Medically Assisted Dying Practices: What Role for Clinical Ethicists?

Medically assisted dying (AD) practices have been legalized in several jurisdictions throughout the world over the last two decades. Because of this increased trend, more individuals now have access to a self-chosen death. Despite its legalization and the diversity of frameworks governing AD, it remains fraught with ethical challenges. However, there is a dearth of literature regarding the specific roles clinical ethicists (CEs) may have in AD provision. We sought to address this literature gap by: (1) Gathering healthcare professionals' (HPs) and CEs perspectives on how CEs may contribute; (2) Identifying how CEs may have been involved thus far; (3) Identifying promising practices and pitfalls related to their involvement. An exploratory qualitative study using focus groups, purposive and snowball sampling. Four online focus groups were held. Groups comprised of (1) HPs and (2) CEs from Quebec and Switzerland. Data was analyzed using thematic analysis. Altogether 21 persons participated, among them 10 ethicists and 11 HPs. Four major themes were identified: (1) Specific Roles for CEs; (2) CEs competencies deemed useful in AD provision; (3) Operationalization of CEs' involvement 5) Obstacles/Pitfalls associated to CEs' involvement in AD. Several roles for CEs have been identified that have been associated with specific ethical challenges that arise in AD. Findings indicate that CEs' integration in AD should be context dependent and should consider several misconceptions associated with the field of clinical ethics in general.