Perceptions of Medical Assistance in Dying in Head and Neck Oncology in Canada: A National Survey Study.

IMPORTANCE

Head and neck oncologists frequently manage patients with advanced malignancies and profound symptom burden. As medical assistance in dying (MAID) becomes more common in Canada, understanding Otolaryngology-Head and Neck Surgery (OHNS) surgeons' perspectives can help characterize practice patterns, perceived barriers, and educational needs.

OBJECTIVE

To assess OHNS surgeons' reported willingness to discuss, assess, or provide MAID in the context of head and neck cancer care and to describe geographic heterogeneity in responses across standard Canadian regions.

DESIGN

National cross-sectional survey distributed in August 2024 to active members of the Canadian Society of OHNS. The 19-question survey, developed by a medical student, resident, and surgeon, with expert review, assessed attitudes, experiences, barriers, and educational needs relating to MAID. Regions were defined as Atlantic (NL, PEI, NS, NB), Central (ON, QC), Prairies (MB, SK, AB), and West Coast (BC).

PARTICIPANTS

Forty-seven attending OHNS surgeons practicing in Canada.

MAIN OUTCOME MEASURES: The primary outcome was variation in overall comfort with MAID across Canadian regions, based on a composite score incorporating comfort discussing MAID when death is foreseeable, not foreseeable, and willingness to administer it. Secondary outcomes included frequency of MAID discussions, willingness to provide second opinions or administer MAID, and factors influencing participation such as training and conscientious objection.

RESULTS

Respondents were primarily from Central Canada (24/47, 51%) and the Prairies (15/47, 32%), with most practicing in academic or tertiary centers (P = .04). Nearly half (22/47, 47%) reported needing further training to feel comfortable discussing MAID. Support for conscientious objection was high (34/47, 72%). Only 4% (2/47) administer MAID as part of their practice, and only 13% (6/47) had ever done so. Common barriers included limited comfort, experience, and exposure. Among the 51% (24/47) of surgeons not routinely discussing MAID with terminally ill patients, 38% (9/24) cited role limitations and 21% (5/24) preferred referral to palliative care. Willingness to provide a second opinion varied across regions (60%-100%), though this was not statistically significant (P = .25).

CONCLUSION

While most respondents support discussing MAID when death is reasonably foreseeable, few participate in its administration. Respondents most commonly identified training/exposure, role delineation, and institutional processes as factors shaping involvement, and many endorsed referral-based pathways as appropriate. Larger studies with province-level analyses are needed to better characterize geographic variation.