Medical assistance in dying: Squabbles over the meaning of ‘irremediable’

Bioethics ◽  
2021 ◽  
Vol 36 (1) ◽  
pp. 1-2
Author(s):  
Udo Schuklenk
Keyword(s):  
Medical Assistance ◽  
Medical Assistance In Dying

scholarly journals Association of socioeconomic status with medical assistance in dying: a case–control analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e043547
Author(s):  
Donald A Redelmeier ◽  
Kelvin Ng ◽  
Deva Thiruchelvam ◽  
Eldar Shafir
Keyword(s):  
Socioeconomic Status ◽  
Palliative Care ◽  
Low Socioeconomic Status ◽  
Case Control ◽  
Control Analysis ◽  
Medical Assistance ◽  
Low Socioeconomic ◽  
Medical Assistance In Dying ◽  
Income Status ◽  
Economic Constraints

ObjectivesEconomic constraints are a common explanation of why patients with low socioeconomic status tend to experience less access to medical care. We tested whether the decreased care extends to medical assistance in dying in a healthcare system with no direct economic constraints.DesignPopulation-based case–control study of adults who died.SettingOntario, Canada, between 1 June 2016 and 1 June 2019.PatientsPatients receiving palliative care under universal insurance with no user fees.ExposurePatient’s socioeconomic status identified using standardised quintiles.Main outcome measureWhether the patient received medical assistance in dying.ResultsA total of 50 096 palliative care patients died, of whom 920 received medical assistance in dying (cases) and 49 176 did not receive medical assistance in dying (controls). Medical assistance in dying was less frequent for patients with low socioeconomic status (166 of 11 008=1.5%) than for patients with high socioeconomic status (227 of 9277=2.4%). This equalled a 39% decreased odds of receiving medical assistance in dying associated with low socioeconomic status (OR=0.61, 95% CI 0.50 to 0.75, p<0.001). The relative decrease was evident across diverse patient groups and after adjusting for age, sex, home location, malignancy diagnosis, healthcare utilisation and overall frailty. The findings also replicated in a subgroup analysis that matched patients on responsible physician, a sensitivity analysis based on a different socioeconomic measure of low-income status and a confirmation study using a randomised survey design.ConclusionsPatients with low socioeconomic status are less likely to receive medical assistance in dying under universal health insurance. An awareness of this imbalance may help in understanding patient decisions in less extreme clinical settings.

scholarly journals QOLP-26. USE OF MEDICAL ASSISTANCE IN DYING (“DEATH WITH DIGNITY”) IN WASHINGTON STATE PATIENTS WITH BRAIN TUMORS.

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii180-ii180
Author(s):  
Jerome Graber ◽  
Kaite Sofie ◽  
Lynne Taylor
Keyword(s):  
Brain Tumors ◽  
Terminal Illness ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
High Grade Glioma ◽  
Washington State ◽  
Medical Assistance ◽  
Death With Dignity ◽  
Medical Assistance In Dying ◽  
Diagnosis Of Cancer

Abstract Since 2009, Washington State has had a “Death with Dignity” (DWD) process whereby people with a terminal illness may legally obtain a prescription for medications that will end their life. Patients initiate a voluntary request from two physicians certifying they have a prognosis &lt; 6 months, are aware of other palliative care options, and have capacity without the comorbidity of a psychiatric diagnosis. Since 2015, over 200 people annually have used the DWD process in Washington. Other papers have described the characteristics of people using DWD with a diagnosis of cancer or amyotrophic lateral sclerosis (ALS) but none have specifically looked at patients with brain tumors (BT) who used DWD. We describe 20 people with BT who accessed DWD since 2015 at our center. Median age at the time of death was 51 (range 38-79) and 75% were men. Glioblastoma was the diagnosis in 10 (50%), anaplastic glioma in 8 (40%), grade II astrocytoma in 1, and a presumed high-grade glioma by imaging in 1. Median Karnofsky Performance Status (KPS) was 90 at diagnosis (range 50-100) and 70 at DWD request (range 40-90). Standard radiation (RT) and chemotherapy was used by 17 (85%) prior to DWD request, while 3 patients (15%, ages 70-79, KPS 50-90) requested DWD immediately after diagnosis and did not undergo further treatment. Pain was present in 4 patients (20%), 2 using opioids (10%). Six patients (30%) continued tumor treatments after approval for DWD. Median OS was 22 months (range 2-285) and 24 months excluding patients who declined treatment (range 8-285). Most glioma patients in our cohort requested DWD after undergoing chemoradiation, pain was uncommon and rarely severe, and survival from diagnosis was comparable to standard therapy. As access to medical assistance in dying continues, further research is needed on its utilization for people with brain tumors.

scholarly journals Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review

2021 ◽  
pp. 104990912110304
Author(s):  
Amy Nolen ◽  
Rawaa Olwi ◽  
Selby Debbie
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Care Hospital ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Before And After

Background: Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD. Objectives: To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD. Methods: This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period. Results: 4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD. Conclusion: We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

Forced and chosen transfers for medical assistance in dying (MAiD) before and during the COVID 19 pandemic: A mixed methods study

Death Studies ◽  
2021 ◽  
pp. 1-7
Author(s):  
Ellen Wiebe ◽  
Brian Sum ◽  
Michaela Kelly ◽  
Mirna Hennawy
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Study ◽  
Medical Assistance ◽  
Medical Assistance In Dying

scholarly journals “What Is Right for Me, Is Not Necessarily Right for You”: The Endogenous Factors Influencing Nonparticipation in Medical Assistance in Dying

2021 ◽  
pp. 104973232110088
Author(s):  
Janine Brown ◽  
Donna Goodridge ◽  
Lilian Thorpe ◽  
Alexander Crizzle
Keyword(s):  
Health Care Providers ◽  
Nurse Practitioners ◽  
Emotional Labor ◽  
Emotional Impact ◽  
Care Providers ◽  
Medical Assistance ◽  
Endogenous Factors ◽  
Medical Assistance In Dying ◽  
Professional Experiences ◽  
The Social

Access to medical assistance in dying (MAID) is influenced by legislation, health care providers (HCPs), the number of patient requests, and the patients’ locations. This research explored the factors that influenced HCPs’ nonparticipation in formal MAID processes and their needs to support this emerging practice area. Using an interpretive description methodology, we interviewed 17 physicians and 18 nurse practitioners who identified as non-participators in formal MAID processes. Nonparticipation was influenced by their (a) previous personal and professional experiences, (b) comfort with death, (c) conceptualization of duty, (d) preferred end-of-life care approaches, (e) faith or spirituality beliefs, (f) self-accountability, (g) consideration of emotional labor, and (h) future emotional impact. They identified a need for clear care pathways and safe passage. Two separate yet overlapping concepts were identified, conscientious objection to and nonparticipation in MAID, and we discussed options to support the social contract of care between HCPs and patients.

scholarly journals Neuro-oncology Clinicians’ Attitudes and Perspectives on Medical Assistance in Dying

2021 ◽  
pp. 1-20
Author(s):  
Seth A Climans ◽  
Warren P Mason ◽  
Kim Edelstein ◽  
Caroline Variath ◽  
Jennifer A H Bell
Keyword(s):  
Medical Assistance ◽  
Medical Assistance In Dying

scholarly journals Organ donation after medical assistance in dying at home

2018 ◽  
Vol 190 (44) ◽  
pp. E1305-E1306
Author(s):  
Johannes Mulder ◽  
Johan P.C. Sonneveld
Keyword(s):  
Organ Donation ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Dying At Home ◽  
At Home

scholarly journals Kidney transplant outcomes after medical assistance in dying

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Patrick P. Luke ◽  
Anton Skaro ◽  
Alp Sener ◽  
Ephraim Tang ◽  
Max Levine ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Large Scale ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Medical Assistance ◽  
Ischemic Time ◽  
Transplant Outcomes ◽  
Medical Assistance In Dying ◽  
Cold Ischemic Time ◽  
The Mean

Introduction: After nearly four years of Canadian experience with medical assistance in dying (MAiD), the clinical volume of organ transplantation following MAiD remains low. This is the first Canadian report evaluating recipient outcomes from kidney transplantation following MAiD. Methods: This was a retrospective review of the first nine cases of kidney transplants following MAiD at a Canadian transplant center. Results: Nine patients underwent MAiD followed by kidney retrieval during the study period. Their diagnoses were largely neuromuscular diseases. The mean warm ischemic time was 20 minutes (standard deviation [SD] 7). The nine recipients had a mean age of 60 (SD 19.7). The mean cold ischemic time was 525 minutes (SD 126). Delayed graft function occurred in only one patient out of nine. The mean 30-day creatinine was 124 umol/L (SD 52) . The mean three-month creatinine was 115 umol/L (SD 29). Conclusions: We report nine cases of kidney transplantation following MAiD. The process minimized warm ischemia, resulting in low delayed graft function rates, and acceptable post-transplant outcomes. Further large-scale research is necessary to optimize processes and outcomes in this novel clinical pathway.

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