• John-Graydon Simmons, Gavin Reynolds, Michael Kekewich, James Downar, Sarina R Isenberg, and Daniel Kobewka.
• Department of Medicine (J.G.S., G.R., D.K.), The Ottawa Hospital, Ottawa, Canada; Department of Clinical and Organizational Ethics (M.K.), The Ottawa Hospital, Ottawa, Canada; Department of Palliative Care (J.D.), Bruyère Continuing Care, Ottawa, Canada; Department of Medicine (J.D., S.R.I.), University of Ottawa, Ottawa, Canada; Department of Family and Community Medicine (S.R.I.), University of Toronto, Toronto, Canada; School of Epidemiology & Public Health (D.K.), University of Ottawa, Ottawa, Canada.
• J Pain Symptom Manage. 2022 Feb 1; 63 (2): 244-250.e2.

BackgroundMedical assistance in dying (MAiD) is available in Canada for patients with grievous and irremediable medical conditions causing unbearable physical or mental suffering. It is not known how the 'grievous and irremediable suffering' criteria is being interpreted and documented by physicians.MethodsRetrospective chart review of MAiD assessments from patients who submitted written MAiD requests to The Ottawa Hospital from June 1, 2016 to September 18, 2018. We used inductive thematic analysis to determine themes and subthemes.ResultsOur sample included 52 patients with a mean age of 70.5 years (SD 14), 24/52 (46%) were male. We identified 5 themes: 1) patient's context and history (e.g., past experiences, lack of disease modifying treatments), 2) physical symptoms (e.g., chronic pain, fatigue), 3) psychosocial symptoms (e.g., social isolation, or inability to communicate), 4) sense of control and 5) irreversibility. These themes were used to create a framework that describes the suffering of patients requesting MAiD. Patients who request MAiD describe how their disease causes suffering through physical symptoms, psychological symptoms and loss of control that is irreversible. These domains of suffering interact with their personal history and context leading to a reality that is unacceptable and irreversible.ConclusionMAiD assessors' working definition of 'grievous and irremediable suffering' as documented in their assessments is consistent with the body of literature on this topic. MAiD assessments could be enhanced with more information about existential aspects of suffering and the impact of illness on meaningful life roles.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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