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. 2021 Jun 1;24(2):82-95.
doi: 10.5770/cgj.24.496. eCollection 2021 Jun.

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

Allison Nakanishi  1   2 , Lauren Cuthbertson  2 , Jocelyn Chase  2   3
Affiliations
Free PMC article

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

Allison Nakanishi et al. Can Geriatr J. .
Free PMC article

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.

Keywords: MAiD; assisted suicide; autonomy; dementia; ethics; euthanasia; medical assistance in dying.

Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES The authors declare that no conflicts of interest exist.

Figures

FIGURE 1
FIGURE 1
Eligible participants included in study data analysis
FIGURE 2
FIGURE 2
Participant responses on the appropriateness and timing of advance requests for MAiD in dementia
FIGURE 3
FIGURE 3
Participant concerns about negative impacts that MAiD and advance requests for MAiD will have on patients with dementia
FIGURE 4
FIGURE 4
Themes arising from qualitative analysis of participant open ended responses: benefits and barriers of advance requests for MAiD in dementia
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