Doctors assessing medically assisted dying eligibility need more training, says Sask. physician

A Saskatchewan physician who works in medically assisted dying says more training is needed for doctors assessing eligibility.

Dr. Lilian Thorpe is a Saskatoon-based geriatric psychiatrist who has been present for around 100 medically assisted deaths and conducted more than 300 assessments for MAID — or medical assistance in dying — eligibility.

"The assessments are very complex and it's hard for [doctors doing assessments] to know, so I think people are really trying to do their best," said Thorpe.

"But I think we need to work on putting together more really intensive training, especially with the assessment of complex patients."

The federal government tabled new legislation outlining changes to rules for MAID last Monday. 

Under the current rules, a medically assisted death procedure requires approval from two assessors — either a physician or a nurse practitioner. 

Currently in Saskatchewan, physicians in a variety of fields — including specialists like anesthetists, radiologists and pathologists — can carry out assessments to decide if a person who wants a medically assisted death is eligible for it. 

Thorpe said she would like to see standardized training, and more refined best practices for physicians doing MAID assessments, because their fields of expertise can be so varied.

Nurse practitioners, who are also eligible to be assessors in Saskatchewan, "actually have a pretty broad experience usually … but some of us physicians have worked in restricted areas where it's a little harder," said Thorpe.  

"Physicians are stepping up to do the right thing — they want to do assessments for people to let them have access but no, sometimes they haven't had that [relevant] experience."

She believes the proposed new legislation will help improve the standard of assessments.

The new legislation would remove the current requirement that a person's natural death must be "reasonably foreseeable," and would disqualify anyone suffering solely from a mental illness from receiving MAID.

In cases where the death is not "reasonably foreseeable", the bill requires one of two physicians who do the assessment of eligibility to have expertise in the medical condition that is causing the person's suffering.

Experts already consulted: Sask. Health Authority 

Dr. Rob Weiler is the medical advisor for the MAID program in Saskatchewan. 

He said specialists are already brought in to provide input on assessing eligibility for MAID in complex cases. 

"Whenever there was a concern about things like capacity or whether there was some concern about whether depression was a major consideration, we always got an expert — perhaps a psychiatrist — involved in doing a part of the assessment, or a medical practitioner who [has] better expertise in those conditions," said Weiler. 

The Saskatoon region currently has five assessors — a geriatric psychiatrist (Thorpe), three anesthetists and a nurse practitioner. 

Weiler said there is no dedicated training for MAID assessors, but people with a lot of experience assist those who are new to doing assessments. 

Educational material, expertise available

He said additional training is always helpful but there is a lot of educational material available, and assessors can be connected with other physicians who have relevant expertise. 

"We always make sure that people are comfortable in the skills that they have in doing the assessment," said Weiler. 

He welcomed the changes outlined in the proposed new legislation overall. 

Currently, two independent witnesses are required to sign off on a request for MAID. Under the proposed new legislation, only one witness would need to sign and that person can be a paid medical care provider. 

The proposed changes also would permit access to MAID to someone whose death is reasonably foreseeable — but who has lost the capacity to consent since deciding to do so through an agreement with a medical or nurse practitioner.

The bill removes the requirement for a 10-day "reflection period" between requesting MAID and receiving it, and waives the requirement that a patient provide final consent.