Samuel Nemeth

Samuel Nemeth

He/Him/His

Sociology & Public Health Researcher

Research

Articles

Examining Public-Facing Hospice Medical Aid in Dying Participation Policies in Legalizing U.S. Jurisdictions [link]
(with Todd Becker, Paul Duberstein, Elizabeth Luth, Sanjana Kumar, Kira Phillips, Veda Kota and Elissa Kozlov) Journal of Palliative Medicine, September 2025

Abstract **Background**: Nearly 9 in 10 patients in the United States who use medical aid in dying (MAID) are enrolled in hospice. Jurisdictions have increasingly mandated that health organizations publicly report their MAID participation policies. Yet comprehensive examination of the prevalence and characteristics of public-facing MAID policies in U.S. hospice providers is lacking. **Objective**: The objective of this study was to comprehensively characterize the availability and content of hospices’ public-facing MAID participation policies in the 11 U.S. jurisdictions where MAID is legal. **Design**: We adopted a cross-sectional design. **Setting/Subjects**: We used the Centers for Medicare & Medicaid Services’ Hospice - General Information data set to identify Medicare-certified hospices in all 11 U.S. jurisdictions where MAID is legal. **Measurements**: Policy availability was assessed via the presence or absence of online hospice MAID participation policies. Policy content was extracted to identify and subsequently categorize clinical domains of MAID participation. **Results**: Only 39 of 724 hospices (5.4%) published a public-facing MAID participation policy. Policy availability was low even within the two jurisdictions mandating hospice online publication (0 of 52 from New Mexico [0.0%]; 14 of 389 from California [3.6%]). Moreover, even when published, policy content was highly variable and often too vague to discern which MAID-related activities were permitted. For instance, 18 of 39 policies (46.2%) did not report whether or not physicians were permitted to prescribe MAID medication. **Conclusions**: The lack of availability and specificity in hospices’ public-facing MAID participation policies may jeopardize patient access to legal end-of-life care options. Irrespective of jurisdictional mandates, greater organizational transparency is needed to support informed decision making.

Racial and Ethnic Differences in Community Belonging and its Impact on Cognitive Function in Older Adults [link]
(with Patricia Thomas, Cassidy Stoddart, and Kenneth Ferraro) The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, February 2025

Abstract This study adds to the literature on the relationship between social relationships and cognitive function by using social integration theory to examine whether a sense of community belonging at different ages is related to cognitive function in later life. We also examine whether the relationship between community belonging, and cognitive function is distinct among White, Black, and Hispanic older adults. Using data from the Health and Retirement Study including the 2017 Life History Mail Survey (N = 3,302), we use parallel measures of community belonging across 3 periods in the life course. We estimated relationships using ordinary least squares (OLS) regression and lagged dependent variable models. Respondents who experienced greater community belonging at age 10 and during later life (i.e., age in 2016) had higher levels of cognitive function in 2018 than those who reported feeling less belonging with their community at those ages (b = 0.193, p < .001; b = 0.090, p < .05, respectively). The main effects of community belonging at any age were not related to change in cognitive function from 2016 to 2018; however, there were significant interaction effects between community belonging at age 10 on cognitive function in 2018 and from 2016 to 2018 (p < .05 and p < .01, respectively) with the beneficial effects of community belonging at age 10 being stronger for Black older adults compared with White older adults. These findings highlight the importance of early and later life community belonging for the cognitive functioning of older adults, and particularly for Black older adults’ cognitive function.

Knowledge of and Preferences for Medical Aid in Dying [link]
(with Elissa Kozlov, Elizabeth Luth, Todd Becker, and Paul Duberstein) Journal of the American Medical Association Network Open, February 2025

Abstract Medical aid in dying (MAID) is legal in jurisdictions covering more than one-fifth of the US population and has been used by a largely White, educated population. The extent to which knowledge of MAID and preferences for personal use align with patterns of use is unknown. This cross-sectional, self-report online survey study used a national Prime Panels–based sample of US adults recruited between July 16 and August 10, 2024. A total of 3227 respondents aged 18 years or older from all US states and Washington, DC, were included. Individuals from states with legal MAID, aged 60 years or older, and members of racial and ethnic minority groups were oversampled. We evaluated knowledge of the legality of MAID in the US and in respondents’ state of residence as well as potential interest in future use of MAID. Descriptive statistics and χ2 tests were used to examine associations by demographic characteristics and place of residence. Of 3227 respondents (mean [SD] age, 55.7 [17.4] years; 1839 women [57.0%]), 1654 (51.3%) did not know if MAID was legal the US, and 1638 (50.8%) did not know if MAID was legal in their state. Respondents in states where MAID is legal were more likely to know that MAID is legal in the US compared with those in states where MAID is not legal (728 of 2164 [33.6%] vs 216 of 1063 [20.3%]; P < .001). Across all respondents, 1420 (44.0%), including 96 of 222 Asian respondents (43.2%), 206 of 605 Black respondents (34.0%), and 129 of 308 Hispanic respondents (41.9%), reported they would definitely or probably consider MAID if they received a diagnosis of a terminal illness. In this online survey study of US adults, substantial interest in using MAID as well as significant knowledge gaps regarding the legality of MAID were reported. These findings highlight the need for public education, policy initiatives, and patient-clinician discussions to ensure equitable access to patient-centered end-of-life options and informed decision-making.