Developing robust systems for Track 2 MAID in Canada: A qualitative study

Developing robust care systems to support the evolving landscape of Medical Assistance in Dying (MAID) in Canada has proven difficult. The complexity of applicants applying under Track 2, in which a reasonably foreseeable natural death is not required for eligibility, has challenged the capacities of systems that were initially developed to care for Track 1 applicants.

To identify structures and practices described by healthcare providers involved in Track 2 care as key to developing a robust system of high quality and safe care for persons applying under Track 2 MAID in Canada.

A qualitative study informed by the principles of Interpretive Description, a pragmatic research approach developed for health disciplines.

Fifty-five healthcare providers, MAID program administrators, and key informants participated in semi-structured interviews. Interviews were conducted over Zoom™, audio-recorded, transcribed, and analysed using strategies outlined in Interpretive Description.

The work of Track 2 care was described as complex, emotionally-laden, risky, and in some regions, inadequately remunerated. MAID coordination centres were effective for Track 2 care when they were team-based; had a structured intake that supported assessors and managed the expectations of applicants; and provided education and navigation support for applicants and family. The coordination centre role was particularly critical when applicants had no primary care provider. The availability of prospective interdisciplinary case consultation was considered essential for optimizing care in the context of Track 2 applicants.

The assessment for, and provision of, MAID is unique in healthcare. It is the only federally legislated healthcare act, and it is irreversible. It is also morally contentious, particularly in the case with Track 2 where applicants' years of life lost may be significant. The safe and effective implementation of Track 2 requires a robust systems approach that to-date is available in only some regions of Canada.