Published Research


1. Bator EX, Philpott B, Costa AP. This moral coil: a cross-sectional survey of Canadian medical student attitudes toward medical assistance in dying. BMC Med Ethics. 2017 Oct 27;18(1):58,017-0218-5.

2. Li M, Rodin G. Medical Assistance in Dying. N Engl J Med. 2017 Aug 31;377(9):897-8.

3. Marrie RA, Salter A, Tyry T, Cutter GR, Cofield S, Fox RJ. High hypothetical interest in physician-assisted death in multiple sclerosis. Neurology. 2017 Apr 18;88(16):1528-34.

4. Robertson WD, Pewarchuk J, Reggler J, Green S, Daws T, Trouton K. Case Review of Medically Assisted Deaths on Vancouver Island. 2017 BC Med J

5. Rosso A, Huyer D, Walker A. Analysis of the Medical Assistance In Dying Cases In Ontario: Understanding the Patient Demographics of Case Uptake In Ontario Since the Royal Assent and Amendments of Bill C-14 in Canada. Acad Forensic Pathol. 2017 7(2): 263-287

6. Allard J, Fortin MC. Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients: the Canadian context. J Med Ethics. 2017 Sep;43(9):601-605.


1. Elie D, Marino A, Torres-Platas SG, Noohi S, Semeniuk T, Segal M, et al. End-of-Life Care Preferences in Patients with Severe and Persistent Mental Illness and Chronic Medical Conditions: A Comparative Cross-Sectional Study. Am J Geriatr Psychiatry. 2018 Jan;26(1):89-97.

2. Khoshnood N, Hopwood MC, Lokuge B, Kurahashi A, Tobin A, Isenberg S, Husain A. Exploring Canadian Physicians’ Experiences Providing Medical Assistance in Dying: A Qualitative Study. J Pain Symptom Manage. 2018 May 15.

3. Beuthin, R & Bruce, A. Medical Assistance in Dying (MAiD): Canadian Nurses’ Experiences. Nurs Forum 2018:1-10

4. Beuthin R. Cultivating Compassion: The Practice Experience of a Medical Assistance in Dying Coordinator in Canada Qualitative Health Research 2018, Vol. 28(11) 1679–1691

5. Wright, A. C. & Shaw, J. C. (2018). The spectrum of end of life care: an argument for access to medical assistance in dying for vulnerable populations. Medicine, Health Care and Philosophy, (), 1-9.

6. Shaw J, Wiebe ER, Nuhn A, Holmes S, Kelly M, Just A. Providing Medical Assistance in Dying: Practice Perspectives. Can Fam Phys 2018;64(9)e394-9.

7. Holmes S, Nuhn A, Kelly M, Shaw J, Just A, Wiebe ER. A Qualitative Study Exploring the Journey of Supporting a Loved One through a Medically-Assisted Death in Canada Can Fam Phys 2018;64(9)e387-93.

8. Nuhn A, Holmes S, Kelly M, Just A, Shaw J, Wiebe ER. Experiences and perspectives of people who pursued Medical Assistance in Dying (MAiD) in Vancouver, Canada Can Fam Phys 2018;64(9)e380-6.

9. Wiebe ER, Shaw J, Green S, Trouton K, Kelly M. Reasons for Requesting Medical Assistance in Dying (MAiD) Can Fam Phys 2018;64(9)674-9.

10. Wiebe E, Green S, Schiff B. Teaching residents about medical assistance in dying. Can Fam Physician. 2018 Apr;64(4):315-6.

11. Robertson WD, Beuthin R. A Review of Medical Assistance in Dying on Vancouver Island July 2016-July 2018

12. Crumley ET, Sheppard C, Bowden C, Nelson G. Canadian French and English newspapers’ portrayals of physicians’ role and medical assistance in dying (MAiD) from 1972-2016: a qualitative textual analysis. BMJ Open. (accepted 18 Dec 2018)

13. Wales J, Isenberg SR, Wegier P, Shapiro J, Cellerius V, Husain A, Khoshnood N. Providing Medical Assistance in Dying within a Home Palliative Care Program in Toronto, Canada: An Observational Study of the First Year of Experience 2018 J Pall Med VOL. 21, NO.11 Published Online: 29 Oct 2018

14. MacDonald S, LeBlanc S, Dalgarno N, Schultz K, Johnston E, Martin M, Zimmerman D. Exploring family medicine preceptor and resident perceptions of medical assistance in dying and desires for education. Can Fam Physician. 2018 Sep;64(9):e400-e6. PMID: 30209114.

15. Stewart DE, Rodin G, Li M. Consultation-liaison psychiatry and physician-assisted death. Gen Hosp Psych Vol 55, November–December 2018, Pages 15-19

16. Verweel L, Rosenberg-Yunger ZRS, Movahedi T, Malek AH. Medical assistance in dying: Examining Canadian pharmacy perspectives using a mixed-methods approach. Can Pharm J (Ott). 2018;151(2):121‐132. Published 2018 Feb 9. doi:10.1177/1715163518754917


1. Brown J, Thorpe L, Goodridge D. Completion of Medical Certificates of Death after an Assisted Death: An Environmental Scan of Practices.

2. Antifaeff K. Social Work Practice with Medical Assistance in Dying: A Case Study. 2019 Nat Assoc Soc Workers doi:10.1093/hsw/hlz002

3. Reel K. Denying Assisted Dying Where Death is Not ‘Reasonably Foreseeable’: Intolerable Overgeneralization in Canadian End-of-Life Law. 2019 Canadian Journal of Bioethics

4. Wiebe E, Shaw J, Wright A, Kelly M. Suicide vs Medical Assistance in Dying (MAiD): a secondary qualitative analysis. Death Studies 2019 in press

5. McMechan, C., Bruce, A. & Beuthin, R. (2019). Canadian Nursing Students’ Experiences with Medical Assistance in Dying. Quality Advancement in Nursing Education (5),1 (Article 2).DOI:

6. Beuthin, R. & Bruce, A. (2019). Medical assistance in dying (MAiD): Ten Things Leaders Need to Know. Canadian Journal of Nursing Leadership, 31(4), 74-81.

7. Bruce, A., & Beuthin, R. (2019). Medically Assisted Dying in Canada: “Beautiful Death” Is Transforming Nurses’ Experiences of Suffering. Canadian Journal of Nursing Research.

8. Shaw, J., Harper, L., Preston, E., Wright, A., Kelly, M., & Wiebe, E. (2019). Perceptions and Experiences of Medical Assistance in Dying Among Illicit Substance Users and People Living in Poverty. OMEGA – Journal of Death and Dying.

9. Selby D, Bean S, Isenberg-Grzeda E. Medical Assistance in Dying (MAiD): A Descriptive Study From a Canadian Tertiary Care Hospital American Journal of Hospice and Palliative Medicine 2019 DOI:10.1177/1049909119859844

10. Dion S, Wiebe E, Kelly M. Quality of care with telemedicine for medical assistance in dying eligibility assessments: a qualitative study Can Med Assoc J Open 2019 doi: 10.9778/cmajo.20190111 cmajo December 13, 2019 vol. 7 no. 4 E721-E729

11. Harty C, Chaput AJ, Trouton K, Buna C, Naik VN. Oral medical assistance in dying (MAiD): informing practiceto enhance utilization in CanadaL’aide me´dicale a`mourir administre´e par voie orale : commente´clairer la pratique pour en ame´liorer son utilisation au Canada Can J Anesth/J Can Anesth (2019) 66:1106–1112

12. Schiller, C., Pesut, B., Roussel, J., & Greig, M. But it’s legal isn’t it? Law and ethics in nursing practice related to medical assistance in dying. (2019). Nursing Philosophy. Published online August 20, 2019[Major] [Impact Factor 1.07]

13. Pesut, B., Thorne, S., & Greig, M. Shades of grey: Conscientious objection in medical assistance in dying. (2019) Nursing Inquiry Published online July 4, 2019.

14. Pesut, B., Thorne, S., Greig, M., Fulton, A., Janke, R., & Vis-Dunbar, M. (2019) Ethical, policy, and practice implications of nurses’ experiences with assisted death: A synthesis. Advances in Nursing Science, 42(3) 216-230. doi: 10.1097/ANS.0000000000000276.

15. Pesut, B., Thorne, S., Stager, M.L., Schiller, C., Penney, C., Hoffman, C., Greig, M., & Roussel, J. (2019) Medical assistance in dying: A narrative review of Canadian nursing regulatory documents. Policy, Politics and Nursing Practice, Published online May 6, 2019. doi/10.1177/1527154419845407.

16. Pesut, B., Greig, M., Thorne, S., Storch, J. Burgess, M., Tishelman, C., Chambaere, K., Janke, R. (2019) Nursing and euthanasia: A narrative review of the nursing ethics literature. Nursing Ethics. Published online May 22, 1-16. Doi:10.1177/0969733019845127.

17. Selby D, Bean S. Oncologists communicating with patients about assisted dying. Current Opinion in Supportive & Palliative Care. 13(1):59-63, March 2019.

18. Bravo GA-O, Trottier L, Rodrigue C, Arcand M, Downie J, Dubois MF, Kaasalainen S, Hertogh CM, Pautex S, Van den Block L. Comparing the attitudes of four groups of stakeholders from Quebec, Canada, toward extending medical aid in dying to incompetent patients with dementia. Int J Geriatr Psychiatry. 2019 Jul;34(7):1078-86.PMID: 31034669.

19. Suva G, Penney T, McPherson CJ.Medical Assistance in Dying: A Scoping Review to Inform Nurses’ Practice. J Hosp Palliat Nurs. 2019 Feb;21(1):46-53. PMID: 30608357.

20. Belanger E, Towers A, Wright DK, Chen Y, Tradounsky G, Macdonald ME.Of dilemmas and tensions: a qualitative study of palliative care physicians’ positions regarding voluntary active euthanasia in Quebec, Canada. J Med Ethics. 2019 Jan;45(1):48-53.AccessionNum: 30377217.

21. Janine Brown, Donna Goodridge, Averi Harrison, Jordan Kemp, Lilian Thorpe, and Robert Weiler. Medical Assistance in Dying: Patients’, Families’, and Health Care Providers’ Perspectives on Access and Care Delivery Journal of Palliative Medicine. ahead of print

22. Wilson DM, Triscott JAC, Cohen J, MacLeod R. Educational needs of healthcare professionals and members of the general public in Alberta Canada, 2 years after the implementation of medical assistance in dying.Health Soc Care Community. 2019 Sep;27(5):1295-302. PMID: 31149763.

23. Wong A, Hsu AT, Tanuseputro P. Assessing attitudes towards medical assisted dying in Canadian family medicine residents: a cross-sectional study. BMC Med Ethics. 2019 Dec 27;20(1):103. PMID: 31881966.

24. Bouthillier ME, Opatrny L. A qualitative study of physicians’ conscientious objections to medical aid in dying.Palliat Med. 2019 Oct;33(9):1212-20. PMID: 31280666.

25. Silvius JL, Memon A, Arain M.Medical Assistance in Dying: Alberta Approach and Policy Analysis.Can J Aging. 2019 Sep;38(3):397-406. PMID: 31046853.Link to full text:

26. Hales BM, Bean S, Isenberg-Grzeda E, Ford B, Selby D.Improving the Medical Assistance in Dying (MAID) process: A qualitative study of family caregiver perspectives. Palliat Support Care. 2019 Oct;17(5):590-5. PMID: 30887936.
Link to full text:

27. Brooks L. Health Care Provider Experiences of and Perspectives on Medical Assistance in Dying: A Scoping Review of Qualitative Studies. Can J Aging. 2019 Sep;38(3):384-96. PMID: 30626453. Link to full text:

28. Konder RM, Christie T. Medical Assistance in Dying (MAiD) in Canada: A Critical Analysis of the Exclusion of Vulnerable Populations.Healthc Policy. 2019 Nov;15(2):28-38. PMID: 32077843.


1. Redelmeier, D.A., Detsky, A.S. Economic Theory and Medical Assistance in Dying. Appl Health Econ Health Policy (2020).

2. Selby DA-OhooX, Bean S, Isenberg-Grzeda E, Bioethics BHD, Nolen A.Medical Assistance in Dying (MAiD): A Descriptive Study From a Canadian Tertiary Care Hospital. Am J Hosp Palliat Care. 2020 Jan;37(1):58-64.AccessionNum: 31256607.

3. Beuthin R, Bruce A, Hopwood MC,Robertson WD, Bertoni K. Rediscovering the art of medicine, rewards, and risks: Physicians’ experience of providing medical assistance in dying in Canada. 2020 SAGE Open Medicine Volume 8: 1–9 DOI: 10.1177/2050312120913452

4. Downer J, et al. Early experience with medical assistance in dying in Ontario, Canada: A cohort study,’ Canadian Medical Association Journal, published online 11 February 2020.

5. Praslickova Z, Kelly M, Wiebe E. (2020) The experience of volunteer witnesses for Medical Assistance in Dying (MAiD) requests, Death Studies, DOI: 10.1080/07481187.2020.1716884

6. Trouton K., Beuthin, R., Thompson, M., Bruce, A., Lemire-Elmore, C., Zhang, A., & Daudt, H. Attitudes and expectations regarding bereavement support for patients, family members, and friends: Findings from a survey of MAID provider. BC Med J, vol. 62 , No. 1 , January February2020 , Pages 18-23

7. Variath C, Peter E, Cranley L, Godkin D, Just D. Relational influences on experiences with assisted dying: A scoping review May 2020 Nursing Ethics DOI: 10.1177/0969733020921493

8. Isenberg-Grzeda E, Bean S, Cohen C, Selby D. Suicide Attempt After Determination of Ineligibility for Assisted Death: A Case Series J Pain Symptom Manage 2020;60:158e163

9. Wiebe ER, Green S, Wiebe K. Medical assistance in dying (MAiD) in Canada: practical aspects for healthcare teams. July 2020 Annals of Palliative Medicine 9(6):38-38. DOI: 10.21037/apm-19-631

10. Durant K-L, Kortes-Miller K. Physician snapshot: the forming landscape of MAiD in northwestern Ontario. Palliative Care and Social Practice. January 2020. doi:10.1177/2632352420932927

11. Oczkowski SJW, Crawshaw D, Austin P, Frolic A et al. How we can improve the quality of care for patients requesting medical assistance in dying: a qualitative study of health care providers
August 2020Journal of Pain and Symptom Management

12. Munro C, Romanova A, Webber C, Kekewich M, Richard R, Tanuseputro P. Involvement of palliative care in patients requesting medical assistance in dying.
Canadian Family Physician November 2020, 66 (11) 833-842;

13. Brown J, Goodridge D, Harrison A, Thorpe L, Kemp J, Weiler R. Care Considerations in a Patient- and Family-Centered Medical Assistance in Dying Program
August 2020 Journal of palliative care DOI: 10.1177/0825859720951661

14.Thomas McMorrow, Ellen Wiebe, Ruchi Liyanage, Sabrina Tremblay-Huet & Michaela Kelly “Interpreting Eligibility Under the Medical Assistance in Dying Law: The Experiences of Physicians and Nurse Practitioners” (2020) 14:1 McGill JL & Health 51.

15. Freeman LA, Pfaff KA, Kopchek L, Liebman J. Investigating palliative care nurse attitudes towards medical assistance in dying: An exploratory cross-sectional study. Journal of Advanced Nursing. 2020 Feb;76(2):535-545. DOI: 10.1111/jan.14252.

16. Lees C, Gubitz G, Horton R. A Retrospective Review of Medically Assisted Deaths in Nova Scotia: What Do We Know and Where Should We Go? J Palliative Medicine.

17. Gerson S. Assisted dying and palliative care in three jurisdictions: Flanders, Oregon, and Quebec. Annals of palliative medicine 12/04/2020.

18. Selby D, Meaney C, Bean S, Isenberg-Grzeda E. Factors predicting the risk of loss of decisional capacity for medical assistance in dying: a retrospective database review
Citing article Oct 2020 · CMAJ Open

19. Leck E, Christie S, Barry T, Barry S. The preliminary opinion of Canadian spine surgeons on Medical Assistance in Dying (MAID); a cross-sectional survey of Canadian Spine Society (CSS) members Dec 2020 · North American Spine Society Journal (NASSJ)

20. Sabrina Tremblay-Huet, Thomas McMorrow, Ellen Wiebe, Michaela Kelly, Mirna Hennawy, Brian Sum, The impact of the COVID-19 pandemic on medical assistance in dying in Canada and the relationship of public health laws to private understandings of the legal order, Journal of Law and the Biosciences, Volume 7, Issue 1, January-June 2020, lsaa087,

21. Donna E. Stewart, Pierre Viens, Oviya Muralidharan, Patti Kastanias, Justine Dembo, and Ekaterina Riazantseva.E-Survey of Stressors and Protective Factors
in Practicing Medical Assistance in Dying. Journal of Palliative Medicine.ahead of print

22. Koksvik G. Practical and ethical complexities of MAiD: Examples from Quebec. November 2020 Wellcome Open Research 5:227 DOI: 10.12688/wellcomeopenres.16306.2

23. Ummel D. De l’importance du sens donné à la mort assistée : l’accompagnement de fin de vie et le processus de deuil en contexte d’aide médicale à mourir
October 2020Frontières 32(1) DOI: 10.7202/1072754ar

24. Frolic A, Swinton M, Murray L, Oliphant A. Double-edged MAiD death family legacy: a qualitative descriptive study. December 2020Supportive and Palliative Care Follow journal
DOI: 10.1136/bmjspcare-2020-002648

25. Mills A, Wortzman R, Bean S, Selby D.Allied Health Care Providers Participating in Medical Assistance in Dying: Perceptions of Support. J Hosp Palliat Nurs. 2020 Jun;22(3):220-8. PMID: 32282557.

26. Zworth M, Saleh C, Ball I, Kalles G, Chkaroubo A, Kekewich M, Miller PQ, Dees M, Frolic A, Oczkowski S. Provision of medical assistance in dying: a scoping review. BMJ Open. 2020 Jul 8;10(7):e036054. PMID: 32641328.

27. Brown, J. Goodridge, D., & Thorpe, L. (2020). Medical assistance in dying in health sciences curricula: A qualitative exploratory study. Canadian Medical Education Journal. DOI: 10.36834/cmej.69325

28. Pesut, B., Thorne, S., Schiller, C., Greig, M., Roussel, J., Tishelman, C. (2020). Constructing good nursing practice for Medical Assistance in Dying in Canada: An Interpretive Descriptive study. Global Qualitative Nursing Research, 7, 1-11

29. Pesut, B., Thorne, S., Storch, J., Chambaere, K., Greig, M., Burgess, M. (2020) Riding an elephant. A qualitative study of nurses’ moral journeys in the context of Medical Assistance in Dying (MAiD). Journal of Clinical Nursing, 29(19-20) 3870-3881.

30. Pesut, B., Thorne, S., Schiller, C., Greig, M., Roussel, J. (2020). The rocks and hard places of MAiD: A qualitative study of nursing practice in the context of legislated assisted death. BMC Nursing. Published online February 17, 2020.


1. Wiebe E, Sum B, Kelly M, Hennawy M. Forced and chosen transfers for medical assistance in dying (MAiD) before and during the COVID 19 pandemic: a mixed methods study. Death Studies 2021 (in press)

2. Rosanne Beuthin, Anne Bruce, Marney Thompson, A. E. (Betty) Andersen & Sarah Lundy (2021) Experiences of grief-bereavement after a medically assisted death in Canada: Bringing death to life, Death Studies, DOI: 10.1080/07481187.2021.1876790

3. Rosenblat, J.D. and Li, M. (2021), Is ketamine a litmus test for capacity in assisted dying with depression?. Psycho‐Oncology.

4. Wiebe ER, Kelly M, McMorrow T, Trembey-Huet S, Hennawy M. How the experience of medical assistance in dying changed during the COVID-19 pandemic in Canada: a qualitative study of providers. April 2021CMAJ Open 9(2):E400-E405 DOI: 10.9778/cmajo.20200163

5. Ward V, Freeman S, Banner D. Care Provider Perspectives of Medical Assistance in Dying in a Canadian Hospice That Does Not Provide Medical Assistance in Dying Jan 2021 · Canadian Journal of Nursing Research

6. Goldberg R, Nissim R, An E, Hales S. Impact of medical assistance in dying (MAiD) on family caregivers. BMJ Support Palliat Care. 2021 Mar;11(1):107-14. PMID: 30826737.

7. Mathews JJ, Hausner D, Avery J, Hannon B, Zimmermann C, Al-Awamer A.Impact of Medical Assistance in Dying on palliative care: A qualitative study. Palliat Med. 2021 Feb;35(2):447-54. PMID: 33126842.

8. Oliphant A, Frolic AN. Becoming a medical assistance in dying (MAiD) provider: an exploration of the conditions that produce conscientious participation. J Med Ethics. 2021 Jan;47(1):51-58. doi: 10.1136/medethics-2019-105758. Epub 2020 May 5. PMID: 32371593.

9. Brown, J. “Its a big difference between having an opinion on something and actively doing it”: Physician and nurse practitioner non-participation in medical assistance in dying. [Doctoral dissertation, University of Saskatchewan]. 2021

10. Brown, J., Goodridge, D., Thorpe, L., & Crizzle, A. (2021) “I am ok with it, but I am not going to do it”: the exogenous factors influencing non-participation in medical assistance in dying. Qualitative Health Research. In Press

11. Brown, J., Goodridge, D., Thorpe, L., & Crizzle, A. (2021) “What is right for me, is not necessarily right for you”: the endogenous factors influencing non-participation in medical assistance in dying. Qualitative Health Research. DOI: 10.1177/10497323211008843

12. Bahji A, Delva N. Making a case for the inclusion of refractory and severe mental illness as a sole criterion for Canadians requesting medical assistance in dying (MAiD): a review April 2021 Journal of Medical Ethics DOI: 10.1136/medethics-2020-107133

13. Nakanishi, A., Cuthbertson, L. & Chase, J. Advance Requests for Medical Assistance in Dying in Dementia: a Survey Study of Dementia Care Specialists. Can Geriatrics J 24, 82–95 (2021).

14. Byram, A. C., Wiebe, E. R., Tremblay-Huet, S. & Reiner, P. B. Advance Requests for MAiD in Dementia: Policy Implications from Survey of Canadian Public and MAiD Practitioners. Canadian Health Policy Journal (2021).

15. Nolen A, Olwi R, Debbie S. Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review. American Journal of Hospice and Palliative Medicine®. July 2021. doi:10.1177/10499091211030443

16. Thangarasa, T., Hales, S., Tong, E. et al. A Race to the End: Family Caregivers’ Experience of Medical Assistance in Dying (MAiD)—a Qualitative Study. J GEN INTERN MED (2021).

17. Crumley ET, Kelly S, Young J, et alHow is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study. BMJ Open 2021;11:e048698. doi: 10.1136/bmjopen-2021-048698

18. Wiebe E, Kelly M, Lalonde K. Oversight of Medical Assistance in Dying (MAiD) in Canada: A Mixed-Methods Report of What We Have and What We Should Have. Canadian Health Policy, August 2021. ISSN 2562-9492

19. Wiebe E, Kelly M. Community characteristics and MAiD uptake in Ontario: an ecological study Canadian Health Policy, August 2021. ISSN 2562-9492

20. Khawaja M, Khawaja A. The Ethics of Dying: Deciphering Pandemic-Resultant Pressures That Influence Elderly Patients’ Medical Assistance in Dying (MAiD) Decisions. Int. J. Environ. Res. Public Health 2021, 18, 8819.

21. Wright D. “Reflection and soul searching”: Negotiating nursing identity at the fault lines of palliative care and medical assistance in dying. Social science & medicine 2021:114366

CAMAP Research Grants awarded April 21, 2021 at the Research Forum

CAMAP Research Awards April 2021

$1575 Medical Assistance in Dying (MAiD): A Readiness Assessment Study of Healthcare Professionals Impacted by New Legislation (Bill C-7
Andrea Frolic,

$3900 The experiences of health care providers with eligible patients’ loss of decision-making capacity while awaiting medical assistance in dying and their perspectives on using advance consent.
Caroline Variath, Elizabeth Peter , Lisa Cranley, Dianne Godkin

$2494.13Mixed Methods Research on Interdisciplinary Support Groups (ISG) for Medical Assistance in Dying (MAID): An Analysis of Promising Practices and Recommendations for Their Implementation

$3937.50 Grief and Bereavement Following Medical Assistance in Dying (MAiD)
Tekla Hendrickson, Mona Kornberg, Sarina Isenberg, Narges Hashemi

$1500 Family and informal supports’ experiences with social support and bereavement during the Medical Assistance in Dying (MAiD) process in Canada: A qualitative study
Ellen T. Crumley, Jocelyne LeBlanc

CAMAP Research Knowledge Transfer Awards April 2021

$2000 Play-Book for Creating, Sustaining and Resourcing a MAiD Bereavement Group
Andrea Frolic, C. Elizabeth Dougherty, Ann Vanderberg, Allyson O

$2300 Assessment of capacity to give informed consent for Medical Assistance in Dying (MAiD): A qualitative study of clinicians’ experience
Ellen Wiebe, Michaela Kelly, Thomas McMorrow, Sabrina Tremblay-Huet, Mirna Hennawy

$2300 Exploring How Family Members Experience Medical Assistance in Dying
Kelly Schutt, Sheryl Reimer-Kirkham, Derrick Klaassen,

Abstracts presented April 21, 2020, at the Virtual MAiD Research Forum

1. Title: Experience with Medical Assistance in Dying (MAiD) when resources are limited: A qualitative study of providers’ experience.

Background: There have been concerns that it may be easier to access MAiD than to get the treatments some people need to control symptoms or get necessary supportive care. Providing MAiD for someone whose unbearable suffering might be relieved by a service they cannot afford could cause ethical dilemmas for providers.

Methods: This was a qualitative study using semi-structured interviews with MAiD providers. We asked participants about their experience in assessing eligibility for MAiD in situations where resources were limited, any challenges or problems they faced and the resources they used. Interviews were conducted in English and French, transcribed verbatim and translated where necessary so that thematic analysis could be done in English.

Results: Most participants were very experienced and they all said they had rarely encountered situations where they felt that the patient might have chosen to live longer if certain services were available. They had encountered situations in which their patient’s suffering had been made worse due to social determinants of health, such as poor housing. Some discussed the issues of isolation and loneliness factoring into the patient’s decision to have MAiD. The main ethical dilemma discussed was that MAiD is not intended to address the failures of society, but, at the same time, individuals have the right to end their suffering.

Discussion: Although our participants had rarely encountered lack of available treatments or services for their patients’ suffering, they recognized that the suffering was sometimes made worse by social determinants of health.

Authors: Ellen Wiebe MD, UBC, Michaela Kelly MSc, Laura B. Spiegel MA, Jean-Frederic Menard LLB, U Sherbrooke, Emily Hawse BA, UBC, Rebecca Dickinson RM

Contact: Ellen Wiebe

2. Title: Exploring Age-Standardized MAiD Rates in Island Health Authority

Background: Among the BC Health Authorities (HA), Island HA has consistently had the highest utilization rate (BC range 1.59 – 6.29% of all deaths. 2019). Prior to this study, it was speculated that differences in population age between HA might be responsible for the differences in MAiD utilization rates. Our aim was to calculate age-standardized MAiD mortality rates and extrapolate those rates for comparison.

Methods: Following approval by the Island Health Research Ethics Board (Protocol: H20-00073), we used the direct method for calculating age standardized MAiD mortality rates for Island HA. Data was obtained from the Island HA MAiD database and BC Stats website. We used 5-year age increments for age; however, ages under 45 and ages greater than 91 were aggregated due to small numbers. We used age-standardized rates to predict age-adjusted 2019 MAiD deaths per HA.

Results: There was considerable difference between the actual percentage of MAiD deaths of all deaths and projected percentages for Interior HA (2.97% vs. 5.41%); Fraser HA (1.59% vs. 6.22%); Vancouver Coastal HA (3.58% vs. 7.24%); and Northern HA (2.57% vs. 4.29%). The actual number of 2019 MAiD deaths for BC was 1,280; however, the projected age-adjusted number of deaths was 2,333.

Discussion: We found that differences in population ages between BC HA are unlikely to be a significant reason for the differences in MAiD percentage of deaths. Differences may be due to HA variation in the provision of MAiD services or other population characteristics.

Authors: Karen L. Courtney, PhD, RN, Rosanne Buethin, PhD, RN, Gerry Bliss, BSc
Junko Fukui Innes, MSc Akzana Klepsch

Contact: Karen L. Courtney, PhD, RN

3. Title: A qualitative study of families’ experiences with medical assistance in dying (MAiD) in Nova Scotia

Background: MAiD became legal in Canada in 2015, with Bill C-14 in 2016 further delineating eligibility criteria and access to MAiD. Previous research has shown that families are often intimately involved in the decision-making process, with conflicting perspectives regarding how they cope with the medically assisted death.

Our study sought to learn about the experiences of family members going through this process, and to determine what additional supports might be beneficial to the bereaved so as to improve MAiD delivery and aftercare.

Methods: We conducted hour-long semi-structured interviews with 20 family members of individuals who had MAiD. Given Covid-19 constraints, interviews took place by telephone or virtually via MS Teams. Interview transcripts were analyzed using an established iterative coding process and thematic analysis.

Results: Prominent themes emphasized the importance of respecting the individual’s autonomy and decision-making, and allowing them to regain a sense of control, particularly when so much had been taken away by virtue of their illness.

The death itself was often described as peaceful. Interviewees were overwhelmingly filled with relief and gratitude for being able to respect the individual’s wishes.

Interviewees invariably spoke of the importance of support for themselves, and identified a desire to build a network of individuals who have gone through similar experiences, allowing them to share their stories, grieve together, and support the next generation.

Discussion: These results will help to improve MAiD delivery and aftercare in Nova Scotia, by informing, developing and enabling access to resources for individuals who accompany a family member on their end-of-life journey.

Authors: Dr. Erika Leck, Dr. Caitlin Jackson-Tarlton, Dr. Ellen Crumley, Dr. Gord Gubitz

Contact: Erika Leck

4. Title: Exploring How Family Members Experience Medical Assistance in Dying Background

Background: Bill C-14 passed into Canadian legislation on June 17, 2016 permitting “…competent adults whose deaths are reasonably foreseeable” to receive Medical Assistance in Dying (MAiD) provided their medical condition is “grievous and irremediable” and causes “enduring and intolerable suffering” (Parliament of Canada, 2016). This study explored how family members experience MAiD, since the 2016 legislation.

Methods: The Listening Guide (Gilligan et al., 2003), a qualitative research methodology rooted in a feminist tradition, was used to listen for the tensions, harmonies, and dissonances experienced by seven family members from across Canada, whose loved ones received MAID. Analysis of in-depth interviews involved listening for story plots within each family member’s narrative and the creation of I-poems, which served to honour the complexity of each participant’s experience.

Results: Analysis revealed that family members experienced tension in negotiating relationship to themselves, to their loved one, and to others involved. These tensions were heard in four voices throughout the study: witnessing, caregiving, honouring choice and supporting dignity, and surrendering and letting go.

Discussion: Current procedures and policies tend to focus on the individual receiving MAiD. Shifting practices to align with relational ethics could challenge healthcare providers to consider how they might support family members. By acknowledging the social context of the patient receiving MAiD, this study extends the discourse surrounding MAiD beyond the realm of individual autonomy, suggesting a shift in care from being patient-focused to being truly personcentred.

Authors: Kelly Schutt, MSN, School of Nursing, Trinity Western University Sheryl Reimer-Kirkham, PhD, School of Nursing, Trinity Western University Derrick Klaassen, PhD, Counselling Psychology, Trinity Western University


5. Title: A Case Series of Completed MAiD Cases for Canadian Prisoners 

Background: Since the legalization of medical assistance in dying (MAiD) in Canada, 11 federally incarcerated patients have requested MAiD, and three have received it. This collective case study seeks to describe the process of care as described by three physicians involved in each of the cases that resulted in MAiD provision.   

Methods: During the summer of 2020, semi-structured interviews were conducted with physicians involved in each of the three known Correctional Services Canada (CSC) MAiD cases. Transcripts were summarized to focus on details of the care process of each patient.   

Results: Case summaries highlight the physicians’ efforts and challenges in assuring patient-centered care. Strengths included: physician concern for equivalency of care and supporting the patient preference of location for MAiD. Challenges included: limited knowledge of CSC guidelines on MAiD; CSC bureaucratic processes that forced longer wait times than typical for patients in the general public; the effect of CSC officers being present during assessment and provision. 

Interpretation: Physician experiences illuminate several barriers to care: concerns of voluntariness and confidentiality that are unique to the prison environment, despite internal CSC measures to safeguard against this; patient preference of location for end of life and death was not always known; ethical considerations surrounding the presence of CSC guards, police officers, and handcuffs at the time of assessment and provision, which may influence the ability of a patient to speak freely and can cause distress for all involved.

Authors: Dr. Jessica Shaw, PhD, RSW ,Peter Driftmier