A 72-year-old woman presents with a 2-month history of dysphagia. She has not visited a clinic for a few years and appears well. She complains of some acid reflux and difficulty “getting the food down.” After an unsuccessful trial of medications for gastroesophageal reflux disease, you refer her for a barium swallow and a chest x-ray scan. To your surprise, the findings are worrying, pointing to a mediastinal mass intruding on the esophagus. Within a few weeks, she has a biopsy confirming small cell carcinoma of the lung. Computed tomography and bone scan findings come back with concerning results suggesting metastasis. You refer the patient to an oncology specialist and she starts a trial of palliative chemotherapy. However, over the next few months, she experiences weight loss, fatigue, and bony pain. She asks you about medical assistance in dying (MAID). Up until now, you would have referred her to the local MAID coordinating office, but as you are working through the case as a clinician teacher with a family practice resident, you pause. Together, can you consolidate and enhance your understanding about MAID to explain it and start this process with her? You are reminded of the key learning objectives for MAID training established in a mixed-methods study focusing on family medicine residency programs in Canada (Table 1).1,2

Learning objectives for MAID in family practice residency

Involvement in assessing patients for MAID enriches clinicians’ capacity for caring. Research indicates the process brings deep satisfaction for clinicians,3 despite the challenges of learning a new approach and the associated administrative burden. Ensuring appropriate information about MAID is provided also requires a comprehensive goals-of-care discussion with the patient and the timely involvement of palliative care.4 As of September 2023, a nationally accredited curriculum in both official languages is available in Canada at no cost for physicians and nurse practitioners.5 The Canadian MAID Curriculum (CMC) was initiated by the Canadian Association of MAID Assessors and Providers (CAMAP) through a grant from Health Canada and with guidance from the National Steering Committee composed of members from most professional health care associations, including the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, and the Canadian Nurses Association. The overall goal of the CMC is to standardize and harmonize the education and approach to MAID of nurse practitioners and medical doctors who assess for eligibility and provide MAID in Canada. Throughout each module, opportunities for clinicians to reflect and improve their resilience are included, addressing the concern that assessing for and providing MAID may trigger questions about values, autonomy, and ethics. To complete the entire curriculum, 27 hours of participation are required: 13 hours of online self-study and 14 hours of facilitated sessions. The CMC was created through a contract with the Queen’s University Learning Management System and now has more than 1000 learners engaged with various stages of the curriculum. Topics 1 (foundations of MAID in Canada) and 2 (clinical conversations that include MAID) are taught through online self-study and provide learners with background about MAID, enabling them to discuss it with patients (Box 1).5

To access the curriculum in English or French, learners must complete a registration form at https://camapcanada.ca/curriculum/how_to_register. Next, an account must be created on Learning Management System, the learning platform hosted by Queen’s University in Kingston, Ont. After receiving a login link, clinicians can start learning, with access to all available online self-study topics and resources for up to 1 year. There is no charge for learners once enrolled.

Educational topics include the following:

Foundations of MAID in Canada

Clinical conversations that include MAID

How to do a MAID assessment

Assessing capacity and vulnerability

Providing MAID

Navigating complex cases with confidence

MAID and mental disorders

Completion of the entire curriculum requires 27 hours of participation: 13 online self-study hours and 14 hours for facilitated sessions. The curriculum is eligible for College of Family Physicians of Canada Mainpro+ certified Group Learning credits, at 3 credits per hour to a maximum of 81 credits.

MAID—medical assistance in dying.

Data from Canadian Association of MAID Assessors and Providers.5

Most Canadians support the Supreme Court decision in Carter v Canada that led to the first MAID legislation in 2016.6 An Ipsos iSay panel poll was conducted from June 7 to 12, 2023, and a representative sample of 3502 Canadians aged 18 years and older was interviewed.7 According to results of this poll, support for the Supreme Court decision is high, at 84%. People older than 55 support it even more strongly, at 89%. Support for it among faith communities is also high, including 83% of Catholics and 79% of Protestants. Therefore, family physicians can expect inquiries about MAID from patients, particularly following diagnosis of an incurable condition or disease.

An assisted death can occur once a person submits a formal request, is found eligible by 2 clinicians, and relevant safeguards are met.8 In 2022, most such requests (13,102 [81.4%]) resulted in the administration of MAID.9 The remaining 18.6% resulted in an outcome other than MAID: 560 individuals were deemed ineligible (3.5% of written requests); 298 individuals withdrew their requests (1.9% of written requests); and 2144 individuals died before receiving MAID (13.3% of written requests). In 2022, 4.1% of those who died in Canada received MAID. Of the 1837 clinicians involved in providing an assisted death in 2022, 67.7% were family physicians.