MAiD to Last: Creating a Care Ecology for Sustainable Medical Assistance in Dying Services

Abstract

This paper depicts a case study of an organizational strategy for the promotion of ethical practice when introducing a new, high-risk, ethically-charged medical practice like Medical Assistance in Dying (MAiD). We describe the development of an interprofessional program that enables the delivery of high-quality, whole-person MAiD care that is values-based and sustainable. A “care ecology” strategy recognizes the interconnected web of relationships and structures necessary to support a quality experience of MAiD for patients, families, and clinicians. This program exemplifies a care ecology approach that addresses common barriers to entry to MAiD practice, and also meets the needs of a variety of stakeholders through the creation of patient and family resources, team supports, standards of practice, professional development opportunities, organizational infrastructure, and community partnerships. We also describe how a thriving care ecology evolves to remain resilient, and to enable integration as the needs of the organization, team and program change over time. The design and development of this program may be adapted to other jurisdictions and organizations where MAiD is introduced, or where new patient populations become eligible for MAiD. This care ecology model may also be applicable to the creation of sustainable programs that provide other morally controversial or novel clinical services.

Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives

“…Thirdly, participants identified support needs for both patients and families during and following the MAiD MI-SUMC assessment, including, in alignment with prior studies on MAiD for conditions other than mental illness [ 26 , 58 , 59 ], instrumental supports with end-of-life planning, and bereavement supports for families [ 60 ]. In the case of denied applications, they also identified the need for clinical supports for MAiD MI-SUMC applicants, including monitoring for suicidal ideation.…”

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

“…The mission of the ADRAS team is to provide high-quality, whole person, sustainable, integrated, and collaborative MAiD services to patients across the Hamilton region using an interprofessional model of care and that attends to the diverse physical, emotional, spiritual, cultural, and relational needs of families, clinicians, and teams. 3…”

“…2 This project launched a new team called the Assisted Dying Resource and Assessment Service or ADRAS team. 3 Six years later—in spite of a rapid rise in the requests for MAiD, new legislative changes, increased case complexity, and a global pandemic—the ADRAS team is still going strong. 4 Our MAiD program is characterized by one attribute that has become increasingly scarce in other sectors of healthcare: resilience.…”

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

“…What values ought to inform MAiD service design to safeguard the moral well-being of a diverse workforce(Frolic et al, 2022b)?• What are the ethical issues and values involved in the practical management and coordination of MAiD cases in Canada (Simpson-Tirone et al, 2022)? • How can MAiD services be designed to overcome barriers to entry to practice and create sustainable access through recruitment and retention of MAiD providers and enabling infrastructure(Frolic et al 2022a)? • How can MAiD services evaluate their effectiveness in delivering on their commitment to provide values-based, high-quality and sustainable MAiD care(Frolic et al 2022c)?…”