CERIEL Winter ‘25 Update: Let the recruitment and interviewing begin!
By Midori Matthew
Happy March, all!
My name is Midori Matthew, and I have been a Graduate Research Assistant with two research projects through The Kernel Network: the first seeking to differentiate physicians’ moral experiences between providing medical assistance in dying (MAiD) and withdrawing life-sustaining treatment (WLT); and the second (and current project) addressing whether MAiD should be considered as part of palliative care. I am currently a third-year doctoral candidate in Health Policy at McMaster University.
The foundation of the current project is based on the idea of ‘intention;’ namely, what a physician’s goals or expectations are when engaging in practices that may hasten a patient’s death. Though many of you will be well aware of this background, MAiD was legalized in Canada in 2016 for individuals facing a reasonably foreseeable natural death. Recent years have seen efforts toward liberalizing this law, expanding eligibility criteria to individuals whose trajectories toward death are less evident, as well as considering those with mental illness as the sole underlying condition. Major Canadian palliative care organizations such as the Canadian Hospice Palliative Care Association have taken a firm stance that MAiD is not aligned with palliative care due to a clear difference in intention between it and other accepted palliative care practices, such WLT or terminal sedation. Practitioners in this school of thought believe that the direct intention to hasten patient death as is the case in MAiD lies outside of the bounds of palliative care and opposes the principle of non-maleficence. On the other side, providers who believe MAiD and palliative care are aligned in practice believe that the goals of both practices are to relieve patient suffering, provide comfort, and to uphold the principle of patient autonomy. This discrepancy in the beliefs of palliative care providers reflects a conceptual disjuncture in how the bioethical idea of ‘intention; is understood and is thus worthy of greater qualitative exploration – which is where our project comes in!
We are excited to announce that we recently received ethics approval for Phase 2 of the latter study, and that we have successfully started recruiting participants with the assistance of our medical connections and the Ontario Medical Association. From now until March/April, we will be engaging in virtual, semi-structured interviews with palliative care physicians on both sides of this debate to determine how they conceive of ‘intention’ in the aforementioned practices in order to practically inform the bioethical literature. The goal of marrying philosophical considerations to bedside medical practice has been and continues to be a core goal of The Kernel Network’s projects. In our project regarding how physicians morally consider MAiD and WLT, we found that current philosophical considerations seeking to distinguish WLT as less acute than MAiD and thus less worthy of the descriptor of active ‘killing’ was insufficient in meeting the nuance in pragmatic considerations taken by clinicians at the bedside. As such, our goals as a team are to capture meaningful firsthand clinical insights to enable the pursuit of evidence-based philosophical debates that offer utility to clinicians, patients, and broader health policy development.
The team looks forward to providing more updates on our interviews and preliminary findings in the months to come, and we thank all collaborators who have been instrumental toward getting the project to this point.