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Reasons for requesting medical assistance in dying
Ellen Wiebe1, Jessica Shaw2, Stefanie Green3
1Clinical Professor in the Department of Family Practice at the University of British Columbia in Vancouver and a family physician who practises in women's health and assisted death. ellenwiebe@gmail.com.
Objective:
To review the charts of people who requested medical assistance in dying (MAID) to examine their reasons for the request.
Design:
Retrospective chart survey.
Setting:
British Columbia.
Participants:
Patients who requested an assisted death and were assessed by 1 of 6 physicians in British Columbia during 2016.
Main Outcome Measures:
Patients' diagnoses and reasons for requesting MAID.
Results:
Data were collected from 250 assessments for MAID: 112 of the patients had assisted deaths, 11 had natural deaths, 35 were assessed as not eligible for MAID, and most of the rest were not ready. For people who had assisted deaths, disease-related symptoms were given as the first or second most important reason for requesting assisted death by 67 people (59.8%), while 59 (52.7%) gave loss of autonomy, 55 (49.1%) gave loss of ability to enjoy activities, and 27 (24.1%) gave fear of future suffering. People who were assessed as eligible but who had not received assisted deaths were more likely to list fear of future suffering (33.7% vs 7.1%) and less likely to list disease-related symptoms (17.4% vs 40.2%) than those who received MAID were. There was a difference in reasons for MAID given by people with different diagnoses; disease-related symptoms were given as the most important reason by 39.0% of patients with malignancies, 6.8% of patients with neurological diseases, and 28.9% of patients with end-organ failure. Loss of autonomy was given as the most important reason by 16.0% of patients with malignancies, 36.4% of patients with neurological diseases, and 23.7% of patients with end-organ failure.
Conclusion:
This study shows that the reasons patients give for requesting an assisted death are similar to those reported in other jurisdictions with similar laws, but in different proportions. Loss of autonomy and loss of ability to enjoy activities were less common reasons among patients in this study compared with other jurisdictions. This might be related to the method of data collection, as in this study, the patients' reasons were recorded by physicians.
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