Grant: Project Grant

On December 10, 2015, an Act respecting end of life care came into force in Québec while at the federal level, an Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) took effect on June 17, 2016. Both laws give patients access to medical aid in dying (MAID) under certain circumstances. Among these is that the person experiences intolerable physical or psychological suffering related to a medical condition. Determining if a patient fulfills the eligibility requirements must be done by two physicians or nurse practitioners. Research in other countries with similar requirements suggests that clinicians find assessing suffering to be very difficult and the way they go about doing so varies considerably between clinicians. Furthermore, because the Québec and federal laws are not identical, there is potential for differences between provinces. In this project, we want to investigate what clinicians are doing in practice when they evaluate the suffering of patients requesting MAID. We will then use this knowledge to propose a method for doing such evaluations. This project has three parts. The first is to compare the methods used to determine intolerable suffering by clinicians who have assessed patients requesting MAID in Québec and Ontario. The second part is to compare Canadian practices to standards of care and real practice in countries that have similar eligibility criteria to Canada. The third part is to propose an approach for assessing suffering of patients who request MAID. The goal is to provide guidance to clinicians who undertake these evaluations so that they are better equipped to deliver good care in these clinical situations.