More people are asking for medical assistance in dying (MAiD), but surprisingly little is known about this population.
“We wanted to better understand the demographics and other characteristics of who was asking for MAiD, as well as what the key reasons for the request were,” says Debbie Selby, MD, a palliative care physician at Sunnybrook Health Sciences Centre in Toronto.
Selby and colleagues reviewed the charts of 97 patients making a formal request for MAiD.1 Of this group, 80 actually received the service. Some key findings:
• Many patients were concerned about losing decision-making capacity. In 39% of cases, the 10-day required reflection period was reduced because of impending loss of decision-making capacity.
“Monitoring each patient closely is critical, given the requirement for capacity and final consent on the day of provision,” Selby explains.
Many requestors placed extremely high value on MAiD as the only end-of-life option that made sense. Those people were distressed about possibly losing capacity — and with it, the option of MAiD. “We try to mitigate their anxiety by assuring them we will act quickly if there are signs suggesting impending loss of capacity,” Selby notes.
• Rarely was pain the reason for the request. “In contrast to what is often said in the lay literature, our anecdotal experiences had been that ‘pain’ was almost never the reason,” Selby says.
The study’s findings supported this. “Physical symptoms had a much lower importance than personal philosophies and personality styles,” Selby reports. Forty-six percent of the group who received MAiD said the request reflected a long-term belief in the importance of autonomy and independence, which predated their illness. “This was simply the end of life that made sense for those requesting MAiD,” Selby adds.
• It was not a lack of access to palliative care that prompted a MAiD request. In nearly half of cases, MAiD was carried out in the palliative care unit. Virtually all patients had access to palliative care. However, there is a misconception that lack of palliative care is the main reason people request MAiD.
“We hoped to add to the data showing this was not the case for our population,” Selby says.
The study’s findings showed that many people had strong pre-existing beliefs on the ability to access assistance in dying at the end of life. “For a specific subset of the population, the option of MAiD is a very important one to have,” Selby observes.
- Selby D, Bean S, Isenberg-Grzeda E, et al. Medical assistance in dying (MAiD): A descriptive study from a Canadian tertiary care hospital. Am J Hosp Palliat Care 2020;37:58-64.