IMPLEMENTATION OF MEDICAL ASSISTANCE IN DYING (MAID): SCOPING HEALTH CARE PROVIDERS’ PERSPECTIVES

In tandem with increased life expectancy is a growing number of older adults living longer in discomfort and pain, with life-debilitating chronic or terminal illness and poor quality-of-life. With a focus on quality-of-dying and a ‘dignified death’ for older adults, medical assistance in dying (MAID) has gained widespread public and professional popularity as an end-of-life alternative, leading to legalization in several countries. However, continued debate about the necessity and limits of various healthcare professions’ involvement persists. Drawing on evidence from regions where MAID has been legalized, a scoping review was conducted to synthesize the literature on roles of diverse healthcare professionals in decision-making and implementation of MAID services for older adults. An exhaustive database search yielded 1,000+ articles. Abstracts were manually curated, with 35 studies fulfilling inclusion criteria and integrated in the final review. Synthesis and analysis of the literature led to five thematic conclusions being highlighted as relevant to older patients seeking MAID: Nurses are increasingly involved in MAID but lack role clarity in decision-making processes; mental health professionals should always be required to assess capacity and consent for MAID decision-making; physician involvement alone is insufficient to manage patient requests; conscientious objection by physicians leads to a de-medicalized framework for MAID; and guidelines/frameworks to clarify healthcare professionals’ roles in interprofessional collaboration. Findings from this review inform policy, practice and research and demonstrate urgency for a multidisciplinary approach to MAID for older adults that clearly defines scope of practice for diverse healthcare professionals to prevent legal, ethical and administrative hurdles.