Assessors’ decision-making regarding applicant eligibility for Track 2 medical assistance in dying in Canada: a qualitative study

BACKGROUND: In 2021, under Bill C-7, Canada revised its medical assistance in dying (MAiD) legislation to extend eligibility to individuals without a reasonably foreseeable natural death (Track 2). We sought to describe the clinical decision-making of assessors when determining applicant eligibility for MAiD Track 2. METHODS: We conducted semistructured virtual interviews of assessors practising in 4 Canadian provinces between April 2024 and March 2025. Interviews were audio-recorded, transcribed, checked for accuracy, and thematically analyzed, following the principles of interpretive description. RESULTS: Twenty-three assessors participated, including 14 physicians and 9 nurse practitioners. Participants described a comprehensive relational approach to assessment that included common understandings of what constituted capacity, voluntariness, and the purpose of the 90-day assessment period. We observed variability in how participants operationalized "a non-reasonably foreseeable natural death" - the defining criterion for Track 2 - and determined what constituted reasonable means to alleviate suffering of applicants. Assessors expressed concern about the risks associated with finding an applicant ineligible. Practitioners noted the value of peer or team-based consultation to robust decision-making processes, navigation of complex cases, and their own well-being as they navigated legally and morally complex assessments. INTERPRETATION: Findings suggest that Track 2 assessments are viewed as legally and morally complex and are conducted within a framework of relational autonomy that reflects MAiD jurisprudence. Best practice supports the implementation of a case consultation model in regions where this is not current practice.