“I Am Okay With It, But I Am Not Going to Do It”: The Exogenous Factors Influencing Non-Participation in Medical Assistance in Dying

Abstract

Medical assistance in dying (MAID) processes are complex, shaped by legislated directives, and influenced by the discourse regarding its emergence as an end-of-life care option. Physicians and nurse practitioners (NPs) are essential in determining the patient's eligibility and conducting MAID provisions. This research explored the exogenous factors influencing physicians' and NPs' non-participation in formal MAID processes. Using an interpretive description methodology, we interviewed 17 physicians and 18 NPs in Saskatchewan, Canada, who identified as non-participators in MAID. The non-participation factors were related to (a) the health care <i>system</i> they work within, (b) the <i>communities</i> where they live, (c) their current <i>practice</i> context, (d) how their participation choices were <i>visible</i> to others, (e) the <i>risks</i> of participation to themselves and others, (f) <i>time</i> factors, (g) the impact of participation on the <i>patient's family</i>, and (h) <i>patient-HCP</i> relationship, and contextual factors. Practice considerations to support the evolving social contact of care were identified.