Dr Eliana Close1, Professor Jocelyn Downie1,2, Professor Ben P White1
1Australian Centre For Health Law Research, Queensland University of Technology, Brisbane, Australia, 2Faculties of Law and Medicine, Dalhousie University, Halifax, Canada
Biography:
Dr Eliana Close is a socio-legal researcher targeting the evolving legal and ethical landscape of end-of-life care. She is currently leading a Canadian case study on medical assistance in dying as part of Professor Ben White's Australian Research Council Future Fellowship project, "Optimal Regulation of Voluntary Assisted Dying".
Abstract:
Aims:
As more jurisdictions legalize assisted dying (AD), debates continue about optimal regulation. Few studies have examined oversight of AD in practice. In Canada, the federal-provincial-territorial divide poses challenges for a coordinated national approach to medical assistance in dying (MAiD) oversight, which provides important lessons for other jurisdictions like Australia. While federal data indicates most MAiD deaths are subject to oversight mechanisms, some question their adequacy. This study seeks to better understand MAiD oversight from the perspectives of clinicians involved in the process, and of key policymakers in federal/provincial governments, regulatory bodies, and healthcare institutions.
Methods:
We conducted 66 semi-structured interviews with 32 MAiD assessors and providers (27 physicians, 5 nurse practitioners), and 40 policymakers (some with overlapping roles) across Canada. Data were analysed using thematic analysis.
Results:
Preliminary themes are: 1) oversight promotes public trust; 2) oversight equals individual case review; 3) local mechanisms and relationships provide and support oversight; 4) disputing MAiD exceptionalism; 5) oversight should add value; 6) balancing effective oversight with health practitioner participation. Differences between provinces/territories highlighted strengths and gaps. While participants suggested scope for greater oversight in some provinces, they also questioned why MAiD should be treated differently from other areas of medical practice.
Conclusions:
This paper (being submitted for publication in September 2024), can inform practical and regulatory solutions in Canada and in other jurisdictions with AD laws. Given the lack of data on experiences of AD oversight worldwide, it provides a fresh basis for discussing AD oversight models and improvements.