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Providing medically assisted dying in Canada: a qualitative study of emotional and moral impact
  1. Janine Penfield Winters1,
  2. Chrystal Jaye2,
  3. Neil John Pickering1,
  4. Simon Walker1
  1. 1Bioethics Centre, University of Otago, Dunedin, New Zealand
  2. 2General Practice and Rural Health, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
  1. Correspondence to Dr Janine Penfield Winters, Bioethics Centre, University of Otago, Dunedin 9016, New Zealand; janine.winters{at}otago.ac.nz

Abstract

Purpose Medical assistance in dying (MAiD) in Canada places the medical provider at the centre of the process. The MAiD provider holds primary responsibility for determining eligibility and becomes acquainted with patients’ inner desires and expressions of suffering. This is followed by the MAiD procedure of administering the lethal agent and being present at the death of eligible patients. We report participants’ perceptions of the emotional and moral impacts of this role.

Methodology Two years after MAiD was legalised in Canada, 22 early-adopting physician providers were interviewed. Data were examined using both phenomenological analysis and a novel ChatGPT-enhanced analysis of an anonymised subset of interview excerpts.

Findings Participants described MAiD as emotionally provocative with both challenges and rewards. Providers expressed a positive moral impact when helping to optimise a patient’s autonomy and moral comfort with their role in relieving suffering. Providers experienced tensions around professional duty and balancing self with service to others. Personal choice and patient gratitude enhanced the provider experience, while uncertainty and conflict added difficulty.

Conclusions Participants described MAiD provision as strongly aligned with a patient-centred ethos of practice. This study suggests that, despite challenges, providing MAiD can be a meaningful and satisfying practice for physicians. Understanding the emotional and moral impact and factors that enhance or detract from the providers’ experience allows future stakeholders to design and regulate assisted dying in ways congruent with the interests of patients, providers, families and society.

  • Euthanasia
  • Health Workforce
  • Personal Autonomy
  • Ethics- Medical

Data availability statement

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Footnotes

  • Contributors JPW is responsible for the overall content as guarantor. The guarantor accepts full responsibility for the finished work and/or the conduct of the study, had access to the data and controlled the decision to publish. JPW conceived the study in close consultation with CJ and NJP, who were involved in every step of conceptualisation and design. JPW, NJP and CJ developed the theoretical framework. JPW collected the data. CJ and NJP aided JPW in the primary analysis. CJ, NJP and SW collaborated in secondary analysis. CJ, NJP and SW supervised the project. All authors discussed the results and contributed to the final manuscript. JPW took the lead in writing the manuscript, and CJ, NJP and SW contributed to all major drafts as well as contributing to the final version of the manuscript and supervised the project. All authors provided critical feedback and helped shape the research, analysis and manuscript. We used ChatGPT to confirm our inductive thematic analysis. This is described in the methods section. In the methods section, we quote the three prompts that we entered for our question to ChatGPT and which anonymised data excerpts were given to the ChatGPT to thematically analyse.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study involves human participants and was approved by 1) University of Otago, Febuary 2019, Reference number: H19/011. 2) Queens University, Canada HSREB, July 2019, Reference number: TRAQ# 6026915 Department Code FMED-6693-19. Participants gave informed consent to participate in the study before taking part.

  • Provenance and peer review Not commissioned; externally peer reviewed.