Neuro-Oncology Clinicians’ Attitudes and Perspectives on Medical Assistance in Dying

Abstract IntroductionMedical assistance in dying (MAiD), also known as physician-assisted death, is currently legal in several locations across the globe. Even more jurisdictions are considering legalizing MAiD. Brain cancer or its treatments can lead to cognitive impairment, which can impact decision-making capacity. In most jurisdictions patients are assessed for mental capacity to inform MAiD eligibility. We sought to explore worldwide neuro-oncology clinicians’ attitudes and perspectives on MAiD, including interpretation of decision-making capacity for patient MAiD eligibility.MethodsAn online survey was distributed to members of national and international neuro-oncology societies. We asked questions about decision-making capacity and MAiD, in part using hypothetical patient scenarios. Multiple choice and free-text responses were captured.ResultsThere were 125 survey respondents. Impaired cognition was identified as the most important factor that would signal a decline in patient capacity. At least 26% of survey respondents had moral objections to MAiD. Fewer clinicians were willing to support a MAiD decision for patients with lower-grade tumors and better performance status.Conclusionshile there are differing opinions on the moral permissibility of MAiD in general and for neuro-oncology patients, most clinicians agree that capacity must be assessed carefully before a decision is made. Further, some patients with brain tumors are not generally thought to be MAiD-eligible due to the nature of their specific diseases. These results can inform assessments of patient capacity in neuro-oncological practice in jurisdictions where MAiD is legal.