Exploring Canadian Physicians' Experiences Providing Medical Assistance in Dying: A Qualitative Study

Abstract

Physicians described relationship, financial, and workload challenges to providing MAiD. We provide several recommendations to address these challenges and help ensure the sustainability of MAiD in countries that provide this service.

Physician snapshot: the forming landscape of MAiD in northwestern Ontario

“…Physicians have been key in rolling out this new legislation into practice and their experiences have been greatly influenced by the communities and the geographic region in which they work. This exploratory study aligns with other research findings, foremostly that, while the implementation of the legislation has not been without its challenges, physician participants found the provision of MAiD to generally be a rewarding experience; 26 , 29 in addition, several participants who had not provided referrals or direct assistance felt that provision was important as they, too, would want access to the service, for themselves and for their families. 26 , 30…”

“…Suggestions outlined in this study for readdressing the parameters of original legislation, training and practices shared many of the issues put forth by physicians on both a national and international scale. 29,32,33 In particular, physicians' concerns regarding ambiguity of both role and legislation, 32,35,36 lack of interprofessional collaboration 26,32 and community support, and the need to return to the original legislation to determine areas deemed necessary for inclusion, notably regarding eligibility and wait times 36 and medical student and physician education and preparation. 29,32,35 Provision of MAiD in rural and remote areas was one area of paucity in the literature, with one source offering a perspective of a physician involved in rural medicine in Newfoundland 37 and another providing this query: as MAiD appears to present a further set of challenges to rural and remote physicians, particularly for those whose scope of practice includes the provision of highquality palliative services, should rural and remote general practitioners in Ontario also be expected to provide access to MAiD?…”

“…Physicians’ concerns regarding affording true choice for their patients 29 – 31 highlighted the need for access to more resources 30 , 31 and collegial and community supports for MAiD providers. Participants echoed sentiments regarding the value of professional and informal mentorship 29 , 32 and the necessity of peer and community support as vital to professional and personal well-being. 26 , 31 It is reasonable to suggest that while legislation from the Supreme Court of Canada requires that physicians provide patients with complete information on all options available to them, including MAiD, and advise patients on how they can access more information, counselling and referral services, how this might be realized in practice is perhaps an area for further investigation.…”

Rediscovering the art of medicine, rewards, and risks: Physicians’ experience of providing medical assistance in dying in Canada

“…36 Stamm 34 suggested that compassion satisfaction can be an antidote to clinician burnout. In a recent study, Khoshnood et al 37 found that MAiD providers also experienced the work as highly rewarding and believed that other physicians and the public were not ready to hear it. The findings from this study support this attitude of reticence alongside the view that MAiD provision is satisfying and personally sustaining.…”

Medical assistance in dying: A political issue for nurses and nursing in Canada

“…While there are existing nursing self‐care supports, for some, the ambiguity and professional uncertainty that exist for those nurses who participate in the MAiD process may result in some nurses opting out of providing this care. Burnout is a real possibility for those who continue to engage in provision of MAiD if adequate support to address the needs of nurses is not ensured; this has been raised as a concern for both physicians (Khoshnood et al, ) and nurses (Lamb, Evans, Babenko‐Mould, Wong, & Kirkwood, ) alike.…”