1
|
Jeanneret R, Close E, Willmott L, Downie J, White BP. Patients' and Caregivers' Suggestions for Improving Assisted Dying Regulation: A Qualitative Study in Australia and Canada. Health Expect 2024; 27:e14107. [PMID: 38896003 PMCID: PMC11187863 DOI: 10.1111/hex.14107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/29/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Assisted dying (AD) has been legalised in a small but growing number of jurisdictions globally, including Canada and Australia. Early research in both countries demonstrates that, in response to access barriers, patients and caregivers take action to influence their individual experience of AD, as well as AD systems more widely. This study analyses how patients and caregivers suggest other decision-makers in AD systems should address identified issues. METHODS We conducted semistructured, qualitative interviews with patients and caregivers seeking AD in Victoria (Australia) and three Canadian provinces (British Columbia, Ontario and Nova Scotia). Data were analysed using reflexive thematic analysis and codebook template analysis. RESULTS Sixty interviews were conducted with 67 participants (65 caregivers, 2 patients). In Victoria, this involved 28 interviews with 33 participants (32 caregivers, 1 patient) about 28 patient experiences. In Canada, this involved 32 interviews with 34 participants (33 caregivers, 1 patient) about 33 patient experiences. We generated six themes, corresponding to six overarching suggestions by patients and caregivers to address identified system issues: (1) improved content and dissemination of information about AD; (2) proactively develop policies and procedures about AD provision; (3) address institutional objection via top-down action; (4) proactively develop grief resources and peer support mechanisms; (5) amend laws to address legal barriers; and (6) engage with and act on patient and caregiver feedback about experiences. CONCLUSION AD systems should monitor and respond to suggestions from patients and caregivers with firsthand experience of AD systems, who are uniquely placed to identify issues and suggestions for improvement. To date, Canada has responded comparatively well to address identified issues, whereas the Victorian government has signalled there are no plans to amend laws to address identified access barriers. This may result in patients and caregivers continuing to take on the burdens of acting to address identified issues. PATIENT OR PUBLIC CONTRIBUTION Patients and caregivers are central to this research. We interviewed patients and caregivers about their experiences of AD, and the article focuses on their suggestions for addressing identified barriers within AD systems. Patient interest groups in Australia and Canada also supported our recruitment process.
Collapse
Affiliation(s)
- Ruthie Jeanneret
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Eliana Close
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Jocelyn Downie
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
- Faculties of Law and Medicine, Health Law InstituteDalhousie UniversityHalifaxNova ScotiaCanada
| | - Ben P. White
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| |
Collapse
|
2
|
Stergiopoulos V, Bastidas-Bilbao H, Gupta M, Buchman DZ, Stewart DE, Rajji T, Simpson AIF, van Kesteren MR, Cappe V, Castle D, Shields R, Hawke LD. Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives. BMC Psychiatry 2024; 24:120. [PMID: 38355467 PMCID: PMC10865571 DOI: 10.1186/s12888-024-05541-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Persons with mental illness as their sole underlying medical condition are eligible to access medical assistance in dying (MAiD) in a small number of countries, including Belgium, the Netherlands, Luxemburg and Switzerland. In Canada, it is anticipated that people experiencing mental illness as their sole underlying medical condition (MI-SUMC) will be eligible to request MAiD as of March 17th 2024. To date, few studies have addressed patient and family perspectives on MAiD MI-SUMC care processes. This study aimed to address this gap and qualitatively explore the perspectives of persons with lived experience of mental illness and family members on care considerations during MI-SUMC implementation. METHODS Thirty adults with lived experience of mental illness and 25 adult family members residing in Ontario participated in this study. To facilitate participant engagement, the semi-structured interview used a persona-scenario exercise to discuss perspectives on MAiD MI-SUMC acceptability and care considerations. Framework analysis was used to inductively analyze data using NVivo 12 Pro. Steps, processes, or other care considerations suggested by the participants were charted in a framework matrix after familiarization with the narratives. Key themes were further identified. A lived-experience advisory group participated in every aspect of this study. RESULTS Six themes were developed from the patient and family narratives: (1) Raising MAiD MI-SUMC awareness; (2) Sensitive Introduction of MAiD MI-SUMC in goals of care discussions; (3) Asking for MAiD MI-SUMC: a person-focused response; (4) A comprehensive circle of MAiD MI-SUMC care; (5) A holistic, person-centered assessment process; and (6) Need for support in the aftermath of the decision. These themes highlighted a congruence of views between patient and family members and described key desired process ingredients, including a person-centred non-judgmental stance by care providers, inter-professional holistic care, shared decision making, and the primacy of patient autonomy in healthcare decision making. CONCLUSIONS Family and patient perspectives on the implementation of MAiD MI-SUMC offer important considerations for service planning that could complement existing and emerging professional practice standards. These stakeholders' perspectives will continue to be essential in MAiD MI-SUMC implementation efforts, to better address the needs of diverse communities and inform improvement efforts.
Collapse
Affiliation(s)
- Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- University of Toronto, Toronto, Ontario, Canada.
| | | | - Mona Gupta
- Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Donna E Stewart
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Tarek Rajji
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Alexander I F Simpson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Vivien Cappe
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - David Castle
- University of Tasmania, Hobart, Tasmania, Australia
- Statewide Mental Health Service, Hobart, Tasmania, Australia
| | - Roslyn Shields
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Silva e Silva V, Silva AR, Rochon A, Lotherington K, Hornby L, Wind T, Bollen J, Wilson LC, Sarti AJ, Dhanani S. Organ donation following medical assistance in dying, Part II: a scoping review of existing processes and procedures. JBI Evid Synth 2024; 22:195-233. [PMID: 37489247 PMCID: PMC10871582 DOI: 10.11124/jbies-22-00140] [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] [Indexed: 07/26/2023]
Abstract
OBJECTIVE The objective of this review was to collate and summarize the current literature on what is known about organ donation following medical assistance in dying (MAiD). For this second part of a 2-part scoping review, the focus is on the existing procedures and processes for organ donation following MAiD. INTRODUCTION Organ donation following MAiD is a novel and contentious issue worldwide. To give direction for future research and initiatives, a comprehensive understanding of the available evidence of existing procedures and processes for organ donation following MAiD is needed. INCLUSION CRITERIA For this review, the population of interest included all individuals who underwent organ donation following MAiD; the concept was defined as procedures and processes involved in organ donation after MAiD; and the context was reports of organ donation following MAiD at home or in any health care setting worldwide. We considered quantitative and qualitative studies, text and opinion papers, gray literature, and unpublished material provided by stakeholders. METHODS This scoping review was conducted in line with JBI methodology. Published studies were retrieved from MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), Web of Science Core Collection, and Academic Search Complete (EBSCOhost). Gray and unpublished literature included reports from websites and organ donation organizations in Canada, Belgium, and The Netherlands. Two independent reviewers screened all reports (both title and abstract, and full text) against the predetermined inclusion criteria, extracted data, and completed a content analysis. Any disagreements between the 2 reviewers were resolved through discussion or with another reviewer. RESULTS We included 121 documents across parts I and II, and we report on 107 documents in this second part. The majority of the 107 documents were discussion papers, published in English, and in Canada from 2019 to 2021. In the content analysis, we identified 5 major categories regarding existing procedures and processes of organ donation following MAiD: i) clinical pathways for organ donation following MAiD; ii) organ donation following MAiD and the donor; iii) clinical practice tools for organ donation following MAiD; iv) education and support for health care providers involved in organ donation following MAiD; and v) health care providers' roles and perceptions during organ donation following MAiD. CONCLUSIONS Findings from this review can be used to provide support and guidance for improvements in procedures and processes, as well as a rich resource for countries currently planning to establish programs for organ donation after MAiD.
Collapse
Affiliation(s)
| | - Amina Regina Silva
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Andrea Rochon
- School of Nursing, St. Lawrence College, Kingston, ON, Canada
| | | | | | - Tineke Wind
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc Medical Center Nijmegen, Nijmegen, The Netherlands
| | | | - Aimee J. Sarti
- Faculty of Medicine, Department of Critical Care, University of Ottawa, Ottawa, ON, Canada
| | - Sonny Dhanani
- Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
4
|
Close E, Downie J, White BP. Practitioners' experiences with 2021 amendments to Canada's medical assistance in dying law: a qualitative analysis. Palliat Care Soc Pract 2023; 17:26323524231218282. [PMID: 38148894 PMCID: PMC10750527 DOI: 10.1177/26323524231218282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/16/2023] [Indexed: 12/28/2023] Open
Abstract
Background In 2016, Canada joined the growing number of jurisdictions to legalize medical assistance in dying (MAiD), when the Supreme Court of Canada's decision in Carter v Canada took effect and the Canadian Parliament passed Bill C-14. Five years later, Bill C-7 introduced several significant amendments. These included removing the 'reasonably foreseeable natural death' requirement (an aspect that was widely debated) and introducing the final consent waiver. Since Bill C-7 is so new, very little research has investigated its operation in practice. Objectives This study investigates the experiences of MAiD assessors and providers regarding the Bill C-7 amendments. It explores implications for understanding and improving regulatory reform and implementation. Design Qualitative thematic analysis of semi-structured interviews. Methods In all, 32 MAiD assessors and providers (25 physicians and 7 nurse practitioners) from British Columbia (n = 10), Ontario (n = 15) and Nova Scotia (n = 7) were interviewed. Results The analysis resulted in five themes: (1) removing barriers to MAiD access; (2) navigating regulatory and systems recalibration; (3) recognizing workload burdens; (4) determining individual ethical boundaries of practice and (5) grappling with ethical tensions arising from broader health system challenges. Conclusion This is one of the first studies to investigate physicians' and nurse practitioners' experiences of the impact of Bill C-7 after the legislation was passed. Bill C-7 addressed key problems under Bill C-14, including the two witnesses requirement and the 10-day waiting period. However, it also introduced new complexities as practitioners decided how to approach cases involving a non-reasonably foreseeable natural death (and contemplated the advent of MAiD for persons with a mental disorder as a sole underlying condition). This study highlights the importance of involving practitioners in advance of legislative changes. It also emphasizes how the regulation of MAiD involves a range of organizations, which requires strong leadership and coordination from the government.
Collapse
Affiliation(s)
- Eliana Close
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001, Australia
| | - Jocelyn Downie
- Health Law Institute, Faculty of Law and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ben P. White
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
5
|
White BP, Jeanneret R, Willmott L. Barriers to connecting with the voluntary assisted dying system in Victoria, Australia: A qualitative mixed method study. Health Expect 2023; 26:2695-2708. [PMID: 37694553 PMCID: PMC10632633 DOI: 10.1111/hex.13867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Voluntary assisted dying (VAD) is increasingly being legalised internationally. In Australia, all six states have now passed such laws, with Victoria being the first in 2019. However, early research in Victoria on the patient experience of seeking VAD shows that finding a connection to the VAD system is challenging. This study analyses the causes of this 'point of access' barrier. METHODS We conducted semi-structured qualitative interviews with family caregivers and a person seeking VAD, with participants recruited via social media and patient interest groups. Data were thematically analysed. We also undertook documentary analysis (content and thematic) of publicly available reports from the oversight body, the Voluntary Assisted Dying Review Board. RESULTS We interviewed 32 family caregivers and one patient across 28 interviews and analysed six Board reports. Finding a point of access to the VAD system was reported as challenging in both interviews and reports. Four specific barriers to connecting with the system were identified: (1) not knowing VAD exists as a legal option; (2) not recognising a person is potentially eligible for VAD; (3) not knowing next steps or not being able to achieve them in practice; and (4) challenges with patients being required to raise the topic of VAD because doctors are legally prohibited from doing so. CONCLUSION Legal, policy and practice changes are needed to facilitate patients being able to find a connection to the VAD system. The legal prohibition on doctors raising the topic of VAD should be repealed, and doctors and institutions who do not wish to be involved in VAD should be required to connect patients with appropriate contacts within the system. Community awareness initiatives are needed to enhance awareness of VAD, especially given it is relatively new in Victoria. PATIENT OR PUBLIC CONTRIBUTION Families and a patient were the focus of this research and interviews with them about the experience of seeking VAD were the primary source of data analysed. This article includes their solutions to address the identified point of access barriers. Patient interest groups also supported the recruitment of participants.
Collapse
Affiliation(s)
- Ben P. White
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Ruthie Jeanneret
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| |
Collapse
|
6
|
Boven C, Dillen L, Dierickx S, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. Relatives' Experiences of Being Involved in Assisted Dying: A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1154-1164. [PMID: 37791685 PMCID: PMC10626978 DOI: 10.1177/10497323231196827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Recent literature demonstrates an interdependence between relatives and healthcare providers throughout euthanasia processes. Yet, current guidelines and literature scarcely specify the interactions between healthcare providers and bereaved relatives. The aim of this work consisted of providing an insight into bereaved relatives' experiences (1) of being involved in euthanasia processes and (2) of their interactions with healthcare providers before, during, and after the euthanasia. The research process was guided by the principles of constructivist grounded theory. Nineteen Dutch-speaking bereaved relatives of oncological patients, who received euthanasia at home or in a hospital less than 24 months ago, participated via semi-structured interviews. These interviews were conducted between May 2021 and June 2022. Due to the intensity of euthanasia processes, relatives wanted to be involved as early as possible, in order to receive time, space, and access to professionals' support whilst preparing themselves for the upcoming loss of a family member with cancer. Being at peace with the euthanasia request facilitated taking a supportive attitude, subsequently aiding in achieving a serene atmosphere. A serene atmosphere facilitated relatives' grief process because it helped them in creating and preserving good memories. Relatives appreciated support from healthcare providers, as long as overinvolvement on their part was not occurring. This study advocates for a relational approach in the context of euthanasia and provides useful complements to the existing euthanasia guidelines.
Collapse
Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Sigrid Dierickx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | | | | |
Collapse
|
7
|
Serota K, Hubert M, Joolaee S, Ho A. Palliative care providers' roles in medical assistance in dying decision-making triads with patients and families: A qualitative analysis. Palliat Support Care 2023:1-6. [PMID: 37817326 DOI: 10.1017/s1478951523001311] [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: 10/12/2023]
Abstract
OBJECTIVES Research on medical assistance in dying (MAiD) decision-making indicates that family members and close friends are often involved in making decisions with patients and their care providers. This decision-making model comprising patients, family members, and palliative care providers (PCPs) has been described as a triad. The objective of this study is to understand PCPs' experiences engaging in MAiD-related decision-making triads with patients and their families in Canada. METHODS Semi-structured qualitative interviews were analyzed using interpretive description. RESULTS We interviewed 48 specialist PCPs in Vancouver (26) and Toronto (22). Interviews were audio-recorded, professionally transcribed, and coded using a coding framework. PCPs take on 5 notable roles in their work with family members around MAiD. They provide emotional support and counseling, balance confidentiality between patients and families, provide education, coordinate support, and mediate family dynamics. SIGNIFICANCE OF RESULTS PCPs take on multiple roles in working with patients and families to make decisions about MAiD. As patients and families may require different forms of support throughout the MAiD pathway, PCPs can benefit from institutional and interprofessional resources to enhance their ability to support patients and families in decision-making and bereavement.
Collapse
Affiliation(s)
- Kristie Serota
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthieu Hubert
- Division of Palliative Care, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Soodabeh Joolaee
- Department of Evaluation and Research Services (DERS) Fraser Health, Fraiser Health Authority, Vancouver, BC, Canada
- Nursing Care Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Anita Ho
- Centre for Applied Ethics, University of British Columbia, Vancouver, BC, Canada
- Bioethics Program, University of California, San Francisco, CA, USA
| |
Collapse
|
8
|
Close E, Jeanneret R, Downie J, Willmott L, White BP. A qualitative study of experiences of institutional objection to medical assistance in dying in Canada: ongoing challenges and catalysts for change. BMC Med Ethics 2023; 24:71. [PMID: 37735387 PMCID: PMC10512474 DOI: 10.1186/s12910-023-00950-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND In June 2016, Canada legalized medical assistance in dying (MAiD). From the outset, some healthcare institutions (including faith-based and non-faith-based hospitals, hospices, and residential aged care facilities) have refused to allow aspects of MAiD onsite, resulting in patient transfers for MAiD assessments and provision. There have been media reports highlighting the negative consequences of these "institutional objections", however, very little research has examined their nature and impact. METHODS This study reports on findings from 48 semi-structured qualitative interviews conducted with MAiD assessors and providers, MAiD team members (working to coordinate care and lead MAiD programs in institutions and health authorities), and family caregivers on their experiences with institutional objection. Participants were recruited from the Canadian provinces of British Columbia, Ontario, and Nova Scotia. Data were analyzed using inductive thematic analysis. RESULTS Themes identified were: (1) basis for institutional objection (with objections commonly rooted in religious values and a particular philosophy of palliative care); (2) scope of objection (demonstrating a wide range of practices objected to); (3) lack of transparency regarding institutional position; (4) impacts on patients; (5) impacts on health practitioners; and (6) catalysts for change. Participants reported that many institutions' objections had softened over time, lessening barriers to MAiD access and adverse impacts on patients and health practitioners. Participants attributed this positive change to a range of catalysts including advocacy by health practitioners and family members, policymaking by local health authorities, education, and relationship building. Nevertheless, some institutions, particularly faith-based ones, retained strong objections to MAiD, resulting in forced transfers and negative emotional and psychological impacts on patients, family members, and health practitioners. CONCLUSIONS This paper adds to the limited evidence base about the impacts of institutional objection and can inform practical and regulatory solutions in Canada and abroad. Reform is needed to minimize the negative impacts on patients, their caregivers, and health practitioners involved in MAiD practice.
Collapse
Affiliation(s)
- Eliana Close
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4000, Australia.
| | - Ruthie Jeanneret
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4000, Australia
| | - Jocelyn Downie
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4000, Australia
- Health Law Institute, Faculties of Law and Medicine, Dalhousie University, Halifax, Canada
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4000, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4000, Australia
| |
Collapse
|
9
|
White BP, Jeanneret R, Close E, Willmott L. Access to voluntary assisted dying in Victoria: a qualitative study of family caregivers' perceptions of barriers and facilitators. Med J Aust 2023; 219:211-217. [PMID: 37308309 DOI: 10.5694/mja2.52004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/05/2023] [Accepted: 05/10/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To investigate barriers to and facilitators of access to voluntary assisted dying in Victoria under the Voluntary Assisted Dying Act 2017 (Vic). DESIGN, SETTING, PARTICIPANTS Qualitative study; semi-structured interviews with people who had applied for voluntary assisted dying or their family caregivers, recruited via social media and interested advocacy groups; interviews conducted 17 August - 26 November 2021. MAIN OUTCOME MEASURES Barriers to and facilitators of access to voluntary assisted dying. RESULTS We interviewed 33 participants about 28 people who had applied for voluntary assisted dying; all but one of the interviews were with family caregivers after their relatives' deaths, and all but three were conducted via Zoom. The major barriers to access identified by participants were finding trained and willing doctors to assess eligibility for voluntary assisted dying; the time required for the application process (especially given how ill the applicants were); the prohibition of telehealth consultations; institutional objections to voluntary assisted dying; and the prohibition of health practitioners raising voluntary assisted dying with their patients. The major facilitators mentioned were care navigators (both the Statewide service and local navigators); finding a supportive coordinating practitioner; the Statewide Pharmacy Service; and system flow once the process had been initiated (although not during the early days of voluntary assisted dying in Victoria). Access was particularly difficult for people in regional areas or with neurodegenerative conditions. CONCLUSIONS Access to voluntary assisted dying has improved in Victoria, and people generally felt supported while navigating the application process once they found a coordinating practitioner or a navigator. But this step, and other barriers, often still made patient access difficult. Adequate support for doctors, navigators and other facilitators of access is vital for the effective functioning of the overall process.
Collapse
Affiliation(s)
- Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| | - Ruthie Jeanneret
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| | - Eliana Close
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| |
Collapse
|
10
|
Kiss A, Lewis KB, Légaré F, Pacheco-Brousseau L, Zhang Q, Wilding L, Sikora L, Stacey D. Appraising publicly available online resources to support patients considering decisions about medical assistance in dying in Canada: an environmental scan. CMAJ Open 2023; 11:E869-E883. [PMID: 37788864 PMCID: PMC10558241 DOI: 10.9778/cmajo.20220224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Medical assistance in dying (MAiD) was legalized in Canada in 2016, with legislation updated in 2021. It is unclear whether resources are available to help patients make this difficult decision; therefore, we sought to identify and quality appraise Canadian MAiD resources for supporting patients making this decision. METHODS We conducted an environmental scan by searching Canadian websites for online MAiD resources that were published after the 2016 MAiD legislation, patient targeted, publicly accessible and able to inform decisions about MAiD in Canada. We excluded resources that targeted health care professionals or policy-makers, service protocols and personal narratives. Two authors appraised resources using the International Patient Decision Aids Standards (IPDAS) criteria and the Patient Education Materials Assessment Tool (PEMAT) for health literacy. Descriptive analysis was conducted. We defined resources as patient decision aids if 7 IPDAS defining criteria were met, and we rated resources as adequate for understandability or actionability if the PEMAT score was 70% or greater. RESULTS We identified 80 MAiD resources. As of March 2023, 62 resources (90%) provided eligibility according to the 2021 legislation and 11 did not discuss any eligibility criteria. The median IPDAS score was 3 out of 7; 52% discussed alternative options and none provided benefits or harms. Of 80 resources, 59% were adequate for understandability and 29% were adequate for actionability. INTERPRETATION Although many resources on MAiD were updated with 2021 legislation, few were adequate to support patients with lower health literacy. There is a need to determine whether a patient decision aid would be appropriate for people in Canada considering MAiD.
Collapse
Affiliation(s)
- Alda Kiss
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont.
| | - Krystina B Lewis
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - France Légaré
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Lissa Pacheco-Brousseau
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Qian Zhang
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Laura Wilding
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Lindsey Sikora
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Dawn Stacey
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| |
Collapse
|
11
|
Quah ELY, Chua KZY, Lua JK, Wan DWJ, Chong CS, Lim YX, Krishna L. A Systematic Review of Stakeholder Perspectives of Dignity and Assisted Dying. J Pain Symptom Manage 2023; 65:e123-e136. [PMID: 36244639 DOI: 10.1016/j.jpainsymman.2022.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The debate on assisted dying and its components, euthanasia and physician-assisted suicide has evolved with the emergence of the right to dignity and the wish to hasten death (WTHD). Whilst shaped by local legal and sociocultural considerations, appreciation of how patients, healthcare professionals and lawmakers relate notions of dignity to self-concepts of personhood and the desire for assisted dying will better inform and direct support of patients. METHODS Guided by the Systematic Evidence Based Approach, a systematic scoping review (SSR in SEBA) on perspectives of dignity, WTHD and personhood featured in PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, Scopus databases and four key Palliative Care journals was conducted. The review hinged on the following questions: "what is the relationship between dignity and the wish to hasten death (WTHD) in the assisted dying debate?", "how is dignity conceptualised by patients with WTHD?" and "what are prevailing perspectives on the role of assisted dying in maintaining a dying patient's dignity?" RESULTS 6947 abstracts were identified, 663 full text articles reviewed, and 88 articles included. The four domains identified include 1) concepts of dignity through the lens of the Ring Theory of Personhood (RToP) including their various definitions and descriptions; 2) the relationship between dignity, WTHD and assisted dying with loss of dignity and autonomy foregrounded; 3) stakeholder perspectives for and against assisted dying including those of patient, healthcare provider and lawmaker; and 4) other dignity-conserving measures as alternatives to assisted dying. CONCLUSION Concepts of dignity constantly evolve throughout the patient's end of life journey. Understanding when and how these concepts of personhood change and trigger the fear of a loss of dignity or intractable suffering could direct timely, individualised and appropriate person-centred dignity conserving measures. We believe an RToP-based tool could fulfil this role and further study into the design of this tool is planned.
Collapse
Affiliation(s)
- Elaine Li Ying Quah
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Jun Kiat Lua
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Darius Wei Jun Wan
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Chi Sum Chong
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Yun Xue Lim
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore; Division of Cancer Education (L.K), National Cancer Centre Singapore Singapore; Division of Supportive and Palliative Care (L.K), National Cancer Centre Singapore (L.K), Singapore; Palliative Care Institute Liverpool (L.K), Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom; Health Data Science (L.K), Liverpool; Duke-NUS Medical School (L.K), Singapore; Centre of Biomedical Ethics (L.K), Singapore; PalC (L.K), The Palliative Care Centre for Excellence in Research and Education, Dover Park Hospice, Singapore.
| |
Collapse
|
12
|
Thomas R, Pesut B, Puurveen G, Thorne S, Tishelman C, Leimbigler B. Medical Assistance in Dying: A Review of Canadian Health Authority Policy Documents. Glob Qual Nurs Res 2023; 10:23333936231167309. [PMID: 37168395 PMCID: PMC10164855 DOI: 10.1177/23333936231167309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
The purpose of this study was to describe policies developed by English-speaking Canadian health authorities to guide multi-disciplinary healthcare practice in the context of MAID. Seventeen policies from 9 provinces and 3 territories were identified and analyzed thematically. Themes developed from these documents related to ensuring a team approach to care, supporting informed patient choice, creating region-specific guidance on eligibility criteria and safeguards, accommodating conscientious objection, and making explicit organizational responsibilities. Ethical language concerned vulnerability, non-judgmental care, dignity, non-abandonment, confidentiality, moral conscience, and diverse cultural values. Overall, these policies addressed important risk mitigation strategies, acknowledged important social contracts, and supported ethical practice. Collectively, these policies outline important considerations in the evolving Canadian context for other jurisdictions seeking to create policy around assisted death.
Collapse
Affiliation(s)
- Robyn Thomas
- University of British Columbia Okanagan, Kelowna, Canada
| | - Barbara Pesut
- University of British Columbia Okanagan, Kelowna, Canada
| | | | - Sally Thorne
- University of British Columbia, Vancouver, Canada
| | | | | |
Collapse
|
13
|
Mulder J, Sonneveld H, Van Raemdonck D, Downar J, Wiebe K, Domínguez-Gil B, Healey A, Desschans B, Neyrinck A, Blanco AP, van Dusseldorp I, Olthuis G. Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021. Am J Transplant 2022; 22:2759-2780. [PMID: 36100362 PMCID: PMC10092544 DOI: 10.1111/ajt.17198] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 01/25/2023]
Abstract
The procedure combining medical assistance in dying (MAiD) with donations after circulatory determination of death (DCDD) is known as organ donation after euthanasia (ODE). The first international roundtable on ODE was held during the 2021 WONCA family medicine conference as part of a scoping review. It aimed to document practice and related issues to advise patients, professionals, and policymakers, aiding the development of responsible guidelines and helping to navigate the issues. This was achieved through literature searches and national and international stakeholder meetings. Up to 2021, ODE was performed 286 times in Canada, the Netherlands, Spain, and Belgium, including eight cases of ODE from home (ODEH). MAiD was provided 17,217 times (2020) in the eight countries where ODE is permitted. As of 2021, 837 patients (up to 14% of recipients of DCDD donors) had received organs from ODE. ODE raises some important ethical concerns involving patient autonomy, the link between the request for MAiD and the request to donate organs and the increased burden placed on seriously ill MAiD patients.
Collapse
Affiliation(s)
- Johannes Mulder
- Anesthesiology/Intensive Care Department, Isala Hospitals, Zwolle, The Netherlands.,Family Medicine Centre Dalfsen, Zwolle, The Netherlands
| | - Hans Sonneveld
- Anesthesiology/Intensive Care Department, Isala Hospitals, Zwolle, The Netherlands
| | | | - James Downar
- Department of Critical Care, University of Ottawa, Ottawa, Canada
| | - Kim Wiebe
- Shared Health Services, Canada, Winnipeg, Canada
| | | | - Andrew Healey
- Intensive Care Department, William Osler Health System Hospitals, Brampton, Canada.,Trillium Gift of Life Donation, Canada
| | - Bruno Desschans
- Transplant Centre Leuven, University Hospital Leuven, Leuven, Belgium
| | - Arne Neyrinck
- Transplant Centre Leuven, University Hospital Leuven, Leuven, Belgium
| | | | - Ingeborg van Dusseldorp
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Gert Olthuis
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|