Medical Assistance in Dying (MAiD): A Descriptive Study From a Canadian Tertiary Care Hospital

Abstract

Background: In June 2016, the Government of Canada passed Bill C-14 decriminalizing medically assisted death. Increasing numbers of Canadians are accessing medical assistance in dying (MAiD) each year, but there is limited information about this population. Objective: To describe the characteristic outcomes of MAiD requests in a cohort of patients at an academic tertiary care center in Toronto, Ontario, Canada. Methods: A retrospective chart review of patients making a formal request for a MAiD eligibility assessment from July 16 to September 18. Data extracted included demographics, diagnosis, psychosocial characteristics, information relating to the MAiD request, and clinical outcome. Results: We received 107 formal requests for MAiD assessment. Ninety-seven patients were found eligible, of whom 80 received MAiD. Cancer was the primary diagnosis for 78% and median age was 74 years. The majority of patients (64%) cited “functional decline or inability to participate in meaningful activities” as the main factor motivating their request for MAiD. Half of patients who received MAiD (46%) described their request as consistent with a long-standing, philosophical view predating their illness. The 10-day reflection period was reduced for 39% of provisions due to impending loss of capacity. Our cohort was very similar demographically to those described both nationally and internationally. Conclusion: Patients seeking MAiD at our institution were similar to those described in other jurisdictions where assisted dying is legal and represent a group for whom autonomy and independence is critical. We noted a very high rate of risk of loss of capacity, suggesting a need for both earlier assessments and regular monitoring.

Advance requests for MAiD in dementia: Policy recommendations emerging from a mixed-methods study of the views of the Canadian public and MAiD practitioners

“…8,9 Bravo et al found that over 70% of older adults, dementia caregivers, nurses, and physicians in Quebec agreed that it was acceptable to provide MAiD to an incompetent patient who was showing signs of distress and had requested MAiD in writing prior to losing capacity. 10 Studies by Nuhn et al 11 and by Selby et al 12 found that the primary reasons given by patients seeking MAiD were loss of function and loss of dignity, similar to our findings reported in Table 3. The Council of Canadian Academies (CCA) Expert Panel examining advance requests concurred with at least two of the policy conclusions emerging from this study: the need for clear definition of intolerable suffering by the patient; and having the requestor describe their motivations for choosing MAiD.…”

Factors predicting the risk of loss of decisional capacity for medical assistance in dying: a retrospective database review

“…Although the Can adian law itself is now under review, and the man datory reflection period may no longer be required in the updated legislation, identifying patients who are at high risk of a rapid change in condition remains clinically relevant. Previously published findings from both our group and others 12,20,21 have suggested that a request for MAiD is a reflec tion of the individual's longstanding personality characteristics, world view and lifelong values. Individuals accessing MAiD typ ically strongly desire control over the conditions of their endof life care and place importance on autonomy, independence and a sense of self.…”

“…11 Prior work has highlighted the importance that patients place on receiving MAiD once they have made the decision to proceed. [12][13][14] For those who are seriously ill or felt to be at risk of losing capacity to provide final consent, the 10day reflection period can be a source of marked anxiety for the patient, with providers needing to balance patientcentred care with adherence to the legislation. The reflection period can be waived if both assessors feel the patient is at immi nent risk of death or loss of capacity, but to date there are no evidencebased data to help assessors determine who might be at such risk.…”

“…Across Canada, as of Dec. 31, 2019, about onethird of patients (34.3%) had a shortened wait time, 3 but nevertheless there are patients who die or lose capacity before provision of MAiD. 12 The goal of this study was to identify clinical factors associated with shortening of the reflection period or loss of capacity to consent before provi sion of MAiD.…”

Association of socioeconomic status with medical assistance in dying: a case–control analysis

“…We surveyed clinicians at a coffee shop inside a leading Canadian hospital that provided medical assistance in dying. 68 Each participant received one version (rich patient or poor patient) of the survey by randomised assignment ( online supplemental appendix §1 ). The typical participant was a middle-aged woman with professional training and years of medical experience (n=494).…”