In the initial three years following the legalization of Medical Assistance in Dying (2016) William Osler Health System (Osler) had created relevant policies, pathways, order sets, and had established and furnished a designated MAiD room. Despite these efforts, Osler had no internal MAiD providers and many conscientious objectors, which meant we relied entirely on one external provider. The organization struggled to provide basic information about MAiD to patients and respond to patient requests and referrals in a sustainable and systematic way. Osler was still hearing from patients that they were not able to access MAiD services. This situation created serious equity and sustainability issues and was not person centred.
In response, the Assisted Dying Resource & Assessment Team (ADRAT) was created. We propose this patient informed, physician led approach supports a safe and efficient Leading Practice for delivery of MAiD. ADRAT consists of >20 physicians and nurse practitioners who have been trained through a peer mentorship model to do MAiD assessments and provisions for Osler patients. Two key drivers for the development of ADRAT included (1) patient/families who shared stories about challenges associated with access and (2) an appointed physician lead. ADRAT began with the goals of increasing access and addressing equity issues, being patient informed, and supporting physician and NP capacity and skill building for provisions & assessment. ADRAT collects data that can show these goals have and continue to be achieved.

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