Medications and dosages used in medical assistance in dying: a cross-sectional study

Abstract

Agrowing number of countries have decriminalized medical assistance in dying (MAiD) as a means for patients to avoid prolonged suffering. [1][2][3][4] Although each jurisdiction's legislative criteria allowing the intentional use of lethal drugs by a clinician vary, in practice, the act of hastening a patient's death can be done in 1 of 2 ways: health care providers can administer a lethal medication directly, or they can prescribe a lethal medication to a patient for self-administration; these 2 methods can also be combined. 5 In Belgium, the Netherlands and Luxembourg, both clinician-administered and self-administered methods are allowed; Colombia allows only clinician-administered methods; and Switzerland, the Australian state of Victoria and several US states permit self-administration only. [5][6][7][8] In Canada, Bill C-14 defined a process and criteria under which MAiD would be permitted, but it did not specify which methods of hastening death could be used. 8 As a result, MAiD in Canada includes both administration of lethal medications by physicians and nurse practitioners, and prescription of lethal medications for self-administration (except in Quebec).Although nearly 7000 Canadians have died with medical assistance, 9 there is little information on the technical aspects of providing MAiD. The current literature predominantly explores the ethical issues, eligibility, and the impact on patients, families and health care providers. 2,10,11 However, it is clear that, across Canada, self-administered MAiD is rare, with fewer than 7 cases reported, 10 a finding consisted with other jurisdictions where both clinician-and self-administered MAiD are legal. 1 Although the Canadian Association of MAiD Assessors and Providers has released a guidance document for intravenous administration of drugs, 12 limited data exist on the specific medications, dosages, timing of administration and complications during clinician-administered MAiD.

Medical Assistance in Dying (MAiD) as a Source of Liver Grafts: Honouring the Ultimate Gift

“…According to a recent Canadian study by Stukalin and colleagues between 2016 and 2020 across 3 centers in Ontario and British Columbia, 70.8% of the patients requesting MAiD had a diagnosis of cancer, followed by Cardio-respiratory end-stage disease (23.6%). Neurodegenerative diseases comprised of only 0.6% of the cases 12. This is similar to the data reported from the Dutch literature where, 80% of the patients requesting MAiD have cancer and are considered ineligible for donation 23.…”

“…Administration of heparin is followed by induction of cardiac arrest by the legally accepted process of MAiD. Discussion of the MAiD provision medications is beyond the scope of this article and has been discussed by other author groups elsewhere 12. After confirmation of asystole, there is a 5-minute no-touch policy, as emphasized above.…”

“…Discussion of the MAiD provision medications is beyond the scope of this article and has been discussed by other author groups elsewhere. 12 After confirmation of asystole, there is a 5-minute no-touch policy, as emphasized above. If there is no return of spontaneous circulation, the recovery team can proceed with organ retrieval.…”

Missed opportunities: saving lives through organ donation following voluntary assisted dying

“…In Victoria, for example, approximately 85% of people who received VAD in the first 2 years died after self‐administration of the VAD medication, 3 suggesting they may have died outside the hospital environment. In contrast, in a Canadian study of 3557 people who received MAID between 2016 and 2020, most people died following intravenous administration of medication by a physician and 44% were in hospital at the time 11 …”

“…In contrast, in a Canadian study of 3557 people who received MAID between 2016 and 2020, most people died following intravenous administration of medication by a physician and 44% were in hospital at the time. 11 The time between administration of VAD medication and death, and the time between death and recovery of organs for transplantation collectively represents a period during which organs may be poorly perfused and oxygenated. The longer the period, the lower the chances of successful transplantation of organs.…”