How do health care professionals in Canada assess applicants for medical assistance in dying (MAiD)? A research article in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251071 describes the careful approach currently used to determine eligibility, and an analysis article suggests an approach to eligibility assessments for advance requests for MAiD — which are currently available in Quebec and being considered elsewhere in Canada.
In 2021, Canada revised MAiD legislation to include eligibility for people who do not have a reasonably foreseeable natural death. This can include people with a serious, incurable illness, disease, or disability; who are in advanced, irreversible decline; and who have physical or psychological suffering that cannot be addressed to the person's satisfaction. These people may be eligible for MAiD under Track 2; Track 1 includes those with a reasonably foreseeable natural death.
The study included interviews with 23 health care professionals who assess eligibility for MAiD in 4 Canadian provinces. Of these, 14 were physicians and 9 were nurse practitioners.
"Participants in this study provided nuanced accounts of the care and thoroughness that characterized these assessments and how they made the complex legal and moral decisions when reviewing an application for MAiD under Track 2," writes Dr. Barbara Pesut, a professor at the University of British Columbia Okanagan's School of Nursing, Kelowna, BC, with coauthors. "Alongside this individualized approach, assessors described a difficult process within their practice communities of developing a common understanding of the Track 2 MAiD legislation and a desire to ensure a consistent approach to determine eligibility."
Assessors viewed the process and considerations to determine Track 2 eligibility as sometimes legally and morally complex. Understanding the patient's life circumstances and support networks as well as their personal preferences were also important considerations when assessing for eligibility.
"Participants reported conducting their assessments carefully and thoroughly by taking a relational autonomy approach to assessment, determining capacity, managing the 90-day assessment period, and communicating a decision of eligibility. All providers involved in the care of those living with serious and irremediable conditions should seek to fully understand applicants' suffering experience," the authors conclude.
An analysis article https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250562 suggests an approach that could be used to determine the presence of intolerable suffering for advance requests for MAiD by people with dementia.
"The assessor must confirm suffering is present, but this interpretation should be influenced by the patients' values, wishes, and goals of care. This is a pragmatic approach that we consider to meet the concerns on both sides of the debate surrounding contemporary suffering," write Drs. Timothy Holland, a family physician and head of the Bioethics Department at Dalhousie University in Halifax, NS, and Mathieu Moreau, a family physician working in palliative care, Bureau de l'éthique clinique, Université de Montréal, Que.
