The preliminary opinion of Canadian spine surgeons on Medical Assistance in Dying (MAID); a cross-sectional survey of Canadian Spine Society (CSS) members.

On June 17, 2016, providing medical assistance in dying became legal in Canada. This controversial change has had reverberating implications for the entire medical community. This is especially true for physicians that regularly deal with end-of-life decisions, among them neurosurgical and orthopedic spine surgeons, whose patients suffer from a variety of debilitating conditions. With this study we sought to document the opinions of Canadian spine surgeons in hopes of better understanding the sentiment within the speciality towards this change and assess how it evolves over time. A cross-sectional survey was sent out to members of the Canadian Spine Society (CSS). The survey encompassed 21 questions pertaining to opinions and attitudes regarding MAID and different facets of the legislation. A total of 51 surgeons responded to the survey, comprised of a mix of orthopedic surgeons (68.6%), pediatric orthopedic surgeons (5.9%), and neurosurgeons (21.6%), practicing all across Canada. The majority support the patients' right to obtain MAID (62.8%) and the right of physicians to participate (82.4%). Most also support the right to conscientious objection (90.1%). The results were split on duty to refer patients for MAID (49.0%). Respondents were also divided on whether they could foresee themselves referring to a MAID service, with 37.2% responding yes. A small minority of respondents (3.9%) felt they could see themselves actively involved in MAID. At the advent of legal MAID, the majority of members of the CSS supported both the right of patients to participate in MAID and the right of physicians to provide this service if they so choose, while still respecting the principle of conscientious objection. Of note, only a small minority were willing to be actively involved. This survey provides a useful baseline of opinions in this practice area and will be used to analyze changes over the next 10 years.

Leck E ，Christie S ，Barry T ，Barry S ... -  《-》

Canadian neurosurgeons' views on medical assistance in dying (MAID): a cross-sectional survey of Canadian Neurosurgical Society (CNSS) members.

The Supreme Court of Canada removed the prohibition on physicians assisting in patients dying on 6 February 2015. Bill C-14, legalising medical assistance in dying (MAID) in Canada, was subsequently passed by the House of Commons and the Senate on 17 June 2016. As this remains a divisive issue for physicians, the Canadian Neurosurgical Society (CNSS) has recently published a position statement on MAID. We conducted a cross-sectional survey to understand the views and perceptions among CNSS members regarding MAID to inform its position statement on the issue. Data was collected from May to June 2016. Of the 300 active membes of the CNSS who recevied the survey, 89 respondents completed the survey, 71% of whom were attending neurosurgeons and 29% were neurosurgery residents. Most respondents,74.2%, supported the right of physicians to participate in MAID with 7.8% opposing. 37% had current patients in their practice fitting the criteria for MAID. 23.6% had been asked by patients to assist with MAID, but only 11% would consider personally providing it. 84% of neurosurgeons surveyed supported the physicians' right to conscientious objection to MAID while 21% thought attending surgeons should be removed from the inquiry and decision-making process. 43.8% agreed that the requirment to refer a patient to a MAID service should be mandatory. Glioblastoma multiforme (65%), quadriplegia/quadriparesis secondary to spinal tumour/trauma (54%) and Parkinson's disease (24%) were the most common suggested potential indications for MAID among the neurosurgical population. Our results demonstrate that most neurosurgeons in Canada are generally supportive of MAID in select patients. However, they also strongly support the physicians' right to conscientious objection.

Althagafi A ，Ekong C ，Wheelock BW ，Moulton R ，Gorman P ，Reddy K ，Christie S ，Fleetwood I ，Barry S ... -  《-》

Assessing attitudes towards medical assisted dying in Canadian family medicine residents: a cross-sectional study.

Wong A ，Hsu AT ，Tanuseputro P 《BMC Medical Ethics》

Oncologists and medical assistance in dying: where do we stand? Results of a national survey of Canadian oncologists.

In June 2016, when the Parliament of Canada passed Bill C-14, the country joined the small number of jurisdictions that have legalized medical assistance in dying (maid). Since legalization, nearly 7000 Canadians have received maid, most of whom (65%) had an underlying diagnosis of cancer. Although Bill C-14 specifies the need for government oversight and monitoring of maid, the government-collected data to date have tracked patient characteristics, rather than clinician encounters and beliefs. We aimed to understand the views of Canadian oncologists 2 years after the legalization of maid. We developed and administered an online survey to medical and radiation oncologists to understand their exposure to maid, self-perceived knowledge, willingness to participate, and perception of the role of oncologists in introducing maid as an end-of-life care option. We used complete sampling through the Canadian Association of Medical Oncologists and the Canadian Association of Radiation Oncology membership e-mail lists. The survey was sent to 691 physicians: 366 radiation oncologists and 325 medical oncologists. Data were collected during March-June 2018. Results are presented using descriptive statistics and univariate or multivariate analysis. The survey attracted 224 responses (response rate: 32.4%). Of the responding oncologists, 70% have been approached by patients requesting maid. Oncologists were of mixed confidence in their knowledge of the eligibility criteria. Oncologists were most willing to engage in maid with an assessment for eligibility, and yet most refer to specialized teams for assessments. In terms of introducing maid as an end-of-life option, slightly more than half the responding physicians (52.8%) would initiate a conversation about maid with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress. In this first national survey of Canadian oncologists about maid, we found that most respondents encounter patient requests for maid, are confident in their knowledge about eligibility, and are willing to act as assessors of eligibility. Many oncologists believe that, under some circumstances, it is appropriate to present maid as a therapeutic option at the end of life. That finding warrants further deliberation by national or regional bodies for the development of consensus guidelines to ensure equitable access to maid for patients who wish to pursue it.

Chandhoke G ，Pond G ，Levine O ，Oczkowski S ... -  《-》

This moral coil: a cross-sectional survey of Canadian medical student attitudes toward medical assistance in dying.

Bator EX ，Philpott B ，Costa AP 《BMC Medical Ethics》