Physician-assisted dying (PAD) is legal in an increasing number of jurisdictions across the United States. Despite this, formal hospice and palliative medicine (HPM) fellowship curricula on PAD are lacking. To address this, a neutral (nonadvocacy) PAD pilot curriculum was developed and implemented in one large HPM fellowship program.
Methods:
A five-lecture curriculum was developed by an interdisciplinary group using Kern’s six-step method. Comfort, knowledge, and satisfaction were assessed.
Results:
17 fellows were eligible to complete curriculum assessments with a 76% response rate on the postcurriculum survey (N = 13). Self-reported comfort improved significantly across all measured domains. Ninety-two percent of respondents were very or somewhat satisfied; 85% of respondents agreed the curriculum maintained a neutral tone.
Conclusion:
HPM fellows value PAD education, even when practicing in a state where it is illegal. A neutral curriculum is feasible, improves comfort, and is well received. This offers a model for integrating PAD education into HPM training.
LeBlancS, MacDonaldS, MartinM, et al.Development of learning objectives for a medical assistance in dying curriculum for family medicine residency. BMC Med Educ, 2022; 22(1):167; doi: 10.1186/s12909-022-03204-1
2.
ShapiroGK, HuntK, BraundH, et al.Development of a canadian medical assistance in dying curriculum for healthcare providers. J Med Educ Curric Dev, 2024; 11:23821205241272376; doi: 10.1177/23821205241272376
3.
DownarJ, GreenS, RadhakrishnanA, et al.An entrustable professional activity descriptor for medical aid in dying: A mixed-methods study. CMAJ Open, 2018; 6(4):E657–E663; doi: 10.9778/cmajo.20180104
4.
SpielvogelR, ScheweS. Helping patients die: Implementation of a residency curriculum in medical aid in dying. Acad Med, 2024; 99(8):863–867; doi: 10.1097/ACM.0000000000005751
5.
CesconJ, EsceA, KorenM, et al.Hospice and palliative medicine fellows’ perspectives on physician-assisted dying education. J Pain Symptom Manage, 2026; 71(3):e372–e376; doi: 10.1016/j.jpainsymman.2025.11.013
6.
American Academy of Hospice and Palliative Medicine. Position Statement: Physician-Assisted Dying. 2007. Available from: https://aahpm.org/advocacy/where-we-stand/pad/ [Last accessed: April14, 2026].
7.
LandzaatLH, BarnettMD, BuckholzGT, et al.Development of entrustable professional activities for hospice and palliative medicine fellowship training in the United States. J Pain Symptom Manage, 2017; 54(4):609–616.e1; doi: 10.1016/j.jpainsymman.2017.07.003
8.
ThomasPA, KernDE, HughesMT, et al.Curriculum Development for Medical Education: A Six-Step Approach. JHU Press; 2016.
9.
KozlovE, LuthEA, NemethS, et al.Knowledge of and preferences for medical aid in dying. JAMA Netw Open, 2025; 8(2):e2461495; doi: 10.1001/jamanetworkopen.2024.61495
10.
KozlovE, NowelsM, GusmanoM, et al.Aggregating 23 years of data on medical aid in dying in the United States. J Am Geriatr Soc, 2022; 70(10):3040–3044.
11.
DalyP. Palliative sedation, foregoing life-sustaining treatment, and aid-in-dying: What is the difference? Theor Med Bioeth, 2015; 36(3):197–213; doi: 10.1007/s11017-015-9329-5
12.
DierickxS, DeliensL, CohenJ, et al.Comparison of the expression and granting of requests for euthanasia in belgium in 2007 vs 2013. JAMA Intern Med, 2015; 175(10):1703–1706; doi: 10.1001/jamainternmed.2015.3982
13.
HetzlerPT, NieJ, ZhouA, et al.A report of physicians’ beliefs about physician-assisted suicide: A national study. Yale J Biol Med, 2019; 92(4):575–585.
14.
PopeTM. Medical Aid in Dying: Key Variations Among U.S. State Laws. SSRN Journal, 2020; doi: 10.2139/ssrn.3743855
Health Canada. Sixth Annual Report on Medical Assistance in Dying in Canada. Health Canada; 2025.
17.
LevenDC, QuillTE. The clinical, ethical and legislative case for medical aid in dying in new york. NYSBA Health Law Journal, 2017; 22(3):27–29.
18.
MeierDE. The treatment of patients with unbearable suffering—the slippery slope is real. JAMA Intern Med, 2021; 181(2):160–161; doi: 10.1001/jamainternmed.2020.6884
19.
MacDonaldS. Leo died the other day. CMAJ, 2019; 191(2):E49–E50; doi: 10.1503/cmaj.180953
20.
DugdaleLS, LernerBH, CallahanD. Pros and cons of physician aid in dying. Yale J Biol Med, 2019; 92(4):747–750.
21.
LemmensT. When death becomes therapy: Canada’s troubling normalization of health care provider ending of life. Am J Bioeth, 2023; 23(11):79–84; doi: 10.1080/15265161.2023.2265265
22.
QuillTE. Death and dignity: A case of individualized decision making. N Engl J Med, 1991; 324(10):691–694; doi: 10.1056/NEJM199103073241010
MacmillanP, HughesS, LoscarA, et al.The Pharmacology of aid in dying: From database analyses to evidence-based best practices. J Palliat Med, 2025; 28(4):492–498; doi: 10.1089/jpm.2024.0379
KirschH. My Mother’s Choices. N Engl J Med, 2025; 392(7):629–631; doi: 10.1056/NEJMp2410639
27.
BuchbinderM, BerensN. Beyond coercion: Reframing the influencing other in medically assisted death. J Med Ethics, 2024; 50(12):841–845; doi: 10.1136/jme-2023-109554
28.
YanH, BytautasJ, IsenbergSR, et al.Grief and bereavement of family and friends around medical assistance in dying: Scoping review. BMJ Support Palliat Care, 2023; 13(4):414–428.
29.
HashemiN, AmosE, LokugeB. Quality of bereavement for caregivers of patients who died by medical assistance in dying at home and the factors impacting their experience: A qualitative study. J Palliat Med, 2021; 24(9):1351–1357.
30.
GoldbergR, NissimR, AnE, HalesS. Impact of medical assistance in dying (MAiD) on family caregivers. BMJ Support Palliat Care, 2021; 11(1):107–114.
31.
GamondiC, PottM, PrestonN, PayneS. Family caregivers’ reflections on experiences of assisted suicide in Switzerland: A qualitative interview study. J Pain Symptom Manage, 2018; 55(4):1085–1094.
32.
BackAL, StarksH, HsuC, et al.Clinician-Patient Interactions About Requests for Physician-Assisted Suicide: A Patient and Family View. Arch Intern Med, 2002; 162(11):1257–1265; doi: 10.1001/archinte.162.11.1257
33.
BlockSD, BillingsJA. Patient requests to hasten death. Arch Intern Med, 1994; 154(18):2039–2047.
34.
QuillTE. Doctor, I want to die. Will You Help Me? JAMA, 1993; 270(7):870–873.
35.
QuillT, ArnoldRM. Responding to a request for hastening death #159. J Palliat Med, 2008; 11(8):1152–1153; doi: 10.1089/jpm.2008.9847
