Table 3 Perceived factors that shaped health leaders’ attitudes towards the introduction of MAiD

Personal illness experiences

Participants described personal experiences outside of their professional work, with family, friends, and neighbours related to the end of life. These experiences led them to further reflect on the value of MAiD.

“I actually went through treatment for breast cancer […] and at the time I remember thinking I wish MAiD was available because if this got worse, I would want it to be able to access it. So, when the legislation passed, there was a bit of personal relief to know that I had that option available to me personally (P24).”

“I had one grandparent who died suddenly in her sleep, so there was no goodbye. There was no chance to have any sort of ending with loved ones […] I think about how with MAiD as an option, people would have that opportunity. Now here we are a few years in and seeing just how amazing those final moments and those goodbyes happen (P21).”

“I had a neighbour who had brain cancer and died […]. He was a proponent of MAiD, [but] it was before MAiD [was available]. I remember his wife talking about how, like, if [MAiD] had been an option in his last weeks of life, he would have taken it because it would have allowed him to die with greater dignity. […] As soon as I heard his story, I was like, okay, I think this is an important component of care that should be offered to patients (P11).”

Professional experiences and identity

Participants emphasized how paid work or career experiences with end-of-life care and MAiD services shaped their attitudes towards MAiD.

“It was really my experiences as a nurse that put me on the path towards ethics […] [and] Just let this person be, whatever time they have left, just let them spend it with the family [rather than them] spending with us poking and prodding, and doing CPR, and hooking them up to all sorts of machines when the outcome was still [that] these [patients] were not going to get better (P25).”

“I am a really big believer that physicians, ultimately what we do is we help people. That’s what physicians do. Once in a while, we diagnose, [and] a few times we even cure them. But most of the time all we really do is help people. We comfort people. We hold their hand when we can’t help people the best we can. We’re mostly givers and helpers, and so I actually see providing MAID as an extension of that work […]. It perfectly fits in with my background in […] medicine (P9).”

Moral and religious beliefs

Participants reflected on their own personal and moral beliefs toward MAiD within their religious contexts. This included a struggle between or reconciliation of their personal and religious beliefs, or rejection of their religious beliefs.

“As a Catholic, my religion would be against it. I also realize that professionally and I think morally I have to recognize the suffering of others and that others have different perspectives [and] different approaches to it. And that it is not my place to impose my personal views or those of anything I represent from a personal perspective on other people especially not in my roles on the palliative care unit […or] in creating federal policy (P31).”

“I think within the religion that’s where the equation happens, [whereby] if you are deciding to go through with MAiD, I think a lot of people will look at that as you are committing suicide. I think that’s why I have been able to think about it a little bit differently, where I think that they’re two completely separate things, where even the support services and the resources out there for those who have suicidal thoughts are very different than the people who are interested to pursue MAiD (P14).”

Valence of patient autonomy and quality of life

Participants valued engaging the patients in healthcare decision-making, related to their rights to end-of-life care, dying with dignity, and having MAiD as a care option. This includes the importance of respecting patients’ desires to have a better quality of life.

“We have the right to make decisions about everything in life except our death, you know? So why should we not be able to decide when and how we die? You can decide everything else […] you can refuse chemo and you can decide not to go to ICU, and you can decide not to have CPR, but you have to have this prolonged lingering death (P10).”

“I think quality of life is […] more important than quantity of life. I think if we can assess the mental capabilities of a person to make sure that they [have] the ability to make a decision, then I think that that should be respected. And that [the patients] are able to then choose the end in like a manner that’s dignified for them (P14).”

“As a social worker, there are some ethically really challenging situations that we face when we’re working with patients who ask for MAiD, but at the end of it, it is their choice, and it is their decision. I think if we can provide the best care to them throughout their whole illness trajectory, and if this is how they want to die then we need to support them to do that (P15).”