Improving end-of-life conversations in the post-MAiD era

Legalizing medical assistance in dying (MAiD) has transformed how palliative and hospice care providers (PHCPs) engage in end of life conversations with patients and their loved ones. We do not currently know how PHCPs in the Toronto area have experienced this tremendous shift, and what challenges they have faced in transforming their practice to accommodate MAiD conversations. We must understand the unique challenges faced by PHCPs so that we can improve the education, resources, and supports available to these essential healthcare providers. We also must ensure that Canadians receive the highest quality care at the end of life, whether or not they choose to pursue a medically assisted death. To examine these unique challenges, I interviewed 22 PHCPs to document their experiences of engaging in end-of-life conversations in the post-MAiD era. Participants included physicians, nurses, social workers, and other allied health professionals employed in faith-based and secular institutions. Their personal beliefs about MAiD varied widely; some identified as conscientious objectors, while others actively engaged in MAiD assessment and provision. Initial thematic analysis revealed that challenges include translating the federal legislation into medical practice; navigating inefficient institutional policies and role ambiguity; developing conversation techniques to share MAiD information with patients and families in a balanced way that is informative yet uncoercive; and, navigating the ethical and organizational issues that arise when patients with declining capacity pursue MAiD. Finally, PHCPs shared personal experiences of burnout, emotional weight, and stigma. Understanding how these factors impact the work and lives of PHCPs allows us to develop targeted strategies to improve the institutional policies surrounding MAiD conversations, referrals, and procedures, as well as decrease the negative personal and emotional consequences of engaging in end-of-life conversations in the post-MAiD era.