• Ellen Wiebe and Michaela Kelly.
• Clinical Professor in the Department of Family Practice in the Faculty of Medicine at the University of British Columbia in Vancouver.
• Can Fam Physician. 2023 Dec 1; 69 (12): 853858853-858.

ObjectiveTo describe clinicians' experiences with assessing patients making track 2 requests for medical assistance in dying (MAID) and providing MAID to such patients in the first 6 months after Canada amended relevant legislation in March 2021 to expand access to MAID.DesignOnline survey with closed and open-ended questions about clinicians' experiences with individual patients making track 2 MAID requests.SettingCanada.ParticipantsDoctors and nurse practitioners who were members of the Canadian Association of MAID Assessors and Providers.Main Outcome MeasuresThe most common reasons patients gave for making track 2 MAID requests and the challenges providers identified in doing these assessments.ResultsTwenty-three MAID providers submitted information about 54 patients who had made track 2 requests between March 17, 2021 and September 17, 2021. The most common diagnoses were chronic pain syndromes, affecting 28 patients (51.9%), and complex chronic conditions such as myalgic encephalomyelitis or chronic fatigue syndrome, affecting 8 patients (14.8%). The most common challenges providers reported were related to patients having concurrent mental illness, noted in 37 assessments (68.5%). In 8 cases (14.8%), providers faced challenges in finding experts to help with assessments. In 19 cases (35.2%), providers felt patients had not been offered all appropriate and available treatments, and in 9 cases (16.7%) providers encountered difficulties in finding such treatments for patients.ConclusionProviders of MAID described many challenges in their experiences with patients making track 2 requests, including assessing individuals with concurrent mental illnesses, being uncertain that patients had been offered appropriate treatments prior to seeking MAID, and being unsure whether patients had seriously considered available treatments. Many providers experienced moral distress in attempting to balance patients' rights with what might be in patients' best interests. This is different from experiences providers have had with patients making track 1 requests, as most of these patients have end-stage malignancy or organ failure and seldom have unmet health care needs. This information could be used to enhance education and support for clinicians as they help patients with track 2 requests access their right to peaceful deaths.Copyright © 2023 the College of Family Physicians of Canada.

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