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Rivest J, Rouly G, Brouillette MJ, Nguyen O, Desbeaumes Jodoin V. Improving Palliative Care and Medical Assistance in Dying Practice in Canada: How Patients-Partners Could Contribute to Continuing Medical Education. Palliat Med Rep 2023; 4:116-119. [PMID: 37095864 PMCID: PMC10122257 DOI: 10.1089/pmr.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
Medical Assistance in Dying (MAiD) is still considered an evolving practice in Canada. Practitioners are facing the challenge of staying up to date and hence need efficient continuing medical education (CME). A patient-partner has been recently invited as a keynote speaker to CME activities in Canada to share her perspectives and views about patient engagement in palliative care and MAiD practice, calling for compassion. To our knowledge, few data exist on patient-partners' contribution to CME on these topics. Based on that experience, we discuss different issues on patient engagement's contribution in such CME events and call for further research.
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Affiliation(s)
- Jacynthe Rivest
- Department of Psychiatry, Centre Hospitalier de l'Universite de Montreal (CHUM) and Centre de Recherche du CHUM (CRCHUM), Montreal, Québec, Canada
- Address correspondence to: Jacynthe Rivest, MD, MA(Ed), FRCPC, Department of Psychiatry, Centre Hospitalier de l'Universite de Montreal (CHUM) and Centre de Recherche du CHUM (CRCHUM), 1051 rue Sanguinet, Montreal, Québec H2X 0C1, Canada.
| | - Ghislaine Rouly
- Centre of Excellence on Partnership with Patients and the Public, Montreal, Québec, Canada
| | - Marie-Josée Brouillette
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Department of Psychiatry, McGill University Health Centre, Montreal, Québec, Canada
| | - Olivia Nguyen
- Palliative Care Division, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Québec, Canada
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Véronique Desbeaumes Jodoin
- Department of Psychiatry, Centre Hospitalier de l'Universite de Montreal (CHUM) and Centre de Recherche du CHUM (CRCHUM), Montreal, Québec, Canada
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Cassidy H, Sims A, Every-Palmer S. Psychiatrists' views on the New Zealand End of Life Choice Act. Australas Psychiatry 2022; 30:254-261. [PMID: 35245990 DOI: 10.1177/10398562221077889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This cross-sectional survey aimed to establish the views and intentions of New Zealand (NZ) psychiatrists regarding their role as competence assessors in the NZ End of Life Choice Act ('Act'). Some questions were replicated from a pre-existing Ministry of Health workforce survey regarding the Act, for comparative analysis between psychiatrists and other health professionals. METHODS The survey was disseminated via email to all NZ psychiatrists registered with the Royal Australia and NZ College of Psychiatry and promoted by snowballing methods to reach non-members. RESULTS There were similar (moderate) levels of understanding of the Act, compared to other health professionals. Psychiatrists show similar levels of support for assisted dying as other health professionals (55% and 47%, respectively), however psychiatrists are significantly less likely to be willing to provide assisted dying services than other health professionals. Concerns were raised regarding the challenges faced by psychiatrists and need for more clarity around the psychiatrist's role. CONCLUSIONS Few NZ psychiatrists were willing to be involved with the Act. There was a perceived lack of information around a psychiatrist's role, responsibilities and legal protections. Further guidance is needed regarding the concept of capacity in assisted dying and the factors that challenge these assessments.
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Affiliation(s)
- Helen Cassidy
- Department of Psychological Medicine, 8494University of Otago, Wellington, New Zealand
| | - Adam Sims
- Department of Psychological Medicine, 8494University of Otago, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, 8494University of Otago, Wellington, New Zealand
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Briggs S, Lindner R, Goldblatt MJ, Kapusta N, Teising M. Psychoanalytic understanding of the request for assisted suicide. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2022; 103:71-88. [PMID: 35168484 DOI: 10.1080/00207578.2021.1999773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The legalisation of assisted dying, including euthanasia and physician assisted suicide, is increasing in countries across the world and constitutes a key contemporary debate, reflecting social changes, in which two views of suicide conflict; that (1) rational reasons justify assisted suicide, providing dignity and control of terminal illness and (2) suicidal wishes are driven by unconscious and disturbing internal conflicts. In this paper we explore the unconscious motives and meanings of requests for assisted suicide. Although there is a paucity of psychoanalytic literature on the subject, and an absence of practice examples, we make two links, firstly, with the literature of palliative and end of life care, and, secondly, with psychoanalytic understanding of suicide, in order to develop the view that unconscious factors are crucial to understanding requests for assisted suicide. We provide an illustrative case example of psychodynamic psychotherapy with a 94-year-old woman, drawing out theoretical and practice implications. We show that unconscious factors and motives lie behind apparently rational requests for assisted suicide, and attention to these through psychoanalytically informed treatment can bring about therapeutic change.
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Affiliation(s)
- Stephen Briggs
- Clinical Education, Development and Research (CEDAR), Department of Psychology, University of Exeter, Exeter, UK
| | - Reinhard Lindner
- Faculty of Social Sciences, University of Kassel, Kassel, Germany
| | | | - Nestor Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Schultz IZ, Stewart AM, Sepehry AA. Determination of Competency for High-Gravity Life-Death Decision-Making. PSYCHOLOGICAL INJURY & LAW 2019. [DOI: 10.1007/s12207-019-09361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fujioka JK, Mirza RM, McDonald PL, Klinger CA. Implementation of Medical Assistance in Dying: A Scoping Review of Health Care Providers' Perspectives. J Pain Symptom Manage 2018; 55:1564-1576.e9. [PMID: 29477968 DOI: 10.1016/j.jpainsymman.2018.02.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/16/2022]
Abstract
RESEARCH AIMS With the growing interest in Medical Assistance in Dying (MAiD), understanding health care professionals' roles and experiences in handling requests is necessary to evaluate the quality, consistency, and efficacy of current practices. This scoping review sought to map the existing literature on health care providers' perspectives of their involvement in MAiD. METHODS A scoping review was conducted to address the following: 1) What are the roles of diverse health care professionals in the provision of MAiD? and 2) What professional challenges arise when confronted with MAiD requests? A literature search in electronic databases and gray literature sources was performed. Articles were screened, and a thematic content analysis synthesized key findings. RESULTS After evaluating 1715 citations and 148 full-text papers, 33 articles were included. Perspectives of nurses (n = 10), physicians (n = 7), mental health providers (n = 7), pharmacists (n = 4), social workers (n = 3), and medical examiners (n = 1) were explored. Professional roles included consulting/supporting patients and/or other staff members with requests, assessing eligibility, administering/dispensing the lethal drugs, providing aftercare to bereaved relatives, and regulatory oversight. Challenges included lack of clear guidelines/protocols, role ambiguity, evaluating capacity/consent, conscientious objection, and lack of interprofessional collaboration. CONCLUSION Evidence from various jurisdictions highlighted a need for clear guidelines and protocols that define each profession's role, scope of practice, and legal boundaries for MAiD. Comprehensive models of care that incorporate multidisciplinary teams alongside improved clinician education may be effective to support MAiD implementation. Little is known about health care providers' perspectives in handling requests, especially outside physician practice and nursing.
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Affiliation(s)
- Jamie K Fujioka
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada.
| | - Raza M Mirza
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada
| | - P Lynn McDonald
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada
| | - Christopher A Klinger
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada
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Macleod ADS. Was Sigmund Freud's death hastened? Intern Med J 2017; 47:966-969. [DOI: 10.1111/imj.13504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/27/2016] [Accepted: 12/27/2016] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW Medical Assistance in Dying (MAID) is now legal in many jurisdictions for competent adults who have intolerable suffering and/or have a terminal illness with a short prognosis. Mental illness can be a source of suffering for these individuals, but it can also affect their capacity to make medical decisions. Clinicians, and psychiatrists in particular, need to understand how to assess patients with mental illness who are requesting MAID, to determine the impact of their mental illness on the MAID request. RECENT FINDINGS Psychiatric disorders can be a primary indication for MAID in parts of Europe, and recent published case series from Belgium and the Netherlands have generated strong responses from the psychiatric community. Patients dying of terminal illnesses who request MAID often have symptoms of depression or anxiety, but psychiatrists are rarely involved in their care. Psychiatrists may be helpful in assessing decision capacity, but documentation of capacity assessment could be improved. There is a broad need to develop educational resources to train current and future physicians about MAID. SUMMARY MAID represents an ethical and clinical challenge for psychiatrists in a variety of ways. As more jurisdictions legalize MAID, the psychiatric community will need to be prepared to meet these challenges with robust clinical standards and educational programs to ensure the highest standards of care for patients.
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Brokering trust: estimating the cost of physician-assisted death. Can J Anaesth 2016; 63:252-3. [DOI: 10.1007/s12630-015-0574-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/16/2015] [Indexed: 11/30/2022] Open
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Pols H, Oak S. Physician-assisted dying and psychiatry: recent developments in The Netherlands. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:506-514. [PMID: 23816378 DOI: 10.1016/j.ijlp.2013.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Netherlands was one of the first countries in the world to establish a legal framework for physician-assisted dying (PAD). In this article, we provide an overview of the public, political, legal, and medical debates on physician-assisted dying in The Netherlands, focusing on the role of psychiatry and mental illness. The number of individuals with chronic mental illness requesting PAD has been relatively small (although the number can be expected to increase because of the activities of various civic organizations advocating the right to die) and Dutch psychiatrists have been extremely reluctant to respond to such requests. Nevertheless, mental conditions have been central to the public debate on PAD by helping to define the nature and limits of current legislation and professional practice. Although a few Dutch psychiatrists have campaigned to increase the involvement of psychiatrists and many support PAD in principle, the majority has been hesitant to engage in PAD despite increasing public pressure.
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Affiliation(s)
- Hans Pols
- Unit for History and Philosophy of Science, Carslaw F07, University of Sydney, NSW 2006, Australia.
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Galletly C. Debates, disputes, discussions and deliberations. Aust N Z J Psychiatry 2012; 46:917-8. [PMID: 23028189 DOI: 10.1177/0004867412461535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia.
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Affiliation(s)
- Christopher J Ryan
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia.
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Macleod RD, Wilson DM, Malpas P. Assisted or hastened death: the healthcare practitioner's dilemma. Glob J Health Sci 2012; 4:87-98. [PMID: 23121745 PMCID: PMC4776959 DOI: 10.5539/gjhs.v4n6p87] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 08/14/2012] [Indexed: 11/25/2022] Open
Abstract
Assisting or hastening death is a dilemma with many ethical as well as practical issues facing healthcare practitioners in most countries worldwide now. Various arguments for and against assisted dying have been made over time but the call from the public for the legalisation of euthanasia and assisted suicide has never been stronger. While some studies have documented the reluctance of medical and other healthcare professionals to be involved in the practice of assisted dying or euthanasia, there is still much open debate in the public domain. Those who have the most experience of palliative care are strongest in their opposition to hastening death. This paper explores salient practical and ethical considerations for healthcare practitioners associated with assisting death, including a focus on examining the concepts of autonomy for patients and healthcare practitioners. The role of the healthcare practitioner has clearly and undoubtedly changed over time with advances in healthcare practices but the duty of care has not changed. The dilemmas for healthcare practitioners thus who have competent patients requesting hastened death extends far beyond acting within a country’s laws as they go to the very heart of the relationship between the practitioner and patient.
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