Medical Assistance in Dying (MAiD) for Canadian Prisoners: A Case Series of Barriers to Care in Completed MAiD Deaths

Background: As of August 2020, 11 patients who were federally incarcerated in a Canadian prison requested medical assistance in dying (MAiD), and three received it. This case study seeks to understand the process of care as described by physicians involved in each of the cases that resulted in MAiD. Methods: During the summer of 2020, semistructured interviews were conducted with physicians involved in each known Correctional Service of Canada (CSC) MAiD case. Transcripts were summarized to illuminate details of the care process for each patient, highlighting barriers to patient-centered care. Results: Each case took place in a different province. One MAiD provision took place in a prison hospital, and two provisions took place after the incarcerated patients were transferred to external community hospitals. Case summaries highlight the physicians' efforts and challenges in assuring patient-centered care. Discussion: Physician experiences illuminate several barriers to care: CSC bureaucratic processes that forced longer wait times than typical for patients in the general public; challenges related to accessing release before MAiD application; knowledge of patient preference for location of death; concerns of voluntariness and confidentiality that are unique to CSC patients; and ethical considerations surrounding the presence of prison guards, police officers, and shackles at the time of assessment or provision. Reporting by the Office of the Correctional Investigator highlights additional challenges in these cases. Further inquiry is necessary to include the perspectives of prisoners and prison staff, and to consider how the evolution of new MAiD legislation will affect MAiD for prisoners.