Introduction Medical Assistance in Dying (MAiD) allows eligible individuals to access medical interventions to end their lives when facing an advanced, irreversible condition accompanied by unbearable suffering.^{1 2} Many individuals who seek a MAiD may not receive MAiD, due to the lengthy and complex nature of the MAiD process.³ We aimed to understand the differences between participants who considered MAiD but did not undergo the procedure and those who underwent a MAiD.

Methods We conducted a secondary analysis of decedent interview data from the Canadian Longitudinal Study on Aging (CLSA) in Canada. Next of kin and proxies of deceased CLSA participants were interviewed about end-of-life characteristics and MAiD considerations for participants who died between June 6, 2016, and March 15, 2022. We examined clinical and demographic characteristics and their association with considering MAiD compared to receiving MAiD. We conducted a descriptive analysis comparing non-MAiD deaths to MAiD-related deaths. Regression methods identified the association between demographic and EoL characteristics factors with consideration and reception of MAiD.

Results There was a total of 981 deceased participants with a completed decedent interview. Approximately 25.4% considered MAiD and 6.7% experienced MAiD. In both groups, most participants were male, married, and died of cancer. Considering MAiD was more likely if individuals died in hospice or palliative care (OR 1.73; CI 1.12–2.67), had health care or end-of-life arrangements (OR 1.75; CI 1.15–2.76), and experienced peace with dying (OR 1.87; CI 1.23–2.92). For those who had a MAiD, they were less likely receive palliative care, but had a better overall quality of death and dying experience. Individuals considering MAiD reported dying in place (64.7 vs 56.3; SD: 0.75) and peace with dying (78.3 vs 63.7; SD 0.77) more frequently than those who did not consider MAiD.

Discussion Given that more than a quarter of older adults are considering MAiD, honest and informed conversations between health care providers and patients regarding MAiD need to become a part of the EoL care planning process.⁴ Palliative care settings may offer effective symptom management and psychosocial support that may alleviate the need for MAiD. Considering MAiD as an end-of-life care pathway, even if not received, enhances the overall quality of the dying experience, by providing autonomy during the end-of-life decision-making process contributing to a positive death experience.^{5 6}

References

1. Downar J, Fowler RA, Halko R, Huyer LD, Hill AD, Gibson JL. Early experience with medical assistance in dying in ontario, Canada: a cohort study. CMAJ. 2020;192.E173-E81.

2. An act to amend the criminal code and to make related amendments to other acts (Medical Assistance In Dying) (S.C. 2016 c.

3. Martin S. A good death: Making the most of our final choices. Toronto CHC.

4. Mathews JJ, Hausner D, Avery J, Hannon B, Zimmermann C, Al-Awamer A. Impact of medical assistance in dying on palliative care: a qualitative study. Palliat Med. 2021;35:447–54.

5. (https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2022.html) SCFaroMAiDiC.

6. https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2022.html. SCFaroMAiDiCN-.

7. Canada S. Medical assistance in dying, 2021. (https://www150.statcan.gc.ca/n1/daily-quotidien/230213/dq230213c-eng.htm). 2023.