Hospice Communication and MAID in Washington State: A Qualitative Case Study of Transparency, Ethics, and Social Work Practice Implications

Medical Aid in Dying (MAID) is legal in Washington State, and most individuals who pursue it are enrolled in hospice care. Despite legalization, many hospices omit MAID from their business websites, leaving patients and families without clear guidance for decision-making. This qualitative case study used exploratory document analysis, guided by the READ approach, to examine how Medicare-certified hospices in Washington communicated, or obscured, their stance on MAID through website content. Only 60% presented any position, policy, or related services online. The analysis assessed clarity, accessibility, and interpretive burden from the perspective of a prospective patient or caregiver. Four typologies emerged, Silent, Compliant, Restrictive, and Affirming, reflecting approaches that ranged from withholding all mention of MAID to providing clear, patient-oriented information. Findings suggest that public communication is not a neutral act but an ethically consequential one. When organizational silence prevails, social workers often bear the burden of interpreting policy and guiding patients with limited institutional support. Positioned at the intersection of ethics, advocacy, and care coordination, social workers are uniquely equipped to promote transparency and patient self-determination. A practice-ready toolkit is provided to support social workers in assessing hospice messaging and advocating for accessible, values-consistent communication in legally authorized settings.