Abstract
Objective:
To better understand the experience of early-adopting physician-providers of Medical Assistance in Dying (MAiD) in Canada.
Background:
MAiD is being implemented in jurisdictions throughout the world. Implementing newly- legalized MAiD presents unique challenges. Because MAiD as a medical procedure is new, practical and logistical challenges have not been previously identified. The procedure itself is high-stakes and irreversible, and the context is marked by controversy, strong opinions, and emotions. This model of assisted dying is dependent on medical professionals, and the first generation of providers may confront novel tensions while negotiating traditional and modern values in Western clinical ethics and standards for medical professionalism. This study contributes to knowledge about the experiences and reflections of providers of newly legalized MAiD in Canada.
Methodology:
Twenty-one English-speaking Canadian physician-providers of MAiD were interviewed in late 2019 about their experiences as early-adopting providers. A qualitative design with an interpretive phenomenological framework was employed. A snowballing recruitment approach began with e-mails introducing the study, sent to individuals from a range of medical backgrounds and with varying opinions about MAID. They were asked to forward the recruitment letter to physicians they believed would be interested in participating in the study or in expanding the recruitment network. Recruitment included providers from rural settings. After informed consent, face-to-face interviews were conducted for all but four participants, who were interviewed via Zoom. Interviews were recorded, reviewed, and transcribed. The immersion/crystallization technique, well aligned with the phenomenological approach, was used for analysis. ATLAS.ti software was used to assist with data management. The first author initiated coding and thematic analyses. Interpretive concordance was accomplished in consultation with my primary PhD supervisors.
Principal Findings:
Five themes that emerged from the data were selected for intensive analysis. These are divided into two umbrella themes. The first umbrella theme relates to how the physician providers experienced and responded to the practical challenges of providing newly legalized assisted dying. These were specific to the Canadian context, where legalization and implementation occurred suddenly, and preparation for individual providers was largely absent. The second umbrella theme relates to professional, emotional, and moral aspects of participants’ experiences. Participants described their experience as providers and their roles within the patient-physician relationship. It might have been expected that the providers of newly legalized assisted dying would find professional and moral contradictions and tensions in their provision of this service, given the history of medical opposition to euthanasia. The interview data revealed that they felt that they were doing the right thing by providing a compassionate service, responding to the autonomous wishes of people seeking assisted dying. Some participants considered their role to be limited to facilitating and accompanying the competent patient through the required processes. Other providers considered their role to include their clinical and moral judgments when interpreting the patient's desire for assisted dying.
Conclusions/Significance:
Participating MAiD providers provided useful insights about the experience of MAiD in the early legalization period in Canada. The practical insights included insights into unexpected events or challenges and how participants prepared for the first provision of MAiD. They also described the preparations and supports that they wished they had, and what they would recommend for future new providers, such as mentorship and communities of practice. Providers did not report experiencing significant emotional or moral impacts after providing MAiD. They perceived that they were helping others and received expressions of gratitude from patients and family. Participants’ views on the role of provider clinical judgment and moral reasoning in qualifying a patient for MAiD were highly variable. The practical implications of this divergence among providers when considering a patient’s presentation for MAiD are considered, and strategies for developing a narrower professional practice consensus in the future are explored.