How is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study

Abstract

ObjectivesThe aims of this study are: (1) to create a flowchart process model of how medical assistance in dying (MAID) occurs in Nova Scotia (NS), Canada and (2) to detail how NS healthcare professionals are involved in each stage of MAID. The research questions are: how is the MAID process carried out and which professionals are involved at which points? and which roles and activities do professionals carry out during MAID?DesignQualitative process model flowchart study with semistructured interviews.SettingPrimary and secondary care in NS, Canada.ParticipantsThirty-two interviewees self-selected to participate (12 physicians, 3 nurse practitioners (NP), 6 nurses, 6 pharmacists and 5 healthcare administrators and advocates). Participants were included if they conduct assessments, provide MAID, fill prescriptions, insert the intravenous lines, organise care and so on.ResultsThe flowchart process model details five stages of how MAID occurs in NS: (1) starting the MAID process, (2) MAID assessments, (3) MAID preparation (hospital in-patient, hospital outpatient, non-hospital), (4) day of MAID and (5) post-MAID (hospital in-patient and outpatient, non-hospital, after leaving setting). Nineteen points where the process could stop or be delayed were identified. MAID differs slightly by location and multiple professionals from different organisations are involved at different points. Some physicians and NP provide MAID for free as they cannot be reimbursed or find it too difficult to be reimbursed.ConclusionsOur study adds knowledge about the MAID activities and roles of NS professionals, which are not documented in the international literature. Clinicians and pharmacists spend significant additional time to participate, raising questions about MAID’s sustainability and uncompensated costs. The process model flowchart identifies where MAID can stop or be delayed, signalling where resources, training and relationship-building may need to occur. Knowing where potential delays can occur can help clinicians, administrators and policymakers in other jurisdictions improve MAID.

Health care providers’ ethical perspectives on waiver of final consent for Medical Assistance in Dying (MAiD): a qualitative study

“…However, such measures require time and resources that many lack [ 32 , 38 ]. Patients and their families who were cared for by a multidisciplinary team, or those with palliative care backgrounds, had better support than others in previous studies [ 38 , 42 ].…”

“…This study highlights the importance of implementing strategies for the safety and wellbeing of healthcare providers to ensure equitable access to MAiD. MAiD team members should be provided adequate remuneration, time and resources to safely implement changes in the legislation and to support patients and family members [ 32 , 37 , 39 , 42 , 47 ]. Mandatory end-of-life care for patients and MAiD-related education are required for all healthcare providers to minimize the burden on palliative care and MAiD providers and improve end-of-life care [ 13 , 37 , 48 ].…”

Barriers to connecting with the voluntary assisted dying system in Victoria, Australia: A qualitative mixed method study

“…To illustrate, despite medical college policy in provinces such as Ontario, British Columbia and Nova Scotia requiring doctors who are unwilling to provide VAD based on their beliefs to provide an effective referral, information, or transfer of care 34–36 (the Ontario policy being legally upheld as valid in court 37 ), access problems remain. For example, Nova Scotia research has shown a key delay in starting the VAD process is a failure or refusal of unwilling providers to make a referral 14 …”

“…For example, Nova Scotia research has shown a key delay in starting the VAD process is a failure or refusal of unwilling providers to make a referral. 14 Finally, while imposing referral or information duties on doctors may address some access issues, some VAD requests may be directed to other health practitioners (such as nurses) who have a conscientious objection. Further, some institutions object to participating in VAD.…”

Medical assistance in dying: A reflection tool for pharmacists

“…Pharmacists' responsibilities in MAiD may encompass medication dispensing, review of medications with the physician or nurse practitioner, postprovision collection of medications and supplies and documentation of legal requirements. 4,5 Although pharmacists' roles have been largely focused on the physical processes for medication handling, there is an emerging recognition that pharmacists' involvement in MAiD is patient-centred. 6,7 There is growing evidence characterizing the experiences of health care professionals involved with MAiD as emotional.…”