The New York Times reports that by September nearly one-third of Americans will reside in jurisdictions where medical aid in dying is legal, yet utilization stays minimal despite polling majorities. This coverage underplays structural barriers identified in peer-reviewed observational data. Oregon’s Death with Dignity Act annual reports (observational, n=~2,500 prescriptions 1997-2023, no RCT feasible due to ethics) show consistent <0.5% of state deaths involve the practice, with cancer diagnoses predominant and minimal hospice overlap. A 2023 JAMA Internal Medicine cohort study (observational, n=4,500 across legal states, conflicts declared none) found racial disparities—White patients overrepresented by 3:1—missed in the original reporting, alongside low physician participation rates (under 1% of eligible MDs). Canadian MAID data (observational registry, n>13,000, Health Canada 2022) reveals rapid uptake post-legalization, suggesting U.S. cultural and regulatory friction rather than inherent demand. These patterns indicate the policy shift prioritizes symbolic autonomy over systemic palliative investment, with small actual use reflecting access inequities rather than broad rejection.