Medical Assistance in Dying in Canada: A Multidisciplinary Pan-Canadian Delphi Study to Inform Clinical Practice Documents and Plan a Research Agendas

Objective: Standardized protocols for assessing and addressing patient suffering are absent from Canadian clinical practice documents on medical assistance in dying (MAiD). Our Delphi study aimed to seek expert consensus on potential improvements to clinical practice documents and on research priorities to address suffering in MAiD. Methods: A multidisciplinary panel of 54 experts from across Canada participated in a modified e-Delphi study. Three rounds of surveys were conducted after a national knowledge dissemination meeting. Results: There was agreement on 27 clinical practice document revisions and on 24 research priorities. Among the main recommendations were early integration of psychosocial and palliative care, providing follow-up and support for patients deemed ineligible for MAiD, addressing mental health stigma, including basic psychosocial assessments in MAiD evaluations, involving social workers when suffering of MAiD requestors is linked to social determinants of health , and clarifying bio-psycho-social-existential issues associated with intolerable suffering (including social determinants of health) in patients requesting MAiD in the context of life-threatening and non-life-threatening conditions. Conclusion: Our results provide practical recommendations for improving MAiD clinical practice documents as they pertain to suffering, as well as identify research priorities to pursue. Our experience can inform clinical policies in Canada and other countries where MAiD is legal or being considered.