• Camille Munro, Anna Romanova, Colleen Webber, Michael Kekewich, Rayelle Richard, and Peter Tanuseputro.
• Palliative medicine physician in the Division of Palliative Medicine in the Department of Medicine at the University of Ottawa and The Ottawa Hospital in Ontario. camunro@toh.ca.
• Can Fam Physician. 2020 Nov 1; 66 (11): 833-842.

ObjectiveTo determine the level of palliative care involvement before and after medical assistance in dying (MAID) requests, and to compare the differences between those who completed MAID and those who requested but did not complete MAID.DesignRetrospective chart review.SettingThe Ottawa Hospital (TOH) in Ontario.ParticipantsNinety-seven patients who requested MAID at TOH between February 6, 2016, and June 30, 2017.Main Outcome MeasuresCompletion of MAID.ResultsEighty-four patients were included in the study. Fifty patients (59.5%) completed MAID. The most common reasons for not completing MAID were death before completion of the required assessments (47.0%), ineligibility (26.5%), and loss of capacity (14.7%). The most common diagnoses were cancer (72.6%) and neurologic disease (11.9%). The most frequent reasons for requesting MAID were physical suffering (77.4%), loss of autonomy (36.9%), and poor quality of life (27.4%). Patients who completed MAID in this study were more likely to report physical suffering as the reason for their request than those who did not complete MAID (84.0% vs 67.6%; P = .08), yet only 23.8% of all patients requesting MAID had an Edmonton Symptom Assessment Scale completed. Before MAID request, 27.4% of patients had a community palliative care physician and 59.5% had palliative care involvement in any setting. The TOH palliative care team was involved in 46.4% of patients who requested MAID.ConclusionThere is still inadequate provision of palliative care for those requesting MAID. Guidelines, legislation, and guidance are needed to help physicians ensure patients are aware of and understand the benefits of palliative care in end-of-life decisions. However, the involvement of palliative care with patients who completed MAID was similar to those who did not complete MAID. Multicentre studies are needed to further explore the MAID process and clarify the role of palliative care in that process.Copyright© the College of Family Physicians of Canada.

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