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Sedgwick M, Brassolotto J, Manduca-Barone A. Rural healthcare professionals' participation in Medical Assistance in Dying (MAiD): beyond a binary decision. BMC Palliat Care 2024; 23:107. [PMID: 38664675 PMCID: PMC11044390 DOI: 10.1186/s12904-024-01440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Medical Assistance in Dying (MAiD) was legalized in Canada in 2016 and amended in 2021. At the time that this study was conducted, the federal government was considering expanding the eligibility criteria to include patients whose death was not reasonably foreseeable. The purpose of this study was to better understand rural healthcare professionals' experiences with assisted dying set against the backdrop of legislative expansion. METHODS A qualitative exploratory study was undertaken with general rural practice physicians, nurse practitioners, registered nurses, ethicists, patients, and patient families in rural Southern Alberta, Canada. For this paper, data from 18 audio-recorded and transcribed semi-structured interviews with healthcare professionals were analyzed using thematic analysis. Categories and patterns of shared meaning that linked to an overarching theme were identified. RESULTS Between the binary positions of full support for and conscientious objection to assisted dying, rural healthcare professionals' decisions to participate in MAiD was based on their moral convictions, various contextual factors, and their participation thresholds. Factors including patient suffering; personal and professional values and beliefs; relationships with colleagues, patients and family, and community; and changing MAiD policy and legislation created nuances that informed their decision-making. CONCLUSIONS The interplay of multiple factors and their degree of influence on healthcare professionals' decision-making create multiple decision points between full support for and participation in MAiD processes and complete opposition and/or abstention. Moreover, our findings suggest evolving policy and legislation have the potential to increase rural healthcare professionals' uncertainty and level of discomfort in providing services. We propose that the binary language typically used in the MAiD discourse be reframed to reflect that decision-making processes and actions are often fluid and situational.
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Affiliation(s)
- Monique Sedgwick
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.
| | - Julia Brassolotto
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
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Navarrete J, Gray M, King MA, Mey A, Woods P, Schindel TJ. Medical assistance in dying: A reflection tool for pharmacists. Can Pharm J (Ott) 2024; 157:53-57. [PMID: 38463175 PMCID: PMC10924575 DOI: 10.1177/17151635241228215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/06/2023] [Indexed: 03/12/2024]
Affiliation(s)
- Javiera Navarrete
- College of Health Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, University
of Alberta, Edmonton
- School of Public Health, University of Alberta, Edmonton
| | - Margaret Gray
- Edmonton and North Zones, Pharmacy Services, University of Alberta Hospital, Edmonton, Alberta
| | - Michelle A. King
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Amary Mey
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
- Griffith Institute for the Development of Education and Scholarship (Health IDEAS), Griffith University, Gold Coast, Australia
| | - Phillip Woods
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Theresa J. Schindel
- College of Health Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, University
of Alberta, Edmonton
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Bravo G, Delli-Colli N, Dumont I, Bouthillier ME, Rochette M, Trottier L. Characterizing Canadian Social Workers Willing to Be Involved in Medical Assistance in Dying for Persons Lacking Decisional Capacity. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:19-34. [PMID: 37366348 DOI: 10.1080/01634372.2023.2229397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
Medical assistance in dying (MAID) is available in Canada for competent persons meeting the legal requirements. Extending access to persons lacking decisional capacity is being considered. Social workers may be called upon to accompany these persons through the MAID process. As part of a larger survey, we asked social workers from Quebec whether they would be willing to be involved should advance requests for MAID be legalized. Of the 367 respondents, 291 replied that they would. Using multivariable logistic regression, we identified characteristics that distinguish them from the other social workers surveyed: importance of religious or spiritual beliefs, being born in Canada, having received assisted-death requests from families, professional experiences with MAID, and dreading the prospect of participating in MAID for persons lacking decisional capacity. These findings underline the need for educational interventions that would increase social workers' confidence in providing high-quality care to clients who opt for MAID.
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Affiliation(s)
- Gina Bravo
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nathalie Delli-Colli
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Dumont
- School of Social Work, Université du Québec à Montréal, Montréal, Canada
| | - Marie-Eve Bouthillier
- Office of Clinical Ethics, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Marianne Rochette
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Montréal, Canada
| | - Lise Trottier
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
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Bravo G, Delli Colli N, Dumont I, Bouthillier ME, Rochette M, Trottier L. Social workers' experiences with medical assistance in dying: Survey findings from Quebec, Canada. SOCIAL WORK IN HEALTH CARE 2023; 62:193-205. [PMID: 37183409 DOI: 10.1080/00981389.2023.2210624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
As part of a larger survey, we asked social workers whether they had been involved in medical assistance in dying (MAID) so far. Of the 367 survey participants, 141 reported that they had. These were invited to describe their roles, needs, and sense of competence, focusing on their last MAID experience. Roles were diversified, beginning before and extending beyond the provision of MAID. Nearly 60% needed training on MAID. Perceived competence was lower among those lacking training. Findings point to educational needs that must be addressed to ensure the quality of end-of-life care and the well-being of social workers who engage in MAID.
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Affiliation(s)
- Gina Bravo
- CIUSSS de l'Estrie - CHUS, Research Centre on Aging, Sherbrooke, Canada
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nathalie Delli Colli
- CIUSSS de l'Estrie - CHUS, Research Centre on Aging, Sherbrooke, Canada
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Dumont
- School of Social Work, Université du Québec à Montréal, Montréal, Canada
| | - Marie-Eve Bouthillier
- Office of Clinical Ethics, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Marianne Rochette
- CIUSSS de l'Estrie - CHUS, Research Centre on Aging, Sherbrooke, Canada
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Canada
| | - Lise Trottier
- CIUSSS de l'Estrie - CHUS, Research Centre on Aging, Sherbrooke, Canada
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Selby D, Wortzman R, Bean S, Mills A. Perception of roles across the interprofessional team for delivery of medical assistance in dying. J Interprof Care 2023; 37:39-46. [PMID: 34915784 DOI: 10.1080/13561820.2021.1997947] [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: 01/10/2023]
Abstract
In 2016, Canada joined many jurisdictions worldwide in legalizing Medical Assistance in Dying (MAiD). Given the paucity of qualitative research regarding the involvement of interprofessional health care providers (HCPs) in MAiD, the goal of this study was to better understand how HCPs viewed their role(s). Semi-structured interviews were conducted with 3 pharmacists, 10 nurses, and 8 social workers at an academic hospital in Toronto. Thematic analysis generated six broad themes: 1) Practical/Technical Component, 2) Education, 3) Support, 4) "Part of the Job," 5) "All of the Job," and 6) Lack of Published Information. While nurses and social workers espoused many commonalities, nursing roles were more "in the moment," whereas social workers viewed their roles as beginning earlier and extending after provision of MAiD. There was a spectrum of how participants perceived their role: pharmacists minimized the task of dispensing medications as an insignificant experience, nurses viewed involvement as consistent with their other professional duties (specifically non-MAiD deaths), and social workers described MAiD as a unique opportunity to employ the full gamut of their skills. The study highlights the importance of supporting HCPs through education and information at both regulatory and research levels, recognizing the key roles they play in MAiD.
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Affiliation(s)
- Debbie Selby
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Family and Community Medicine, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rachel Wortzman
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Family and Community Medicine, Toronto, Canada
| | - Sally Bean
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anneliese Mills
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anthropology, University of Toronto, Toronto, ON, Canada
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Bravo G, Delli-Colli N, Dumont I, Bouthillier ME, Rochette M, Trottier L. Social Workers' Attitudes Toward Medical Assistance in Dying for Persons With Dementia: Findings From a Survey Conducted in Quebec, Canada. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:273-292. [PMID: 35793419 DOI: 10.1080/15524256.2022.2093314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Canada has legalized medical assistance in dying (MAID) for mentally competent persons who satisfy the legal requirements. Debate is ongoing as to whether MAID should be accessible to no-longer-competent persons through an advance request. We conducted an anonymous vignette-based survey among 367 social workers from Quebec to (1) elicit their attitudes toward MAID in the context of dementia; (2) assess their underlying values and beliefs; and (3) compare their attitudes to those of nurses (n = 291) and physicians (n = 136). Acceptability of MAID among social workers ranges from 42% in the case where the person depicted in the vignette was still competent to request MAID herself, to 92% in that where she was incompetent, had requested MAID in writing before losing capacity, showed signs of severe distress, and was close to death. Acceptability tends to be higher among social workers than among nurses and physicians. Forty-one per cent of social workers dread the prospect of participating in the MAID process for a person lacking decisional capacity. Nonetheless, 83% would agree to be involved. Should MAID become accessible to persons lacking decisional capacity, social workers willing to be involved will need to be educated and trained in participating in this emotionally-charged process.
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Affiliation(s)
- Gina Bravo
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nathalie Delli-Colli
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Dumont
- School of Social Work, Université du Québec à Montréal, Montréal, Canada
| | - Marie-Eve Bouthillier
- Office of Clinical Ethics, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Marianne Rochette
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Canada
| | - Lise Trottier
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
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Schindel TJ, Woods P, Mey A, King MA, Gray M, Navarrete J. Hospital Pharmacists' Experiences with Medical Assistance in Dying: A Qualitative Study. Can J Hosp Pharm 2022; 75:294-301. [PMID: 36246437 PMCID: PMC9524557 DOI: 10.4212/cjhp.3213] [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: 04/05/2023]
Abstract
Background Pharmacists in many countries have long been involved in some aspect of assisted dying. Since 2016, when Canada enacted legislation permitting medical assistance in dying (MAiD), the number of patients seeking the procedure has increased yearly. Despite the global nature of pharmacists' involvement, little is known about how they experience MAiD practice. Objective To study how pharmacists experience the practice of caring for patients who seek MAiD. Methods This qualitative study used semistructured interviews with pharmacists who had cared for patients seeking MAiD. Interviews, conducted between June 2019 and October 2020, were audio-recorded and transcribed verbatim. Data were examined using a modified framework analysis approach. Data were coded and sorted using Quirkos and Microsoft Excel software. Themes were defined through an iterative process involving constant comparison. Results Nineteen hospital pharmacists representing a range of practice settings in Alberta participated in the study. The experience of caring for patients seeking assistance in dying brought to light 3 themes: finding a place in the process, serving in a caring role, and bearing emotional burdens. Pharmacists' experiences were personal, relational, emotional, and dynamic. Conclusions Each of the pharmacists experienced MAiD practice in a unique way. Although their roles in MAiD were primarily medication-focused, their experiences highlighted the centrality of patient choices, autonomy, and needs. The results of this study will inform pharmacists (including those not yet engaged in MAiD practice) about the role, and will also be valuable for pharmacy organizations and educators seeking to support pharmacists and the profession, as well as policy-makers seeking to expand pharmacists' roles in MAiD.
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Affiliation(s)
- Theresa J Schindel
- , BSP, MCE, PhD, ACPR, FCSHP, is with the Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Edmonton, Alberta, and is appointed to the School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Phillip Woods
- , BPharm, PhD, is with the School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia, and is appointed to the Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Edmonton, Alberta
| | - Amary Mey
- , BPharm (Hons), PhD, is with the Griffith Institute for the Development of Education and Scholarship (Health IDEAS) and the School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Michelle A King
- , BPharm, PhD (Medicine), is with the School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Margaret Gray
- , BSP, FCSHP, is with Pharmacy Services, Alberta Health Services, Edmonton, Alberta
| | - Javiera Navarrete
- , BScPharm, MScPharm, is with the Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Edmonton, Alberta
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