Factors influencing the involvement of health care professionals in the administration of medical aid in dying in Quebec

Abstract

On February 16, 2023, the Quebec provincial Minister for Health and Seniors introduced Bill 11, which would allow people suffering from serious and incurable diseases to benefit from medical aid in dying (MAID) through an advanced consent, in anticipation of incapacity. In addition, people with severe neuromotor disabilities such as quadriplegia would also be eligible for MAID if they meet the other eligibility criteria. If this bill is adopted, we can expect the number of MAID to increase in the coming years. Moreover, the number of HCPs who agree to be involved in the process of administering MAID remains relatively stable and objectively low, which generates an additional clinical, psychological and administrative burden for HCPs who agree to provide this care. Through a narrative review of the scientific literature, we found that there have been very few empirical studies about the factors that contribute (positively or negatively) to HCP involvement in the MAID process. The data show that among the factors that have been identified in the scientific literature as discouraging the involvement of HCPs in MAID, some are related to HCPs’ freedom of conscience and their core values, while others are more pragmatic and emerge from the reality of the field. Many factors influence negatively HCP participation in MAID. However, some of these factors, specifically those that are not related to the exercise of freedom of conscience, may potentially be mitigated by the implementation of appropriate resources, such as the creation of a space for safe dialogue. This article highlights the heterogeneity of factors that can interfere with the involvement of HCPs in MAID and, above all, the need for further investigation of these issues in order to adequately take them into consideration in the organization and provision of care.