Has medical assistance in dying changed end-of-life care in the ICU? A qualitative survey of Canadian intensivists.

ABSTRACT

PURPOSE: Since 2016, Canada has permitted medical assistance in dying (MAID). Our aims were to understand how Canadian intensivists view MAID and the impact of MAID on end-of-life care in the ICU. MATERIAL AND METHODS: This was a descriptive qualitative study of responses from a 41-item questionnaire. We recruited intensivists and trainees from 11 pediatric ICU programs and 14 adult ICU programs across Canada between December 2019 and May 2020. Two qualitative researchers inductively coded responses and then conducted preliminary thematic analysis. Themes were subsequently refined through group discussion. RESULTS: We obtained 150 complete questionnaires (33% response rate), of which 50% were adult practitioners and 50% pediatric. We identified six main themes including intensivists have a wide range of opinions on MAID; MAID has not changed ICU practice; and moral distress has a diverse impact on practice. Physicians also discussed the role of provider intent and the importance of treating withdrawal of life-sustaining treatments (WLST) as a process to protect patients, families, and providers. CONCLUSIONS: Canadian intensivists hold a wide range of opinions on MAID, but most agree it has not changed ICU practice. Importantly, intensivists also hold differing views on the relevance of physician intent in medical ethics.