The article, Neuro-oncology Clinicians’ Attitudes and Perspectives on Medical Assistance in Dying, from Canadian Journal of Neurological Sciences describes the results of an international survey of neuro-oncology clinicians about medical assistance in dying (MAiD) among patients with brain cancer. Assisted suicide and voluntary euthanasia fall under the umbrella of MAiD. More and more jurisdictions are legalizing MAiD worldwide. This survey was designed to address the clinical dilemmas faced when neuro-oncology patients request MAiD. In some cases, the same tumour-related disability the prompts the request for MAiD also compromises decision-making capacity. In some cases, the clinical criteria for MAiD are vague, especially as they relate to reasonably forseeable natural death. Some clinicians have moral objections to MAiD.

A survey was sent to > 10,000 neuro-oncology clinicians worldwide and 125 completed the survey. After the survey, respondents were given the option of participating in a follow-up interview. Most survey responses were from the United States, Canada, and the Netherlands. Most respondents were adult neuro-oncologists, half were female, and had been in practice a median of 10–14 years. Among respondents, 45% were Christian and 43% declared no religion. They tended to live (61%) in jurisdicitons where MAiD was illegal, and only 16% had participated in the MAiD process. One quarter (26%) of respondents held moral objections to MAiD while 57% did not and the remaining 17% were unsure. Those who lived in a place where MAiD was legal were less likely to be unsure about moral objections to MAiD. Impaired cognition was identified as the most important factor that would signal a decline in patient capacity.  Fewer clinicians were willing to support a MAiD decision for patients with lower-grade tumors and better performance status. There was striking disagreement about which hypothetical patients had capacity to make a MAiD decision and which patients’ MAiD decisions would receive the respondent’s support.

This is the first worldwide study of the attitudes of neuro-oncology clinicians on MAiD. While 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. These survey results can inform assessments of patient capacity in neuro-oncological practice in jurisdictions where MAiD is legal.

The authors are enthusiastic about the interest that this article has generated and look forward to sharing in the near future the results of their qualitative interviews with neuro-oncology clinicians.

The Canadian Journal of Neurological Sciences (CJNS) is a widely circulated, internationally recognized medical journal that publishes peer-reviewed articles in neurology and neurosciences. Learn more about the journal here.

Neuro-oncology Clinicians’ Attitudes and Perspectives on Medical Assistance in Dying will be available freely online to all until October 31, 2021.