Because it was new: Unexpected experiences of physician providers during Canada's early years of legal medical assistance in dying

• Published in: Health policy (Amsterdam) Vol. 125; no. 11; pp. 1489 - 1497
• Main Authors: Winters, Janine Penfield, Pickering, Neil, Jaye, Chrystal
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.11.2021; Elsevier Science Ltd
• Subjects: Anxiety; assisted dying; Assisted suicide; Canada; Death & dying; Emotions; Euthanasia; Humans; implementation; Legalization; Legislation; Medical Assistance; Palliative Care; Physicians; Qualitative research; Suicide, Assisted; Teams; unexpected events; unknown unknowns; Canada; euthanasia; unknown unknowns; unexpected events; implementation; assisted dying
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2021.09.012

•Euthanasia and assisted dying are being legalized in multiple jurisdictions across the world.•Early-adopting providers faced a lack of individual and collective knowledge to guide them.•Interviews with Canadian doctors reveal a variety of unforeseen occurrences.•Stake-holders can gain invaluable information from the first-hand accounts of early-adopting providers.•Providers, policy-makers and regulators benefit from insights from the first cohort of providers. Implementing newly legalized euthanasia or assisted dying presents challenges. The procedure is high-stakes and irreversible and the context is controversial and associated with high emotions and strong opinions. This qualitative study reports unexpected experiences of twenty-one medical doctors who provided Medical Assistance in Dying (MAID) in the first years after legalization in Canada. The phrase ‘because it was new’ occurred multiple times as doctors attributed unanticipated experiences to the lack of individual and collective experience or knowledge. Positively viewed surprises included increased awareness of palliative care and an unexpected personal sense of fulfillment from helping others. Negative surprises were attributed multiple factors including ambiguously phrased legislation, systems issues and individual inexperience. Participants described issues such as technical difficulties around provision, provider anxiety, logistical snags and inability to adequately counsel and guide families. Participants expressed desire for more guidance, mentoring, training, and team communication. This article draws on phenomenological analysis of data to present providers’ accounts of their experiences in the Canadian context. This will assist new providers and jurisdictions in anticipating and preparing for circumstances that were unexpected for the first cohort.