title: Physician-assisted death: A Canada-wide survey of ALS health care providers.
abstract: OBJECTIVE
  To survey amyotrophic lateral sclerosis (ALS) health care providers to determine attitudes regarding physician-assisted death (PAD) after the Supreme Court of Canada (SCC) invalidated the Criminal Code provisions that prohibit PAD in February 2015.
  
  
  METHODS
  We conducted a Canada-wide survey of physicians and allied health professionals (AHP) involved in the care of patients with ALS on their opinions regarding (1) the SCC ruling, (2) their willingness to participate in PAD, and (3) the PAD implementation process for patients with ALS.
  
  
  RESULTS
  We received 231 responses from ALS health care providers representing all 15 academic ALS centers in Canada, with an overall response rate for invited participants of 74%. The majority of physicians and AHP agreed with the SCC ruling and believed that patients with moderate and severe stage ALS should have access to PAD; however, most physicians would not provide a lethal prescription or injection to an eligible patient. They preferred the patient obtain a second opinion to confirm eligibility, have a psychiatric assessment, and then be referred to a third party to administer PAD. The majority of respondents felt unprepared for the initiation of this program and favored the development of PAD training modules and guidelines.
  
  
  CONCLUSIONS
  ALS health care providers support the SCC decision and the majority believe PAD should be available to patients with moderate to severe ALS with physical or emotional suffering. However, few clinicians are willing to directly provide PAD and additional training and guidelines are required before implementation in Canada.
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Agessandro
authors.initials: A
authors.lastname: Abrahao
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: James
authors.initials: J
authors.lastname: Downar
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Hanika
authors.initials: H
authors.lastname: Pinto
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dupré
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Aaron
authors.initials: A
authors.lastname: Izenberg
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: William
authors.initials: W
authors.lastname: Kingston
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Korngut
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Colleen
authors.initials: C
authors.lastname: O'Connell
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Nicolae
authors.initials: N
authors.lastname: Petrescu
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Christen
authors.initials: C
authors.lastname: Shoesmith
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Anu
authors.initials: A
authors.lastname: Tandon
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Ana Beatriz
authors.initials: AB
authors.lastname: Vargas-Santos
authors.affiliation: From Sunnybrook Health Sciences Centre (A.A., H.P., A.I., W.K., N.P., A.T., L.Z.), University of Toronto, Canada; Universidade Federal de São Paulo (A.A.), Brazil; Critical Care and Palliative Care (J.D.), University Health Network, Toronto; Clinic of Neuromuscular & Neurogenetic Diseases (N.D.), CHU de Québec, Faculty of Medicine, Laval University; Department of Clinical Neurosciences (L.K.), Hotchkiss Brain Institute, University of Calgary; Dalhousie University Faculty of Medicine (C.O.), Stan Cassidy Centre for Rehabilitation; Department of Clinical Neurological Sciences (C.S.), Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; and Division of Rheumatology (A.B.V.-S.), Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Brazil. lorne.zinman@sunnybrook.ca.
authors.forename: Lorne
authors.initials: L
authors.lastname: Zinman
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000690:Amyotrophic Lateral Sclerosis / Q000523:psychology; D001291:Attitude of Health Personnel; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D012067:Religion; D017236:Suicide, Assisted / Q000523:psychology