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Clinician responses to legal requests for hastened death: a systematic review and meta-synthesis of qualitative research
  1. Tejal Patel,
  2. Kayonne Christy,
  3. Lawrence Grierson,
  4. Joshua Shadd,
  5. Alexandra Farag,
  6. Danielle O'Toole,
  7. Jennifer Lawson and
  8. Meredith Vanstone
  1. Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Tejal Patel, Department of Family Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; tpatel{at}


Background The legalisation of medical assistance in dying in numerous countries over the last 20 years represents a significant shift in practice and scope for many clinicians who have had little-to-no training to prepare them to sensitively respond to patient requests for hastened death.

Aims Our objective was to review the existing qualitative literature on the experiences of healthcare providers responding to requests for hastened death with the aim of answering the question: how do clinicians make sense of, and respond to patients’ expressed wishes for hastened death?

Methods We performed a systematic review and meta-synthesis of primary qualitative research articles that described the experiences and perspectives of healthcare professionals who have responded to requests for hastened death in jurisdictions where MAiD (Medical Assistance in Dying) was legal or depenalised. A staged coding process was used to identify and analyse core themes.

Results Although the response to requests for hastened death varied case-by-case, clinicians formulated their responses by considering seven distinct domains. These include: policies, professional identity, commitment to patient autonomy, personal values and beliefs, the patient-clinician relationship, the request for hastened death and the clinician’s emotional and psychological response.

Conclusion Responding to a request for hastened death can be an overwhelming task for clinicians. An approach that takes into consideration the legal, personal, professional and patient perspectives is required to provide a response that encompasses all the complexities associated with such a monumental request.

  • medical assistance in dying
  • palliative care
  • medical education
  • euthanasia
  • physician assisted suicide

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  • Contributors TP, LG, JS, AF, DO and MV conceptualised the study design. Data was extracted by KC and verified by MV. The search was developed and conducted by JL. Data analysis was led by TP, KC and MV with input from LG, JS and AF. The manuscript was drafted by TP, KC and MV, and all authors critically revised the manuscript and approved the final version.

  • Funding This work was supported by the Department of Family Medicine, McMaster University (no grant number) and the Government of Ontario through a Health System Research Fund grant entitled 'Harnessing Evidence and Values for Health System Excellence'.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Author note At the time the work was completed, KC was a Research Assistant at McMaster University in the Department of Family Medicine. Currently, she is a masters student in the Department of Sociology at the University of British Columbia.