Initiating MAID conversations

During your practice, you may have encountered patients with life-limiting illnesses who may be interested in MAID (Medical Assistance in Dying) based on your understanding of the patient and their illness. Have you ever hesitated to bring up this option due to concerns around the legality or ethics of this conversation? One case in the CMAJ listed below describes the story of one patient’s suicide as a result of this hesitation and the traumatic experience it left for his family.

Thankfully, there is now a position statement by the Canadian Association of MAID Assessors and Providers (CAMAP) that discusses initiation of MAID conversations and is explicitly referenced in Government of Canada messaging to health professionals.

In summary, there is no provision in the law that prohibits healthcare professionals from initiating a discussion about MAiD or responding to questions about MAiD from a patient… so long as they do not have the aim of inducing, persuading, or convincing the patient to request MAiD, any healthcare professional can legally provide information, initiate and engage in discussion, and educate patients about MAiD. There is no legal restriction on who can raise the subject, i.e., the healthcare professional or patient. Clinicians should therefore consider discussing MAID as part of goals of care conversations and make use of opportunities to introduce the idea or explore it further.

Family physicians are well-positioned to utilize our relationships and expertise of shared decision making to delicately engage patients on this topic. Early initiation of MAID discussions can allow for greater rapport-building as their primary care provider and ensure assessment prior to losing decision-making capacity. Further information on the above as well as in the additional context of conscientious objection is available in the resources below:

• Leo died the other day | CMAJ  

• Advice to the Profession: Medical Assistance in Dying (MAID) – Canada.ca  
• Final Bringing up MAiD

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