Understanding Incorrectness: Structural and Ideologic Predictors of Public Knowledge About MAID Legality in the U.S

Medical aid in dying (MAID) is legal in an increasing number of U.S. jurisdictions, yet public understanding of its legal status remains limited. Prior studies often collapse incorrect and "don't know" responses, obscuring potentially distinct ideological and structural correlates.

To examine predictors of uncertainty and misinformation about MAID legality among U.S. adults.

Cross-sectional survey.

We used a convenience sample of U.S. adults recruited through Cloud Research's Prime Panels (N = 3,222), oversampling racial and ethnic minoritized groups, older adults (≥ 60 years), and residents of MAID-legal states. Analyses focused on two subsamples restricted to respondents who were uncertain or incorrect about MAID legality: national-level knowledge (n = 2,278) and state level knowledge among residents of MAID-legal states (n = 1,711).

Respondents indicated whether MAID was legal (a) anywhere in the US and (b) in their state. Knowledge was categorized as "correct," "incorrect" (misinformation), or "don't know." Logistic regressions identified predictors of misinformation versus not knowing at state and national levels.

In the national sample, misinformed respondents (vs those who answered "don't know") were more likely to believe MAID should not be legal compared to respondents who were unsure about legality (average marginal effects (AME) = 0.22; CI: 0.14, 0.29; p < 0.001). They were also more likely to say that MAID is morally acceptable compared to respondents unsure about its morality (AME = 0.11; CI: 0.06, 0.17; p < 0.001). In both subsamples, structural factors (lower educational attainment and greater financial insecurity) were associated with higher likelihood of uncertainty rather than misinformation.

Public knowledge about MAID legality reflects two distinct patterns: misinformation appears ideologically motivated, while uncertainty is linked to structural factors. Efforts to improve health literacy may reduce uncertainty, but misinformation may require value-aligned communication and trusted messengers to support informed decision-making.