Learning about psychiatric aspects of medical assistance in dying: a pilot survey of self-perceived educational needs among assessors in a Canadian academic hospital.

BACKGROUND: Medical assistance in dying (MAiD) was legalized in Canada in 2016, although it has been accessible as an end-of-life option in the province of Quebec since 2015. Before its implementation in clinical settings, few physicians had received formal training on requests assessments. New data indicate MAiD requesters have high rates of psychiatric comorbidities. Hence, assessment and management of psychiatric and psychosocial issues among MAiD requesters are important competencies to develop for assessors, although few training programs address them. The aim of our study was to explore physicians' self-perceived educational needs on psychiatric aspects related to MAiD in the province of Quebec. METHODS: We conducted a cross-sectional online survey and used a non-probability sampling design in one academic tertiary care center. A descriptive analysis was performed, and responders were compared on different variables. RESULTS: From twenty-five physician assessors, nineteen responded anonymously to an online survey (n=19). The findings of our pilot study revealed that participants felt highly competent in most psychiatric aspects at end-of-life and related to MAiD practice, except for psychotherapy and psychopharmacology as well as depression identification. Most indicated strong interest in further training. No statistical differences were found among responders regarding previous experience or training in palliative care. CONCLUSIONS: Based on our study, MAiD assessors reported high level of competency in managing psychiatric issues among requesters, but that they also expressed a strong desire for additional education.

Ethical judgment in assessing requests for medical assistance in dying in Canada and Quebec: What can we learn from other jurisdictions?

This paper concerns the ethical judgment that lies at the heart of assessing requests for Medical Assistance in Dying (MAID) in Canada and Quebec, namely is it ethically right to help the person requesting assistance to end his or her life? We address situations in which making this judgment may be challenging despite the person fulfilling legal eligibility requirements. Using three clinical cases that are challenging by virtue of the legal requirement that a person experience intolerable suffering we explore this issue. We review practice guidance provided to providers and assessors in six jurisdictions and discuss potential resources to inform the ethical judgments involved in MAID assessments.

Assistance in dying across borders: How the transnational circulations of persons, terms and themes influence the construction of a public problem.

Assistance in dying has become a transnational issue debated and lawfully practiced in several jurisdictions around the world. This article focuses on persons, terms and themes that circulate from one context authorizing assistance in dying to another. Building on Joseph Gusfield's concepts of judgment, ownership and responsibility, we explore how national debates on assistance in dying draw on transnational circulations which are instrumental in the construction of this issue as a public problem. Adopting a transnational lens shows that local public problems of assistance in dying should not be apprehended in isolation nor compared as independent contexts.

Assistance in dying: Conditions for international comparison.

This special issue of Death Studies interrogates conditions for conducting international comparisons of assistance in dying regimes, and of related discourses and practices. To do so, it provides comparative social sciences and humanities perspectives on assistance in dying. In this editorial introduction, we first trace the origin of this special issue to the symposium held in 2018 in Lausanne, Switzerland. We then offer a short exploration of how assistance in dying regimes have been compared in the literature. Finally, we identify key conditions for conducting international comparisons of assistance in dying based on the articles presented in this issue of Death Studies.

Assistance in dying: A comparative look at legal definitions.

Euthanasia, assisted suicide, medical assistance in dying, death with dignity: these and many other different terms are used around the world to capture various types of assistance in dying. This diversity in terminology can create confusion both in academic debates and in policy-making if it is unclear what type of action or inaction is intended to be captured, by whom, and under what circumstances. By defining and contrasting several terms and legal status of assistance in dying in jurisdictions authorizing it, this comparative glossary aims to lay a foundation that prevents linguistic and conceptual confusion.