Introducing Medical Assistance in Dying in Canada: Lessons on Pragmatic Ethics and the Implementation of a Morally Contested Practice

Abstract

Medical Assistance in Dying (MAiD) in Canada has had a tumultuous social and legal history. In the 6 years since assisted dying was decriminalized by the Canadian Parliament in June 2016, the introduction of this practice into the Canadian healthcare system has been fraught with ethical challenges, practical hurdles and grassroots innovation. In 2021, MAiD accounted for approximately 3.3% of all Canadian deaths annually, and more patients are seeking MAiD year over year as this option becomes more widely know. Unfortunately, some patients who want MAiD are unable to access it in a timely manner because of a lack of willing MAiD providers. This introduction describes statistics about the uptake of MAiD in Canada and the challenges presented by Canadians' rapid acceptance of this end of life care option. In this special edition of HEC Forum about the implementation of MAiD in Canada, authors depict a range of ethical challenges and strategies to address issues related to MAiD access and quality, organizational engagement, clinician recruitment and retention, and support for a morally diverse workforce. In each article, the authors reflect on the question: What are the practical ethics involved in introducing assisted dying into a new healthcare context, and how can ethicists and ethics resources collaborate with stakeholders to ensure the integration of ethical considerations as this practice continues to evolve?

Practitioners’ experiences with 2021 amendments to Canada’s medical assistance in dying law: a qualitative analysis

“… 29 , 33 This support is particularly important to combat what Frolic and Oliphant label the ‘looming access crisis’, with the number of new MAiD providers not increasing proportionally with the number of cases. 37 …”

Ongoing Debate on Medically-Assisted Death in Canada

“…20 Thus, the increase in demand for MAiD services and the number of new MAiD providers has not been proportional, as demonstrated in the 2021 federal report. 19 Despite a 32.4% increase in MAiD throughout 2020, there was only a 17.2% increase in providers over the same period. 1,19 Accessing MAiD is a laborious process for both physicians and patients.…”

“…3 However, the growing demand for MAiD services faces a looming issue concerning the number of willing MAiD providers, as MAiD is an optional "add-on" responsibility for physicians and nurse practitioners. 19,20 By nature, the responsibility of being a MAiD provider is highly regulated, emotionally taxing, and laden with various potential ethical and moral quandaries. 20 Thus, the increase in demand for MAiD services and the number of new MAiD providers has not been proportional, as demonstrated in the 2021 federal report.…”

Leader as CARER: An ecological approach to designing a resilient MAiD program

“…There is evidence that the rate of physicians and nurse practitioners entering the practice is not keeping pace with the increase in MAiD requests. 8…”