Advance Requests for Medical Assistance in Dying in Dementia: a Survey Study of Dementia Care Specialists

  • Allison Nakanishi Vancouver Island Health Authority, University of British Columbia
  • Lauren Cuthbertson University of British Columbia
  • Jocelyn Chase University of British Columbia, Providence Health Care
Keywords: dementia, medical assistance in dying, MAiD, euthanasia, assisted suicide, autonomy, ethics

Abstract

Background

Current Canadian Medical Assistance in Dying (MAiD) legislation requires individuals to have the mental capacity to consent at the time of the procedure. Advance requests for MAiD (ARs for MAiD) could allow individuals to document conditions where MAiD would be desired in the setting of progressive dementia.

Methods

Greater Vancouver area dementia care clinicians from family practice, geriatric medicine, geriatric psychiatry, and palliative care were approached to participate in an online survey to as­sess attitudes around the appropriateness of ARs for MAiD. Quantitative analysis of survey questions and qualitative analysis of open-ended response questions were performed.

Results

Of 630 clinicians approached, 80 were included in the data analysis. 64% of respondents supported legislation allowing ARs for MAiD in dementia. 96% of respondents articulated barriers and concerns, including determination of capacity, protecting the interests of the future individual, navigating conflict among stakeholders, and identifying coercion. 78% of respondents agreed with a mandatory capacity assessment to create an AR, and 59% agreed that consensus between clinicians and substitute decision-makers was required to enact an AR.

Conclusion

The majority of Vancouver dementia care clinicians participat­ing in this study support legislation allowing ARs for MAiD in dementia, while also articulating ethical and logistical concerns with its application.

Author Biographies

Allison Nakanishi, Vancouver Island Health Authority, University of British Columbia

Geriatric Medicine, Division of Geriatric Medicine

Lauren Cuthbertson, University of British Columbia

Division of Geriatric Medicine

Jocelyn Chase, University of British Columbia, Providence Health Care

Division of Geriatric Medicine, Geriatric Medicine

Published
2021-05-10
How to Cite
Nakanishi, A., Cuthbertson, L., & Chase, J. (2021). Advance Requests for Medical Assistance in Dying in Dementia: a Survey Study of Dementia Care Specialists. Canadian Geriatrics Journal, 24(2), 82-95. https://doi.org/10.5770/cgj.24.496
Section
Original Research