Medical‐assistance in Dying (MAiD) for Dementia Patients in Canada and Netherlands: A Literature Review
Bibliographic record
Abstract
Abstract Background Dementia is the seventh leading cause of death worldwide. The notion of Medical‐assistance in Dying (MAiD) among dementia and Alzheimer’s patients has been legalized in Canada and Netherlands. However, there has been little research dedicated to clinical intervention and clinical ethics in MAiD as well as policy, legal, ethical barriers and challenges, and research gaps for physicians, dementia care specialists, healthcare providers, and carers. In Canada, MAiD accounts for 2.5% of all deaths, including dementia. Method A comprehensive search in Google Scholar, PubMed, and the National Library of Medicine was conducted to discover evidence‐based MAiD practice, legislation, and ethical protocols among dementia and Alzheimer’s patients worldwide through peer‐reviewed research articles published between 2012 and 2022 that focused on quantitative, qualitative, and mixed methods. This includes MAiD education, clinical practices, legislation, attitudes and experiences of physicians, geriatricians, dementia care specialists and health care providers and barriers in MAiD in dementia for patients and their decision‐making capacity in the early or late stages of dementia. Result Three Canadian studies demonstrate knowledge and experiences of dementia care specialists for advanced requests for MAiD in British Columbia; capture physicians' characteristics and attitudes toward MAiD for non‐competent dementia patients in Quebec; and reflect insight into the current practises of MAiD among dementia patients focused on their autonomy and mental capacity of consent in Canada. Studies in the Netherlands reveal physicians' experiences and workload, pressure and expectations of relatives and societies to access end‐of‐life options and care for MAiD; and argue on early vs. late stages in Dutch practices and decision‐making and consent among incompetent dementia patients. Conclusion The roles of Alzheimer’s societies, stakeholders, MAiD assessors and providers, and social support systems are critical in educating, advocating for, and empowering dementia patients and carers to MAiD in the early and late stages. More research is needed to inform policymakers and legislators in developing a roadmap for educational interventions to MAiD assessors and providers, health care providers, medico‐legal practitioners, stakeholders, and family carers on ethical, cultural, spiritual, and legal issues, as well as legislative process related to MAiD any changes to the law in societies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.016 | 0.033 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".