Conduit or conductor? Physician providers' descriptions of their role as MAiD assessors in the first years after legalisation in Canada.

PURPOSE

This qualitative study investigates how Canadian physician-providers of medical assistance in dying (MAiD) perceived their role in making judgements when assessing patients for MAiD.

METHODOLOGY

21 Canadian physician MAiD providers were interviewed about their experience as early-adopting providers. The data were analysed using a phenomenological approach to identify themes and thematic groupings regarding providers' perceptions of roles and reasoning while undertaking MAiD assessments.

FINDINGS

Participants universally endorsed a focus on providing patient-centred care. They varied in how they approached decision-making for patients applying for MAiD and how they viewed their role within the doctor-patient relationship. Group 1 participants placed moral decision-making with the patient, indicating a limited role for the provider. They focused on guiding the competent patient through the statutory MAiD requirements to actualise patient autonomy. Some described their role as 'conduits'. Group 2 had intermediate views. Group 3 participants described their professional judgement as important to the moral calculus of approval for MAiD. Their role was like that of a train conductor in that they positioned themselves as responsible for wider patient interests as part of maintaining their own professional and moral integrity during MAiD.

CONCLUSIONS/SIGNIFICANCE: Participants' narratives indicate that decisions about MAiD assessments are strongly influenced by provider reasoning regarding the physician's role in MAiD assessment and provision. This divergence reflects unclear role expectations in the context of rapidly changing cultural expectations regarding MAiD.