 2022Article
- Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada.Journal of medical ethics · 2021Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
objectivesEconomic constraints are a common explanation of why patients with low socioeconomic status tend to experience less access to medical care. We tested whether the decreased care extends to medical assistance in dying in a healthcare system with no direct economic constraints.
designPopulation-based case-control study of adults who died.
settingOntario, Canada, between 1 June 2016 and 1 June 2019. PATIENTS: Patients receiving palliative care under universal insurance with no user fees. EXPOSURE: Patient's socioeconomic status identified using standardised quintiles.
main outcome measureWhether the patient received medical assistance in dying.
resultsA total of 50 096 palliative care patients died, of whom 920 received medical assistance in dying (cases) and 49 176 did not receive medical assistance in dying (controls). Medical assistance in dying was less frequent for patients with low socioeconomic status (166 of 11 008=1.5%) than for patients with high socioeconomic status (227 of 9277=2.4%). This equalled a 39% decreased odds of receiving medical assistance in dying associated with low socioeconomic status (OR=0.61, 95% CI 0.50 to 0.75, p<0.001). The relative decrease was evident across diverse patient groups and after adjusting for age, sex, home location, malignancy diagnosis, healthcare utilisation and overall frailty. The findings also replicated in a subgroup analysis that matched patients on responsible physician, a sensitivity analysis based on a different socioeconomic measure of low-income status and a confirmation study using a randomised survey design.
conclusionsPatients with low socioeconomic status are less likely to receive medical assistance in dying under universal health insurance. An awareness of this imbalance may help in understanding patient decisions in less extreme clinical settings.
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