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Jeanneret R, Prince S. Nurses and Voluntary Assisted Dying: How the Australian Capital Territory's Law Could Change the Australian Regulatory Landscape. JOURNAL OF BIOETHICAL INQUIRY 2024:10.1007/s11673-024-10370-y. [PMID: 38869817 DOI: 10.1007/s11673-024-10370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024]
Abstract
On June 5, 2024, the Australian Capital Territory passed a law to permit voluntary assisted dying ("VAD"). The Australian Capital Territory became the first Australian jurisdiction to permit nurse practitioners to assess eligibility for VAD. Given evidence of access barriers to VAD in Australia, including difficulty finding a doctor willing to assist, the Australian Capital Territory's approach should prompt consideration of whether the role of nurses in VAD should be expanded in other Australian jurisdictions. Drawing on lessons from Canada, which currently permits nurse practitioners to assess patient eligibility, we argue that the time has come for Australian jurisdictions to expand the role of nurses in VAD systems. This would be an important step in ensuring access to VAD for patients in practice. Attention, however, must also be paid to ensuring adequate remuneration of nurses (and doctors) if this goal of promoting access is to be achieved in practice.
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Affiliation(s)
- R Jeanneret
- Medical School and T. C. Beirne School of Law, University of Queensland, 288 Herston Rd, Herston, QLD, 4006, Australia.
| | - S Prince
- Australian Centre for Health Law Research, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia
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2
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Nissim R, Chu P, Stere A, Tong E, An E, Selby D, Bean S, Isenberg-Grzeda E, Rodin G, Li M, Hales S. "Walk me through the final day": A thematic analysis study on the family caregiver experience of the Medical Assistance in Dying procedure day. Palliat Med 2024; 38:660-668. [PMID: 38720655 PMCID: PMC11158002 DOI: 10.1177/02692163241248725] [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] [Indexed: 06/07/2024]
Abstract
BACKGROUND Legalization of assisted dying is progressively expanding worldwide. In Canada, the Medical Assistance in Dying Act became law in 2016. As assisted dying regulations evolve worldwide, comprehending its subjective impact and broader consequences, especially on family members, becomes pivotal for shaping practice, policy, and training. AIM The goal of this study is to understand the experience of family caregivers on the assisted dying procedure day. DESIGN Qualitative, thematic analysis, research using semi-structured interviews. SETTING/PARTICIPANTS Family caregivers of patients who received assisted dying in two hospitals in Canada were recruited. Interviews were conducted at least 6 months after patient death. Conceptual saturation was achieved after analyzing 18 interviews. RESULTS While caregivers expressed gratitude for the availability of Medical Assistance in Dying, they also described the procedure day as potentially jarring and unsettling. We identified five aspects that shaped their experience: attuned support from the clinical team; preparation for clinical details; congruence between the setting and the importance of the event; active participation and ceremony; and pacing and timing of the procedure. Together, these aspects impacted the level of uneasiness felt by caregivers on the procedure day. CONCLUSIONS This study emphasized the importance of a family-centered approach to delivering Medical Assistance in Dying. It underscored recognizing the needs of family caregivers during the procedure day and offering strategies to ease their experience. Healthcare providers in jurisdictions where assisted dying is legal or deliberated should consider the applicability of these findings to their unique context.
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Affiliation(s)
- Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paige Chu
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alison Stere
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eryn Tong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ekaterina An
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Debbie Selby
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sally Bean
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Elie Isenberg-Grzeda
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Pesut B, Thorne S, Chambaere K, Hall M, Schiller CJ. The Evolving Complexities of MAID Care in Canada From a Nursing Perspective. Glob Qual Nurs Res 2024; 11:23333936241228233. [PMID: 38433773 PMCID: PMC10908223 DOI: 10.1177/23333936241228233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 03/05/2024] Open
Abstract
Medical Assistance in Dying (MAID) legislation has evolved rapidly in Canada with significant impacts on nursing practice. The purpose of this paper is to describe evolving complexities in legislative context and practice standards that influence the experiences nurse practitioners and registered nurses have with MAID. Qualitative interviews were conducted with 25 registered nurses and 10 nurse practitioners from diverse contexts across Canada. Participants described their practices and considerations when discussing MAID as part of advance care planning; their use of, and challenges with, waivers of consent; their practice considerations in negotiating the complexities of clients for whom death is not reasonably foreseeable; and their moral wrestling with the inclusion of MAID for persons whose sole underlying medical condition is mental illness. Findings illustrate the moral complexities inherent in the evolving legislation and the importance of robust health and social care systems to the legal and ethical implementation of MAID in Canada.
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Affiliation(s)
- Barbara Pesut
- University of British Columbia Okanagan, Kelowna, Canada
| | - Sally Thorne
- University of British Columbia, Vancouver, Canada
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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.
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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
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Pesut B, Thorne S. Reflections on the relational ontology of medical assistance in dying. Nurs Philos 2023; 24:e12438. [PMID: 37032463 DOI: 10.1111/nup.12438] [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: 09/28/2022] [Accepted: 03/19/2023] [Indexed: 04/11/2023]
Abstract
Canadian nursing practice has been profoundly influenced by the legalization of medical assistance in dying in 2016, requiring that nurses navigate new and sometimes highly challenging experiences. Findings from our longitudinal studies of nurses' experiences suggest that these include deep emotional responses to medical assistance in dying, an urgency in orchestrating the perfect death, and a high degree of relational impact, both professionally and personally. Here we propose a theoretical explanation for these experiences based upon a relational ontology. Drawing upon the work of Wildman, we understand a relational ontology to be one in which relationships are more fundamentally central than the conceptual entities that provide the context to practice. It is in a relationship that conceptual entities, and their affiliated values, are created and recreated. Seen as causal, relationships have ontological status, with important implications for how we consider the concepts of death, suffering, and time in this context. From a conceptual perspective, suffering is primarily self-defined based upon personal histories, time reflects the potential remaining until death, and death is primarily biological and amoral, although social discourses of a good and bad death surround the death trajectory. However, within a relational ontology of medical assistance in dying, these understandings shift. Death becomes primarily social rather than biological, suffering is shared, and time until death is now clearly delimited. Accordingly, nurses assume a profound responsibility for influencing outcomes that are authentically person-centered. These understandings provide important insights into nurses' experiences, enabling us to recognize the causal effects, both intended and unintended, of nurses' relational practices amidst the complexities of assisted death. Drawing on such a perspective, we find implications for how we provide spaces for nurses to reflect on, and have conversations about, their experiences with some of the greatest mysteries of life-death, suffering, and time.
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Affiliation(s)
- Barbara Pesut
- School of Nursing, Principal Research Chair in Palliative and End-of-Life Care, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Knox M, Wagg A. Institutional Resistance to Medical Assistance in Dying in Canada: Arguments and Realities Emerging in the Public Domain. Healthcare (Basel) 2023; 11:2305. [PMID: 37628502 PMCID: PMC10454636 DOI: 10.3390/healthcare11162305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Since the legalization of medical assistance in dying (MAiD) in Canada in 2016, volitional non-participation in MAiD on the part of some healthcare institutions has revealed ethical uncertainties, potential access problems, and policy gaps. The problem has remained much neglected in the literature base, with no comprehensive studies on the subject so far. We analyzed print media articles and grey literature on institutional objections to and non-participation in MAiD. Thematic analyses were performed on all data to better understand the diverse stakeholder arguments and positions that characterize this important public health debate. Our search yielded 89 relevant media articles and 22 legislative, policy, and other relevant documents published since 2016 in the English language. We identified four main themes about institutional refusals to participate in MAiD, articulated as the following questions: (1) Who has the right to conscience? (2) Can MAiD be considered a palliative practice? (3) Are there imbalances across diverse stakeholder rights and burdens? and (4) Where are the gaps being felt in MAiD service implementation? Stakeholder views about institutional conscience with respect to MAiD are varied, complex, and evolving. In the absence of substantial systematic evidence, public domain materials constitute a key resource for understanding the implications for service access and determining the relevance of this contentious issue for future MAiD research and policy.
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Affiliation(s)
- Michelle Knox
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2P4, Canada
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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.
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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
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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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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.
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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
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Liu T, Liu W, Leung A, Jia S, Lee P, Liu L, Mutsaers A, Miller S, Honarmand K, Malik S, Qu M, Ball I. Medical Assistance in Dying in Oncology Patients: A Canadian Academic Hospital's Experience. Curr Oncol 2022; 29:9407-9415. [PMID: 36547153 PMCID: PMC9777282 DOI: 10.3390/curroncol29120739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Medical assistance in dying (MAID) was legislatively enacted in Canada in June 2016. Most studies of patients who received MAID grouped patients with cancer and non-cancer diagnoses. Our goal was to analyze the characteristics of oncology patients who received MAID in a Canadian tertiary care hospital. METHODS We conducted a retrospective review of all patients with cancer who received MAID between June 2016 and July 2020 at London Health Sciences Centre (LHSC). We describe patients' demographics, oncologic characteristics, symptoms, treatments, and palliative care involvement. RESULTS Ninety-two oncology patients received MAID. The median age was 72. The leading cancer diagnoses among these patients were lung, colorectal, and pancreatic. At the time of MAID request, 68% of patients had metastatic disease. Most patients (90%) had ECOG performance status of 3 or 4 before receiving MAID. Ninety-nine percent of patients had distressing symptoms at time of MAID request, most commonly pain. One-third of patients with metastatic or recurrent cancer received early palliative care. The median time interval between the first MAID assessment and receipt of MAID was 7 days. INTERPRETATION Most oncology patients who received MAID at LHSC had poor performance status and almost all had distressing symptoms. The median time interval between first MAID assessment and receipt of MAID was shorter than expected. Only one-third of patients with metastatic or recurrent cancer received early palliative care. Improving access to early palliative care is a priority in patients with advanced cancer. STUDY REGISTRATION We received research approval from Western University's Research Ethics Board (REB) with project ID number 115367, and from Lawson's Research Database Application (ReDA) with study ID number 9579.
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Affiliation(s)
- Tony Liu
- Department of Medicine, Western University, London, ON N6A 5C1, Canada
| | - Wei Liu
- Division of Radiation Oncology, University of British Columbia, Vancouver, BC V5Z 4E6, Canada
| | - Aaron Leung
- Department of Medicine, Western University, London, ON N6A 5C1, Canada
| | - Sangyang Jia
- Department of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada
| | - Patsy Lee
- Department of Medicine, Western University, London, ON N6A 5C1, Canada
| | - Luke Liu
- Michael G. DeGroote School of Medicine, Hamilton, ON L8P 1H6, Canada
| | - Adam Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre—Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - Sue Miller
- London Health Sciences Centre Medical Assistance in Dying Program, London, ON N6H 1T3, Canada
| | - Kimia Honarmand
- Department of Medicine, Western University, London, ON N6A 5C1, Canada
| | - Shiraz Malik
- Department of Family Medicine, Western University, London, ON N6A 5C1, Canada
| | - Melody Qu
- Division of Radiation Oncology, Western University, London, ON N6A 5W9, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, ON N6A 5C1, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON N6A 5C1, Canada
- Correspondence:
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Variath C, Peter E, Cranley L, Godkin D. Experiences of healthcare providers with eligible patients' loss of decision-making capacity while awaiting medical assistance in dying. Palliat Care Soc Pract 2022; 16:26323524221128839. [PMID: 36268274 PMCID: PMC9577066 DOI: 10.1177/26323524221128839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/06/2022] [Indexed: 11/09/2022] Open
Abstract
Background In Canada, under Bill C-14, patients who met all eligibility requirements were prevented from accessing medical assistance in dying (MAiD) following their loss of decision-making capacity while awaiting MAiD. The changes introduced with Bill C-7 continue to limit access to patients who did not enter a waiver of final consent agreement with their healthcare providers. Little is known about the experiences with patients' loss of capacity to consent and subsequent ineligibility for MAiD. Understanding healthcare providers' experiences has important implications for improving end-of-life care for those with capacity-limiting conditions. Purpose To explore Canadian healthcare providers' experiences with end-of-life of eligible patients who became ineligible for MAiD due to their loss of decision-making capacity to consent and the relational influences on their experiences prior to the implementation of Bill C-7 in Canada. Method A critical qualitative methodology and a feminist ethics theoretical lens guided this study. A voice-centred relational approach that allowed an in-depth exploration of how power, relationality and moral agency influenced participants' experiences was used for data analysis. Data consisted of semi-structured interviews with 30 healthcare providers. Findings The analysis resulted in the following four main themes and corresponding subthemes: (1) identifying factors that may result in ineligibility for MAiD due to capacity loss; (2) maintaining eligibility required to access MAiD; (3) preparing for an alternative end-of-life; (4) experiencing patients' capacity loss. Discussion This study highlights that while MAiD is legally available to eligible Canadians, access to MAiD and care for eligible patients who were unable to access MAiD due to their loss of decision-making varied based on the geographical locations and access to willing MAiD and end-of-life care providers. The availability of high-quality palliative care for patients throughout the MAiD process, including following the loss of capacity to consent and subsequent ineligibility, would improve the end-of-life experience for all those involved. The need to establish a systematic approach to prepare and care for patients and their families following the patients' loss of capacity and subsequent ineligibility for MAiD is also identified.
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Affiliation(s)
| | - Elizabeth Peter
- Lawrence S. Bloomberg Faculty of Nursing,
University of Toronto, Toronto, ON, CanadaJoint Centre for Bioethics,
University of Toronto, Toronto, ON, Canada
| | - Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing,
University of Toronto, Toronto, ON, Canada
| | - Dianne Godkin
- Trillium Health Partners-Mississauga Hospital,
Mississauga, ON, CanadaLawrence S. Bloomberg Faculty of Nursing, University
of Toronto, Toronto, ON, CanadaJoint Centre for Bioethics, University of
Toronto, Toronto, ON, Canada
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