Exploring loss of decision-making capacity and access in medical assistance in dying (MAiD)

Caroline Variath, a PhD student at the Lawrence Bloomberg Faculty of Nursing, first became interested in understanding access to medical assistance in dying (MAiD) while she was providing end-of-life nursing care to incapacitated patients in acute and critical care settings.

I noticed that some patients who were found to be eligible for MAiD were unable to access it because of a loss of capacity to consent,” says Variath. “So, I became interested in learning about the type of end-of-life care offered to these patients, which became the basis for my doctoral work.

Variath received a $3,900 research grant in 2021 as well as approximately a total of $3,300 in knowledge transfer grants between 2021 and 2022 from the Canadian Association of MAiD Assessors and Providers (CAMAP) to explore the experiences of health care providers with eligible patients who experienced a loss of decision-making capacity while awaiting MAiD. Variath also wanted to understand the perspectives of healthcare providers on using the waiver of final consent amendment that was introduced with Bill C-7.

“The waiver of final consent amendment introduced with Bill C-7 offers eligible patients an opportunity to enter into an agreement to waive the final confirmation of consent, an option which minimizes their risk of becoming ineligible for MAiD due to a loss of decision-making capacity,” explains Variath.

The findings of Variath’s study will help, she says, to inform policies and guidelines on the implementation of the recent amendments to the Canadian MAiD legislation (Bill C-7) as well as help support the care of patients who were assessed and approved for MAiD but who later became ineligible because of their loss of decision-making capacity.

Variath notes that her research also has strong implications for policies on advance care planning and considerations to further expand access to MAiD for those with capacity limiting conditions.

“The generous support offered by CAMAP has allowed me to focus on my research and disseminate my findings widely through open access publications,” says Variath of the importance of the grants. “The support of my supervisor Dr. Elizabeth Peter has been integral to my research, and I hope to continue to advocate for the needs of patients and healthcare providers to improve end-of-life care.”