In June of 2016, the federal government of Canada passed legislation to legalize medically assisted dying. Nearly one year later, healthcare providers at the University Health Network (UHN) in Toronto have published a paper in the New England Journal of Medicine outlining their approach to implementing a medical assistance in dying (MAiD) protocol in Canada’s largest hospital.
Psychiatrist and study author Dr. Madeline Li explained that upholding the act and implementing MAiD required a multidisciplinary approach. Both a framework built around identifying and assessing eligible patients and providing service, and an education plan to help doctors and nurses were necessary in implementing the program.
The UHN established three teams to address the clinical, assessment and interventional needs of MAiD. While the act provides eligible patients with the option of being provided with a euthanasia drug to be self-administered at home, the UHN has opted to administer the intravenous drugs in the hospital.
Numbers reported to the medical advisory committee show that in its first year or being available, 74 patients being treated at UHN inquired about MAiD. Of these inquiries, 74 percent were from patients whose primary diagnosis was some form of cancer.
Just under 40 percent of these patients went onto the assessment phase, with 25 of these patients being approved under the MAiD protocol. Nineteen patients opted to receiving the intravenous drug causing death.
“Just prior to delivery of MAiD, all patients who reached this stage were evaluated by intervention-team physicians to determine whether they currently met criteria for informed consent for MAiD,” wrote Li in the publication, who is a psychiatrist in the Department of Supportive Care at UHN.
According to statistics compiled by CBC, between June 17 of 2016 (when the legislation was passed) and March 31 of 2017, 365 patients in Ontario died with medical assistance. In Quebec – which legalized medically assisted dying in December of 2015 – 469 patients opted for MAiD between December 10, 2015 and December 9, 2016.
“Just as advocacy from outside mainstream medicine brought palliative care ‘from the margins to the centre’, so has it brought MAiD into the mainstream of medicine,” said Li. “It is now clear that MAiD education must be included in undergraduate medical education curricula in Canada, and in the training for a variety of specialties including general medicine, family medicine, oncology, neurology, respirology, palliative care, pharmacy, psychiatry, social work, spiritual care, and bioethics.”