Oversight of medical assistance in dying (MAiD) in Canada: perspectives of MAiD assessors/providers and organizational regulatory actors

In 2016, Canada amended the federal Criminal Code to legalize medical assistance in dying (MAiD). While there is a federal monitoring system for MAiD, oversight is considered a provincial/territorial responsibility. Some provinces have established MAiD-specific oversight mechanisms, while others have not, fuelling debates about optimal regulation. This article reports on qualitative research about how key stakeholders perceive oversight and its role in MAiD regulation. The research focused on three Canadian provinces with different approaches to oversight (British Columbia, Ontario, and Nova Scotia). It involved 68 interviews with two key groups: MAiD assessors and providers (physicians and nurse practitioners who provide MAiD); and 'organizational actors' working in governments, regulatory bodies, professional organizations, and healthcare institutions. Despite different oversight models, participants had a broad preference for their province's model. Participants had diverse views about the adequacy of oversight, with some calling for deeper case assessment. Additional improvements included embedding mechanisms for quality improvement and alleviating the burden of oversight on practitioners. Participants also emphasized that MAiD was part of medical practice, and other mechanisms beyond MAiD-specific oversight played a role in accountability. This study can inform discussions about optimal models of MAiD oversight in Canada and in other countries considering assisted dying laws.