• Mika K Hamer, Christine M Baugh, Dragana Bolcic-Jankovic, Elizabeth R Kessler, Vinay Kini, Hillary D Lum, Julie Ressalam, and Eric G Campbell.
• Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. mika.hamer@cuanschutz.edu.
• J Gen Intern Med. 2024 May 6.

BackgroundApproximately 20% of the United States' population lives in a state or jurisdiction where medical aid in dying (MAiD) is legal. It is unknown how physicians' own barriers are associated with their provision of the spectrum of MAiD services.ObjectiveTo measure physicians' religious and/or ethical barriers to providing MAiD services and how such barriers relate to physicians' intentions and behaviors.DesignThree-wave cross-sectional survey fielded in Colorado in 2020-2021.ParticipantsPhysicians providing care to patients likely clinically eligible for MAiD according to probabilistic sampling.Main MeasuresPhysicians self-reported barriers to their own participation in MAiD. We considered large ethical and/or religious barriers to be conscience-based barriers. We measured physicians' self-reported intention to participate and self-reported prior participation in MAiD since it was legalized in Colorado in 2017. We estimated differences in intention and behavior outcomes according to presence of conscience-based barriers, adjusting for physician gender, race/ethnicity, time in practice, and specialty.Key ResultsAmong 300 respondents, 26% reported "large" ethical and/or religious barriers to their involvement in MAiD. Physicians with longer time in practice and those identifying as non-White were more likely to report conscience-based barriers to MAiD. Comparing physicians with and without conscience-based barriers to MAiD, we found no difference in ancillary participation (discussing, referring) but significant differences in direct participation (serving as consultant [5% vs. 31%] or attending [0% vs. 22%]).ConclusionsApproximately one-quarter of physicians likely to care for MAiD-eligible patients in Colorado reported religious and/or ethical barriers to MAiD. Despite religious and/or ethical barriers, the vast majority of physicians were willing to discuss MAiD and/or refer patients seeking MAiD services. These data provide important empirical foundation for policy from hospitals and health systems as well as medical specialty groups with official positions on MAiD.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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