• Narges Khoshnood, Marie-Clare Hopwood, Bhadra Lokuge, Allison Kurahashi, Anastasia Tobin, Sarina Isenberg, and Amna Husain.
• Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: narges.khoshnood@sinaihealthsystem.ca.
• J Pain Symptom Manage. 2018 Aug 1; 56 (2): 222-229.e1.

ContextMedical assistance in dying (MAiD) allows a practitioner to administer or prescribe medication for the purpose of ending a patient's life. In 2016, Canada was the latest country, following several European countries and American states, to legalize physician-assisted death. Although some studies report on physicians' attitudes toward MAiD or describe patient characteristics, there are few studies that explore the professional challenges faced by physicians who provide MAiD.ObjectivesThe objective of the study was to explore the professional challenges faced by Canadian physicians who provide MAiD.MethodsSixteen physicians from across Canada who provide MAiD completed in-depth, semistructured telephone interviews. An inductive thematic analysis approach guided data collection and the iterative, interpretive analysis of interview transcripts. Three members of the research team systematically co-coded interview transcripts, and the emerging themes were developed with the broader research team. NVivo was used to manage the coded data.ResultsParticipants described three challenges associated with providing MAiD: 1) their relationships with other MAiD providers were enhanced and relationships with objecting colleagues were sometimes strained; 2) they received inadequate financial compensation for time, and 3) they experienced increased workload, resulting in sacrifices to personal time. Although these providers did not intend to stop providing MAiD at the time of the interview, they indicated their concerns about whether they would be able to sustain this service over time.ConclusionPhysicians described relationship, financial, and workload challenges to providing MAiD. We provide several recommendations to address these challenges and help ensure the sustainability of MAiD in countries that provide this service.Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

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