Patient experiences with requests for medical assistance in dying: Perspectives of those with complex chronic conditions.

OBJECTIVE: To explore experiences of patients who have complex chronic conditions (CCCs), such as fibromyalgia and chronic fatigue syndrome, when they request medical assistance in dying (MAID) in Canada. DESIGN: Qualitative study using semistructured interviews. SETTING: Canada. PARTICIPANTS: Individuals with CCCs who had contacted any 1 of 4 advocacy organizations between January 21, 2021, and December 20, 2022, about requesting MAID for suffering related to CCCs or who had applied and been assessed for MAID. METHODS: Interviews were conducted virtually (by video or audio) and recordings were transcribed. Thematic analysis was conducted in an iterative manner with abductive analysis. As interviews were completed, transcripts were reviewed and emerging themes were discussed at regular intervals. MAIN FINDINGS: Sixteen individuals were interviewed. All spoke of long-lasting suffering that was unresponsive to an array of medical treatments. Although some participants had hoped to receive MAID immediately following the 90-day assessment period, many mentioned that approval would provide or had provided validation of their illness and a sense of control, especially should their illness become unbearable. Participants sharply distinguished between MAID and suicide, saying they preferred MAID because it offered greater certainty and caused less emotional pain to others. Many said that participating in this research was beneficial because they believed the interviewers truly listened to them. CONCLUSION: Participants described experiences with CCCs and requests for MAID. This information may provide family doctors with new insight to inform interactions with patients with CCCs.

E-Survey of Stressors and Protective Factors in Practicing Medical Assistance in Dying.

Objective: To better identify, quantify, and understand the current stressors and protective factors reported by Canadian medical assistance in dying (MAiD) assessors and providers to inform policy, education, and supports. Methods: E-survey of MAiD stressors (n = 33) and protective factors (n = 27); resilience measurement and comments relating to practice involving physicians and nurse practitioners who provide MAiD services and belong to the Canadian Association of MAiD Assessors and Providers or a francophone equivalent. The survey was conducted, while Parliament was considering changes to MAiD eligibility criteria, which occurred during COVID-19 pandemic restrictions. Results: In total, there were 131 respondents (response rate 35.8%). Two possible changes to future eligibility (mental disorders as the sole reason for MAiD and mature minors) were highly scored as were extra clinical load and patients' family conflict over MAiD. Twenty percent of respondents considered stopping MAiD work. The CD Resilience Scale-2 mean score was 6.90. Highly scored protective factors included compassionate care, relief of suffering, patient autonomy, patient gratitude, feelings of honor, privilege, and professionally satisfying work. Discussion: The identified stressors and reasons for considering stopping MAiD work indicate needs for policy, education, and supports to be optimized or developed. Respondents showed high resilience and highly scored protective factors, which should be optimized. This survey should be repeated in countries where MAiD is legal to determine stressors and protective factors in MAiD practice, stressors addressed, and protective factors enhanced where feasible in the local context for optimal care.