Conduit or conductor? Physician providers’ descriptions of their role as MAiD assessors in the first years after legalisation in Canada
Bibliographic record
Abstract
PURPOSE: This qualitative study investigates how Canadian physician-providers of medical assistance in dying (MAiD) perceived their role in making judgements when assessing patients for MAiD. METHODOLOGY: 21 Canadian physician MAiD providers were interviewed about their experience as early-adopting providers. The data were analysed using a phenomenological approach to identify themes and thematic groupings regarding providers' perceptions of roles and reasoning while undertaking MAiD assessments. FINDINGS: Participants universally endorsed a focus on providing patient-centred care. They varied in how they approached decision-making for patients applying for MAiD and how they viewed their role within the doctor-patient relationship. Group 1 participants placed moral decision-making with the patient, indicating a limited role for the provider. They focused on guiding the competent patient through the statutory MAiD requirements to actualise patient autonomy. Some described their role as 'conduits'. Group 2 had intermediate views. Group 3 participants described their professional judgement as important to the moral calculus of approval for MAiD. Their role was like that of a train conductor in that they positioned themselves as responsible for wider patient interests as part of maintaining their own professional and moral integrity during MAiD. CONCLUSIONS/SIGNIFICANCE: Participants' narratives indicate that decisions about MAiD assessments are strongly influenced by provider reasoning regarding the physician's role in MAiD assessment and provision. This divergence reflects unclear role expectations in the context of rapidly changing cultural expectations regarding MAiD.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".