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Shapiro GK, Tong E, Nissim R, Zimmermann C, Allin S, Gibson JL, Lau SCL, Li M, Rodin G. Perspectives of Canadian health leaders on the relationship between medical assistance in dying and palliative and end-of-life care services: a qualitative study. CMAJ 2024; 196:E222-E234. [PMID: 38408784 PMCID: PMC10896594 DOI: 10.1503/cmaj.231241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Medical assistance in dying (MAiD) was legalized in Canada in 2016, but coordination of MAiD and palliative and end-of-life care (PEOLC) services remains underdeveloped. We sought to understand the perspectives of health leaders across Canada on the relationship between MAiD and PEOLC services and to identify opportunities for improved coordination. METHODS In this quantitative study, we purposively sampled health leaders across Canada with expertise in MAiD, PEOLC, or both. We conducted semi-structured interviews between April 2021 and January 2022. Interview transcripts were coded independently by 2 researchers and reconciled to identify key themes using content analysis. We applied the PATH framework for Integrated Health Services to guide data collection and analysis. RESULTS We conducted 36 interviews. Participants expressed diverse views about the optimal relationship between MAiD and PEOLC, and the desirability of integration, separation, or coordination of these services. We identified 11 themes to improve the relationship between the services across 4 PATH levels: client-centred services (e.g., educate public); health operations (e.g., cultivate compassionate and proactive leadership); health systems (e.g., conduct broad and inclusive consultation and planning); and intersectoral initiatives (e.g., provide standard practice guidelines across health care systems). INTERPRETATION Health leaders recognized that cooperation between MAiD and PEOLC services is required for appropriate referrals, care coordination, and patient care. They identified the need for public and provider education, standardized practice guidelines, relationship-building, and leadership. Our findings have implications for MAiD and PEOLC policy development and clinical practice in Canada and other jurisdictions.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
| | - Eryn Tong
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Rinat Nissim
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Camilla Zimmermann
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Sara Allin
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Jennifer L Gibson
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Sharlane C L Lau
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Madeline Li
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Gary Rodin
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
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Brassolotto J, Manduca-Barone A, Zurbrigg P. Medical Assistance in Dying: A Review of Related Canadian News Media Texts. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:167-186. [PMID: 36454353 PMCID: PMC9713138 DOI: 10.1007/s10912-022-09764-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 05/07/2023]
Abstract
Medical assistance in dying (MAiD) was legalized in Canada in 2016. Canadians' opinions on the service are nuanced, particularly as the legislation changes over time. In this paper, we outline findings from our review of representations of MAiD in Canadian news media texts since its legalization. These stories reflect the concerns, priorities, and experiences of key stakeholders and function pedagogically, shaping public opinion about MAiD. We discuss this review of Canadian news media on MAiD, provide examples of four key themes we identified (vulnerability, autonomy, dignity, and human rights), and discuss their implications for health policy and equity. Though key stakeholders share the values of autonomy, dignity, and human rights, they appeal to them in diverse ways, sometimes with conflicting policy demands. These representations offer a useful gauge of how views about MAiD continue to shift alongside changes in federal legislation. These stories can influence related policies, respond to the powerful voices that shape MAiD legislation, and have the potential to change national conversations. Our analysis adds to the existing body of scholarship on MAiD by examining post-Bill C-7 news media, identifying related health equity issues and tensions, and discussing potential impacts of MAiD's representations in news media.
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Affiliation(s)
- Julia Brassolotto
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K 3M4 Canada
| | - Alessandro Manduca-Barone
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K 3M4 Canada
| | - Paige Zurbrigg
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K 3M4 Canada
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Shomron B. The mediated discourse and voice of euthanasia: the Israeli media as a case study. MEDICAL HUMANITIES 2022; 48:76-84. [PMID: 33893226 DOI: 10.1136/medhum-2020-012097] [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] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Euthanasia is an important social and quality of life issue. However, it is highly controversial and thus continuously debated especially given its legitimacy and legality differ between countries. Little is known about the role media plays concerning this topic. To fill this gap, this study applies a mixed methods approach to a case study of Israeli media, including a quantitative content analysis of news articles (to measure the discourse of 'civil participation'), a thematic analysis of news articles (to examine the 'voice') and a quantitative content analysis of Facebook comments (to measure 'being heard'). Results indicate that while the media highly enables the media capability of 'voice' (both 'voicing' and 'being heard'), it limits the media capability of 'civil participation' to a narrow array of discourse, hindering the social debate. These results reveal the role the media plays regarding euthanasia, integral to individuals' quality of life through the realisation of their media capabilities, and in relation to the act of euthanasia itself.
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Affiliation(s)
- Baruch Shomron
- Communication Studies, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Shapiro GK, Tong E, Nissim R, Zimmermann C, Allin S, Gibson J, Li M, Rodin G. Exploring key stakeholders' attitudes and opinions on medical assistance in dying and palliative care in Canada: a qualitative study protocol. BMJ Open 2021; 11:e055789. [PMID: 34862301 PMCID: PMC8646969 DOI: 10.1136/bmjopen-2021-055789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Canadians have had legal access to medical assistance in dying (MAiD) since 2016. However, despite substantial overlap in populations who request MAiD and who require palliative care (PC) services, policies and recommended practices regarding the optimal relationship between MAiD and PC services are not well developed. Multiple models are possible, including autonomous delivery of these services and formal or informal coordination, collaboration or integration. However, it is not clear which of these approaches are most appropriate, feasible or acceptable in different Canadian health settings in the context of the COVID-19 pandemic and in the post-pandemic period. The aim of this qualitative study is to understand the attitudes and opinions of key stakeholders from the government, health system, patient groups and academia in Canada regarding the optimal relationship between MAiD and PC services. METHODS AND ANALYSIS A qualitative, purposeful sampling approach will elicit stakeholder feedback of 25-30 participants using semistructured interviews. Stakeholders with expertise and engagement in MAiD or PC who hold leadership positions in their respective organisations across Canada will be invited to provide their perspectives on the relationship between MAiD and PC; capacity-building needs; policy development opportunities; and the impact of the COVID-19 pandemic on the relationship between MAiD and PC services. Transcripts will be analysed using content analysis. A framework for integrated health services will be used to assess the impact of integrating services on multiple levels. ETHICS AND DISSEMINATION This study has received ethical approval from the University Health Network Research Ethics Board (No 19-5518; Toronto, Canada). All participants will be required to provide informed electronic consent before a qualitative interview is scheduled, and to provide verbal consent prior to the start of the qualitative interview. Findings from this study could inform healthcare policy, the delivery of MAiD and PC, and enhance the understanding of the multilevel factors relevant for the delivery of these services. Findings will be disseminated in conferences and peer-reviewed publications.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
| | - Eryn Tong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Gibson
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Van Gorp B, Olthuis G, Vandekeybus A, van Gurp J. Frames and counter-frames giving meaning to palliative care and euthanasia in the Netherlands. BMC Palliat Care 2021; 20:79. [PMID: 34082736 PMCID: PMC8176618 DOI: 10.1186/s12904-021-00772-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Based on the case of palliative care and euthanasia in the Netherlands, this paper presents an analysis of frames and counter-frames used in the ongoing public debate about these two intertwined topics. Each (counter)frame presents a cultural theme that can act as a prism to give meaning to palliative care and/or euthanasia. Each frame comprehends a different problem definition, consequences and policy options. Typical word choices and metaphors are identified that can evoke these frames and the underlying reasoning. The frames do not belong to a specific stakeholder but a pattern can be seen in their use that is related to interests and ideology. Methods An inductive framing analysis was conducted of 2,700 text fragments taken from various Dutch newspapers, websites of stakeholders and policy documents in the period 2016–2018. After an extensive process of thematic coding, axial coding, selective coding and peer review seven frames and seven counter-frames about palliative care and euthanasia were constructed. Fifteen experts in the field of palliative and/or end-of-life care commented on the overview during a member check. Results Two frames about palliative care were constructed: the Fear of death frame, which stresses the hopeless ‘terminality’ of palliative care and the Heavy burden frame, in which palliative care is too big a responsibility for the relatives of the patient. In addition, two counter-frames were constructed: palliative care as a contributor to Quality of life and Completion. With regard to euthanasia, five frames were identified that lead to a problematising definition: Thou shalt not kill, Slippery slope, Lack of willpower, I am not God, and Medical progress. Five counter-frames offer a non-problematising definition of euthanasia in the debate: Mercy, Prevention, Triumph of reason, Absolute autonomy, and Economic utility thinking. Conclusions The debate in the Netherlands on euthanasia and palliative care is characterized by a plurality of angles that goes beyond the bipolar distinction between the pros and cons of euthanasia and palliative care. Only with an overview of all potential frames in mind can an audience truly make informed decisions. The frame matrix is not only useful for policy makers to know all perspectives when joining public debate, but also to health care workers to get into meaningful conversations with their patients and families. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00772-9.
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Affiliation(s)
- Baldwin Van Gorp
- KU Leuven, Institute for Media Studies, Parkstraat 45 box 3603, 3000, Leuven, Belgium.
| | - Gert Olthuis
- Radboud University Medical Center, Radboud Institute for Health Sciences, department IQ healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Anneleen Vandekeybus
- KU Leuven, Institute for Media Studies, Parkstraat 45 box 3603, 3000, Leuven, Belgium
| | - Jelle van Gurp
- Radboud University Medical Center, Radboud Institute for Health Sciences, department IQ healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Gerson SM, Koksvik GH, Richards N, Materstvedt LJ, Clark D. The Relationship of Palliative Care With Assisted Dying Where Assisted Dying is Lawful: A Systematic Scoping Review of the Literature. J Pain Symptom Manage 2020; 59:1287-1303.e1. [PMID: 31881289 PMCID: PMC8311295 DOI: 10.1016/j.jpainsymman.2019.12.361] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/28/2019] [Accepted: 12/13/2019] [Indexed: 01/21/2023]
Abstract
CONTEXT A central approach of palliative care has been to provide holistic care for people who are dying, terminally ill, or facing life-limiting illnesses while neither hastening nor postponing death. Assisted dying laws allow eligible individuals to receive medically administered or self-administered medication from a health provider to end their life. The implementation of these laws in a growing number of jurisdictions therefore poses certain challenges for palliative care. OBJECTIVES To analyze the research literature about the relationship of assisted dying with palliative care, in countries where it is lawful. METHODS A five-stage scoping review process was adapted from the Joanna Briggs Institute. Data sources searched through October 2018 were MEDLINE, CINAHL, PsychINFO, SCOPUS, and ProQuest dissertations and theses, with additional material identified through hand searching. Research studies of any design were included, but editorials or opinion articles were excluded. RESULTS After reviewing 5778 references from searches, 105 were subject to full-text review. About 16 studies were included: from Belgium (n = 4), Canada (n = 1), Switzerland (n = 2), and the U.S. (n = 9). We found that the relationship between assisted dying and palliative care practices in these locations took varied and sometimes combined forms: supportive, neutral, coexisting, not mutually exclusive, integrated, synergistic, cooperative, collaborative, opposed, ambivalent, and conflicted. CONCLUSION The studies in this review cast only partial light on challenges faced by palliative care when assisted dying is legal. There is pressing need for more research on the involvement of palliative care in the developing practices of assisted dying, across a growing number of jurisdictions.
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Affiliation(s)
- Sheri Mila Gerson
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Scotland, United Kingdom.
| | - Gitte H Koksvik
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Scotland, United Kingdom
| | - Naomi Richards
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Scotland, United Kingdom
| | - Lars Johan Materstvedt
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Scotland, United Kingdom; Faculty of Humanities, Department of Philosophy and Religious Studies, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - David Clark
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Scotland, United Kingdom
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Tinc PJ, Sorensen JA, Weinehall L, Lindvall K. An exploration of rollover protective structures (ROPS) rebate program media coverage: strategies for implementation and sustainment. BMC Public Health 2019; 19:1257. [PMID: 31510988 PMCID: PMC6739911 DOI: 10.1186/s12889-019-7586-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/02/2019] [Indexed: 12/03/2022] Open
Abstract
Background Media advocacy plays an important role in public health initiatives, as it can provide vital information to target populations, policy makers, or other relevant stakeholders. Unfortunately, little is currently known about the use of media advocacy to promote occupational safety and health programs. This study explores media coverage related to the Rollover Protection Structure (ROPS) Rebate Programs, which were designed to encourage the use of rollover protection on agricultural tractors, thus reducing the risk of tractor overturn fatalities. The Program’s portrayal in the media, as well as the role that the media has played in implementing and sustaining these Programs. Methods Media articles pertaining to any of the state-based or National ROPS Rebate Programs and published between November 1, 2006 and October 31, 2018 were included for review. Discourse analysis was used to understand the messages portrayed by the media and how those messages shaped the outcomes of the ROPS Rebate Programs. Results During the study period, 212 unique articles were published about the ROPS Rebate Programs. While these articles all portrayed the ROPS Rebate Programs in a largely positive light, they were used at different stages, from pre-implementation through sustainment of the ROPS Rebate Programs, and to different extents. Conclusions Media articles have played an important role in implementing and sustaining the ROPS Rebate Programs. Based on the results of this study, more robust and continuous media coverage are important for the longevity and success of public health programs.
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Sikka T. Barriers to Access: A Feminist Analysis of Medically Assisted Dying and the Experience of Marginalized Groups. OMEGA-JOURNAL OF DEATH AND DYING 2019; 84:4-27. [PMID: 31530085 DOI: 10.1177/0030222819873770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this article, I argue that a holistic strategy is needed to ascertain how implicit bias, on the part of health-care providers, and structural impediments work together to produce significant barriers to access to medical assistance in dying for marginalized groups-particularly those experiencing intersecting or interlocking forms of identity-based oppressions. In doing so, I also make the case that this kind of primary, patient-centered, and institutional research could benefit from the insights of critical feminism and materialist feminist theory by highlighting and challenging inequalities, opening up debate, and exploring new forms of knowledge production. It also offers a way to shape future research of medical assistance in dying, as it relates specifically to the study of how overlapping forms of structural and interpersonal marginalization (e.g., implicit bias), inclusive of race, gender, class, ethnicity, dis/ability, sexuality, and so on are expressed and experienced.
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Affiliation(s)
- Tina Sikka
- School of Arts and Cultures, Newcastle University, Newcastle upon Tyne, UK
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Crumley ET, Sheppard C, Bowden C, Nelson G. Canadian French and English newspapers' portrayals of physicians' role and medical assistance in dying (MAiD) from 1972 to 2016: a qualitative textual analysis. BMJ Open 2019; 9:e020369. [PMID: 31048417 PMCID: PMC6502060 DOI: 10.1136/bmjopen-2017-020369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To examine how Canadian newspapers portrayed physicians' role and medical assistance in dying (MAiD). DESIGN Qualitative textual analysis. SETTING Online and print articles from Canadian French and English newspapers. PARTICIPANTS 813 newspaper articles published from 1972 to 2016. RESULTS Key Canadian events defined five eras. From 1972 to 1990, newspapers portrayed physician's MAiD role as a social issue by reporting supportive public opinion polls and revealing it was already occurring in secret. From 1991 to 1995, newspapers discussed legal aspects of physicians' MAiD role including Rodriguez' Supreme Court of Canada appeal and Federal government Bills. From 1996 to 2004, journalists discussed professional aspects of physicians' MAiD role and the growing split between palliative care and physicians who supported MAiD. They also reported on court cases against Canadian physicians, Dr Kevorkian and suffering patients who could not receive MAiD. From 2005 to 2013, newspapers described political aspects including the tabling of MAiD legislation to change physicians' role. Lastly, from 2014 to 2016, newspapers again portrayed legal aspects of physicians' role as the Supreme Court of Canada was anticipated to legalise MAiD and the Québec government passed its own legislation. Remarkably, newspapers kept attention to MAiD over 44 years before it became legal. Articles generally reflected Canadians' acceptance of MAiD and physicians were typically portrayed as opposing it, but not all did. CONCLUSIONS Newspaper portrayals of physicians' MAiD role discussed public opinion, politicians' activities and professional and legal aspects. Portrayals followed the issue-attention cycle through three of five stages: 1) preproblem, 2) alarmed discovery and euphoric enthusiasm and 3) realising the cost of significant progress.
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Affiliation(s)
- Ellen T Crumley
- Rowe School of Business, Faculty of Management, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Caroline Sheppard
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chantelle Bowden
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gregg Nelson
- Departments of Oncology and Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Bélanger E, Towers A, Wright DK, Chen Y, Tradounsky G, Macdonald ME. Of dilemmas and tensions: a qualitative study of palliative care physicians' positions regarding voluntary active euthanasia in Quebec, Canada. JOURNAL OF MEDICAL ETHICS 2019; 45:48-53. [PMID: 30377217 DOI: 10.1136/medethics-2017-104339] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/22/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES In 2015, the Province of Quebec, Canada passed a law that allowed voluntary active euthanasia (VAE). Palliative care stakeholders in Canada have been largely opposed to euthanasia, yet there is little research about their views. The research question guiding this study was the following: How do palliative care physicians in Quebec position themselves regarding the practice of VAE in the context of the new provincial legislation? METHODS We used interpretive description, an inductive methodology to answer research questions about clinical practice. A total of 18 palliative care physicians participated in semistructured interviews at two university-affiliated hospitals in Quebec. RESULTS Participants positioned themselves in opposition to euthanasia. Their justifications were framed within their professional commitment to not hasten death, which sat in tension with the value of patients' autonomy to choose how to die. Participants described VAE as unacceptable if it impeded opportunities to evaluate and alleviate suffering. Further, they contested government rhetoric that positioned VAE as a way to improve end-of-life care. Participants felt that VAE would diminish the potential of palliative care to relieve suffering. Dilemmas were apparent in their narratives, about reconciling respect for patient autonomy with broader palliative care values, and the value of accompanying and not abandoning patients who make requests for VAE while being committed to neither prolonging nor hastening death. CONCLUSIONS This study provides insight into nuanced positions of experienced palliative care physicians in Quebec and confirms expected tensions between an important stakeholder and the practice of VAE as guided by the new legislation.
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Affiliation(s)
- Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Anna Towers
- Department of Oncology, McGill University, Montreal, Quebec, Canada
| | | | - Yuexi Chen
- Palliative Care McGill, McGill University Montreal, Montreal, Quebec, Canada
| | - Golda Tradounsky
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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11
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Braverman DW, Marcus BS, Wakim PG, Mercurio MR, Kopf GS. Health Care Professionals' Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency. J Pain Symptom Manage 2017; 54:538-545.e3. [PMID: 28716621 PMCID: PMC5632116 DOI: 10.1016/j.jpainsymman.2017.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/21/2017] [Accepted: 07/07/2017] [Indexed: 11/16/2022]
Abstract
CONTEXT Health care professionals (HCPs) are crucial to physician-assisted death (PAD) provision. OBJECTIVES To quantitatively assess the favorability of justifications for or against PAD legalization among HCPs, the effect of the terms "suicide" and "euthanasia" on their views and their support for three forms of PAD. METHODS Our questionnaire presented three cases: physician-assisted suicide, euthanasia for a competent patient, and euthanasia for an incompetent patient with an advance directive for euthanasia. Respondents judged whether each case was ethical and should be legal and selected their justifications from commonly cited reasons. The sample included physician clinicians, researchers, nonphysician clinicians, and other nonclinical staff at a major academic medical center. RESULTS Of 221 HCPs, the majority thought that each case was ethical and should be legal. In order of declining favorability, justifications supporting PAD legalization were relief of suffering, right to die, mercy, acceptance of death, nonabandonment, and saving money for the health care system; opposing justifications were the slippery slope argument, unnecessary due to palliative care, killing patients is wrong, religious views, and suicide is wrong. The use of suicide and euthanasia terminology did not affect responses. Participants preferred physician-assisted suicide to euthanasia for a competent patient (P < 0.0001) and euthanasia for an incompetent patient to euthanasia for a competent patient (P < 0.005). CONCLUSIONS HCPs endorsed patient-centered justifications over other reasons, including role-specific duties. Suicide and euthanasia language did not bias HCPs against PAD, challenging claims that such value-laden terms hinder dialogue. More research is required to understand the significance of competency in shaping attitudes toward PAD.
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Affiliation(s)
- Derek W Braverman
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
| | | | - Paul G Wakim
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Gary S Kopf
- Yale School of Medicine, New Haven, Connecticut, USA
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12
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Karsoho H, Fishman JR, Wright DK, Macdonald ME. Suffering and medicalization at the end of life: The case of physician-assisted dying. Soc Sci Med 2016; 170:188-196. [PMID: 27821302 DOI: 10.1016/j.socscimed.2016.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/22/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
'Suffering' is a central discursive trope for the right-to-die movement. In this article, we ask how proponents of physician-assisted dying (PAD) articulate suffering with the role of medicine at the end of life within the context of a decriminalization and legalization debate. We draw upon empirical data from our study of Carter v. Canada, the landmark court case that decriminalized PAD in Canada in 2015. We conducted in-depth interviews with 42 key participants of the case and collected over 4000 pages of legal documents generated by the case. In our analysis of the data, we show the different ways proponents construct relationships between suffering, mainstream curative medicine, palliative care, and assisted dying. Proponents see curative medicine as complicit in the production of suffering at the end of life; they lament a cultural context wherein life-prolongation is the moral imperative of physicians who are paternalistic and death-denying. Proponents further limit palliative care's ability to alleviate suffering at the end of life and even go so far as to claim that in some instances, palliative care produces suffering. Proponents' articulation of suffering with both mainstream medicine and palliative care might suggest an outright rejection of a place for medicine at the end of life. We further find, however, that proponents insist on the involvement of physicians in assisted dying. Proponents emphasize how a request for PAD can set in motion an interactive therapeutic process that alleviates suffering at the end of life. We argue that the proponents' articulation of suffering with the role of medicine at the end of life should be understood as a discourse through which one configuration of end-of-life care comes to be accepted and another rejected, a discourse that ultimately does not challenge, but makes productive use of the larger framework of the medicalization of dying.
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Affiliation(s)
- Hadi Karsoho
- Department of Sociology, Department of Social Studies of Medicine, 3647 Peel Street, Room 307, Montreal, QC H3A 1X1, Canada.
| | - Jennifer R Fishman
- Biomedical Ethics Unit, Department of Social Studies of Medicine, 3647 Peel Street, Room 307, Montreal, QC H3A 1X1, Canada.
| | - David Kenneth Wright
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
| | - Mary Ellen Macdonald
- Oral Health and Society Research Unit, Faculty of Dentistry, McGill University, Montreal, QC H3A 1G1, Canada.
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Karsoho H, Wright DK, Macdonald ME, Fishman JR. Constructing physician-assisted dying: the politics of evidence from permissive jurisdictions in Carter v. Canada. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/13576275.2016.1157061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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