Assessment of capacity to give informed consent for medical assistance in dying: a qualitative study of clinicians' experience

CMAJ Open. 2021 Apr 13;9(2):E358-E363. doi: 10.9778/cmajo.20200136. Print 2021 Apr-Jun.

Abstract

Background: Under the Canadian Criminal Code, medical assistance in dying (MAiD) requires that patients give informed consent and that their ability to consent is assessed by 2 clinicians. In this study, we intended to understand how Canadian clinicians assessed capacity in people requesting MAiD.

Methods: This qualitative study used interviews conducted between August 2019 and February 2020, by phone, video and email, to explore how clinicians assessed capacity in people requesting MAiD, what challenges they had encountered and what tools they used. The participants were recruited from provider mailing listserves of the Canadian Association of MAiD Assessors and Providers and Aide médicale à mourir. Interviews were audio-recorded and transcribed verbatim. The research team met to review transcripts and explore themes as they emerged in an iterative manner. We used abductive reasoning for thematic analysis and coding, and continued to discuss until we reached consensus.

Results: The 20 participants worked in 5 of 10 provinces across Canada, represented different specialties and had experience assessing a total of 2410 patients requesting MAiD. The main theme was that, for most assessments, the participants used the conversation about how the patient had come to choose MAiD to get the information they needed. When the participants used formal capacity assessment tools, this was mostly for meticulous documentation, and they rarely asked for psychiatric consults. The participants described how they approached assessing cases of nonverbal patients and other challenging cases, using techniques such as ensuring a quiet environment and adequate hearing aids, and using questions requiring only "yes" or "no" as an answer.

Interpretation: The participants were comfortable doing MAiD assessments and used their clinical judgment and experience to assess capacity in ways similar to other clinical practices. The findings of this study suggest that experienced MAiD assessors do not routinely require formal capacity assessments or tools to assess capacity in patients requesting MAiD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Canada
  • Clinical Decision-Making* / ethics
  • Clinical Decision-Making* / methods
  • Codes of Ethics
  • Euthanasia, Active, Voluntary* / ethics
  • Euthanasia, Active, Voluntary* / legislation & jurisprudence
  • Euthanasia, Active, Voluntary* / psychology
  • Guidelines as Topic
  • Humans
  • Informed Consent / standards*
  • Mental Competency*
  • Nurses
  • Physicians
  • Practice Patterns, Physicians' / ethics
  • Practice Patterns, Physicians' / standards
  • Professional Practice / statistics & numerical data*
  • Qualitative Research
  • Right to Die / ethics
  • Right to Die / legislation & jurisprudence
  • Social Control, Formal / methods*
  • Suicide, Assisted* / ethics
  • Suicide, Assisted* / legislation & jurisprudence
  • Suicide, Assisted* / psychology