Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

Abstract

Background Even as healthcare providers and systems were settling into the processes required for Medical Assistance in Dying (MAID) under Bill C-14, new legislation was introduced (Bill C-7) that extended assisted death to persons whose natural death is not reasonably foreseeable. The purpose of this paper is to describe the experiences of nurses and nurse practitioners with the implementation and ongoing development of this transition. Methods This qualitative longitudinal descriptive study gathered data through semi-structured telephone interviews with nurses from across Canada; cross sectional data from 2020 to 2021 is reported here. The study received ethical approval and all participants provided written consent. Findings Participants included nurses (n = 34) and nurse practitioners (n = 16) with significant experience with MAID. Participants described how MAID had transitioned from a new, secretive, and anxiety-producing procedure to one that was increasingly visible and normalized, although this normalization did not necessarily mitigate the emotional impact. MAID was becoming more accessible, and participants were learning to trust the process. However, the work was becoming increasingly complex, labour intensive, and often poorly remunerated. Although many participants described a degree of integration between MAID and palliative care services, there remained ongoing tensions around equitable access to both. Participants described an evolving gestalt of determining persons’ eligibility for MAID that required a high degree of clinical judgement. Deeming someone ineligible was intensely stressful for all involved and so participants had learned to be resourceful in avoiding this possibility. The required 10-day waiting period was difficult emotionally, particularly if persons worried about losing capacity to give final consent. The implementation of C-7 was perceived to be particularly challenging due to the nature of the population that would seek MAID and the resultant complexity of trying to address the origins of their suffering within a resource-strapped system. Conclusions Significant social and system calibration must occur to accommodate assisted death as an end-of-life option. The transition to offering MAID for those whose natural death is not reasonably foreseeable will require intensive navigation of a sometimes siloed and inaccessible system. High quality MAID care should be both relational and dialogical and those who provide such care require expert communication skills and knowledge of the healthcare system.

Medical Assistance in Dying: A Review of Canadian Health Authority Policy Documents

“…An important decision for each province and territory has been how to set up MAID services in a way that balances safety with accessibility ( Wiebe et al, 2021 ). One of the initial challenges was accessibility to MAID ( Oczkowski et al, 2021a , 2021b ), in part, because of the difficulties in finding sufficient MAID assessors and providers across the vast geographic distances of Canada ( Pesut, Thorne, Wright, et al, 2021 ; Wiebe et al, 2021 ). Many primary care providers chose not to act as MAID assessors and/or providers for a variety of reasons in addition to conscientious objection.…”

Medical Assistance in Dying in Oncology Patients: A Canadian Academic Hospital’s Experience

“…Thus, the short interval from first assessment to completion of MAID in our study is compatible with our finding that most patients had poor performance status at the time of MAID request. Of note, following the time period investigated in our study, a change in the Canadian MAID legislation occurred on 17 March 2021 that removed the 10 day waiting period for MAID in patients with a reasonably foreseeable natural death [ 17 ].…”

Improving Palliative Care and Medical Assistance in Dying Practice in Canada: How Patients-Partners Could Contribute to Continuing Medical Education

“…Some may ask themselves whether the patient is suicidal or not, has a comorbid psychiatric disorder, or has lost capacity to consent. 6 , 15–18 Preliminary data revealed that assessors are interested in further training on psychiatric aspects. 19 Centering MAiD on the patient's needs remains a complex task.…”

“…In Canada, the province of Quebec gave access to Medical Assistance in Dying (MAiD) 5 in December 2015, as it became accessible across the rest of Canada in June 2016. 6 , 7 MAiD was first an end-of-life option, but its accessibility has expanded, including to those whose death is not foreseeable. 8 It is still an evolving practice.…”