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Medical assistance in dying in Canada: A review of regulatory practice standards and guidance documents for physicians.

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Titel: Medical assistance in dying in Canada: A review of regulatory practice standards and guidance documents for physicians.
Autoren: Close, Eliana, Gupta, Mona, Downie, Jocelyn, White, Ben P.
Quelle: Palliative Care & Social Practice; 6/24/2025, p1-24, 24p
Schlagwörter: ASSISTED suicide laws, MEDICAL protocols, HEALTH services accessibility, QUALITATIVE research, RESEARCH funding, CONTENT analysis, PHYSICIANS' attitudes, CONTINUUM of care, THEMATIC analysis, RESEARCH methodology, PHYSICIANS, DATA analysis software, PATIENT decision making
Geografische Kategorien: CANADA
Abstract: Background: Medical assistance in dying ("MAiD") became legal across Canada in 2016, and in Québec in 2015. Provincial/territorial regulatory bodies play a critical role in MAiD as they can issue binding requirements on health practitioners. Law and regulatory standards are the "twin pillars" of MAiD regulation, yet the content of MAiD practice standards for physicians is unstudied. Design: This article analysed MAiD guidance for physicians from Canadian medical regulators (often called the "College of Physicians and Surgeons"), using a qualitative descriptive approach, informed by regulatory space theory. Methods: We identified MAiD-specific regulatory documents (practice standards and related documents) using web-based searches and follow-up inquiries. We analysed the documents using qualitative descriptive analysis and the Framework Method, facilitated by NVivo. The analysis focused on identifying areas where regulators issued guidance beyond the law. Results: We identified 15 regulatory documents from 11 of the 13 provinces and territories. We determined that these documents primarily outline the law without detailed guidance on how to apply it. We identified eight areas for which regulators provided guidance that went beyond the MAiD-specific legislation, most relating to core aspects of medical practice, such as competency, documentation, and patient-centred care. The rights and obligations of conscientious objectors were a predominant focus in all documents. The documents largely lacked guidance about the meaning of terms in the legislation. There was also variation in standards between provinces and territories; the documents focused on similar topics but varied in their policy choices. Physicians in each province/territory are therefore subject to differing expectations (to some extent). Conclusion: This study highlights a gap in guidance on the meaning of legal terms in the Criminal Code MAiD provisions and highlights interprovincial/territorial variability in MAiD practice standards and guidance for physicians. The study demonstrates the risks of fragmentation inherent in polycentric regulation, which can be challenging for physicians to navigate. Plain language summary: Medical assistance in dying in Canada: What do regulators expect of physicians? In Canada, medical assistance in dying (MAiD) became legal in 2016, with Québec legalizing it in 2015. In each province and territory, regulatory bodies like the "College of Physicians and Surgeons," play a key role in guiding physicians on how to carry out MAiD. However, there has been little research on regulators' practice standards for physicians. This study examined MAiD-related guidance for physicians from Canadian medical regulators. We found 15 documents from 11 provinces and territories that were specific to MAiD. The goal was to see how these documents went beyond the law and provided additional requirements and advice on how to handle MAiD in practice. The results showed that most documents mainly restate the law, with limited extra guidance. However, there were eight areas where regulators offered advice that went beyond the legal requirements. These areas included medical competencies, proper documentation, and patient-centered care. One key focus in all documents was the rights of physicians who object to MAiD for personal or moral reasons. The study also found that the guidance varied between provinces and territories. While most documents covered similar topics, the specific expectations differed somewhat. This may create some confusion for physicians, as they may face different standards depending on where they practice. Overall, the study points out the lack of clear guidance on the meaning of certain legal terms and highlights the variation in MAiD regulation for physicians across Canada. [ABSTRACT FROM AUTHOR]
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Datenbank: Complementary Index
Beschreibung
Abstract:Background: Medical assistance in dying ("MAiD") became legal across Canada in 2016, and in Québec in 2015. Provincial/territorial regulatory bodies play a critical role in MAiD as they can issue binding requirements on health practitioners. Law and regulatory standards are the "twin pillars" of MAiD regulation, yet the content of MAiD practice standards for physicians is unstudied. Design: This article analysed MAiD guidance for physicians from Canadian medical regulators (often called the "College of Physicians and Surgeons"), using a qualitative descriptive approach, informed by regulatory space theory. Methods: We identified MAiD-specific regulatory documents (practice standards and related documents) using web-based searches and follow-up inquiries. We analysed the documents using qualitative descriptive analysis and the Framework Method, facilitated by NVivo. The analysis focused on identifying areas where regulators issued guidance beyond the law. Results: We identified 15 regulatory documents from 11 of the 13 provinces and territories. We determined that these documents primarily outline the law without detailed guidance on how to apply it. We identified eight areas for which regulators provided guidance that went beyond the MAiD-specific legislation, most relating to core aspects of medical practice, such as competency, documentation, and patient-centred care. The rights and obligations of conscientious objectors were a predominant focus in all documents. The documents largely lacked guidance about the meaning of terms in the legislation. There was also variation in standards between provinces and territories; the documents focused on similar topics but varied in their policy choices. Physicians in each province/territory are therefore subject to differing expectations (to some extent). Conclusion: This study highlights a gap in guidance on the meaning of legal terms in the Criminal Code MAiD provisions and highlights interprovincial/territorial variability in MAiD practice standards and guidance for physicians. The study demonstrates the risks of fragmentation inherent in polycentric regulation, which can be challenging for physicians to navigate. Plain language summary: Medical assistance in dying in Canada: What do regulators expect of physicians? In Canada, medical assistance in dying (MAiD) became legal in 2016, with Québec legalizing it in 2015. In each province and territory, regulatory bodies like the "College of Physicians and Surgeons," play a key role in guiding physicians on how to carry out MAiD. However, there has been little research on regulators' practice standards for physicians. This study examined MAiD-related guidance for physicians from Canadian medical regulators. We found 15 documents from 11 provinces and territories that were specific to MAiD. The goal was to see how these documents went beyond the law and provided additional requirements and advice on how to handle MAiD in practice. The results showed that most documents mainly restate the law, with limited extra guidance. However, there were eight areas where regulators offered advice that went beyond the legal requirements. These areas included medical competencies, proper documentation, and patient-centered care. One key focus in all documents was the rights of physicians who object to MAiD for personal or moral reasons. The study also found that the guidance varied between provinces and territories. While most documents covered similar topics, the specific expectations differed somewhat. This may create some confusion for physicians, as they may face different standards depending on where they practice. Overall, the study points out the lack of clear guidance on the meaning of certain legal terms and highlights the variation in MAiD regulation for physicians across Canada. [ABSTRACT FROM AUTHOR]
ISSN:26323524
DOI:10.1177/26323524251338859