Is Death Taboo for Older Chinese Immigrants?

2020 ◽  
pp. 003022282092788 ◽  
Author(s):  
Weiguo Zhang
Keyword(s):  
Focus Groups ◽  
Medical Treatment ◽  
End Of Life Care ◽  
Chinese Immigrants ◽  
Chinese Immigrant ◽  
Life Care ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Greater Toronto Area ◽  
Older Chinese

Much of the scholarly literature sees death as a taboo topic for Chinese. To test this assumption, this study held seven focus groups in the Greater Toronto Area in 2017. It found that the majority of the older Chinese immigrant participants talked about death freely using either the word death or a euphemism. They talked about various issues including medical treatment and end-of-life care, medical assistance in dying, death preparation, and so on. A small number did not talk about death, but it seemed their reluctance was related to anxiety or discomfort or simply reflected a choice of words. The study concludes death as taboo could be a myth, at least for older Chinese immigrants.

scholarly journals How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers

2021 ◽  
Vol 15 ◽  
pp. 263235242110459
Author(s):  
Anita Ho ◽  
Joshua S. Norman ◽  
Soodabeh Joolaee ◽  
Kristie Serota ◽  
Louise Twells ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Assisted Dying ◽  
Life Care ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Qualitative Thematic Analysis

Background: More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying. Understanding how end-of-life care discussions between patients and specialist palliative care providers may be affected by such legislation can inform end-of-life care delivery in the evolving socio-cultural and legal environment. Aim: To explore how the Canadian Medical Assistance in Dying legislation affects end-of-life care discussions between patients and multidisciplinary specialist palliative care providers. Design: Qualitative thematic analysis of semi-structured interviews. Participants: Forty-eight specialist palliative care providers from Vancouver (n = 26) and Toronto ( n = 22) were interviewed in person or by phone. Participants included physicians ( n = 22), nurses ( n = 15), social workers ( n = 7), and allied health professionals ( n = 4). Results: Qualitative thematic analysis identified five notable considerations associated with Medical Assistance in Dying affecting end-of-life care discussions: (1) concerns over having proactive conversations about the desire to hasten death, (2) uncertainties regarding wish-to-die statements, (3) conversation complexities around procedural matters, (4) shifting discussions about suffering and quality of life, and (5) the need and challenges of promoting open-ended discussions. Conclusion: Medical Assistance in Dying challenges end-of-life care discussions and requires education and support for all concerned to enable compassionate health professional communication. It remains essential to address psychosocial and existential suffering in medicine, but also to provide timely palliative care to ensure suffering is addressed before it is deemed irremediable. Hence, clarification is required regarding assisted dying as an intervention of last resort. Furthermore, professional and institutional guidance needs to better support palliative care providers in maintaining their holistic standard of care.

Perceptions and Experiences of Medical Assistance in Dying Among Illicit Substance Users and People Living in Poverty

2019 ◽  
pp. 003022281988982
Author(s):  
Jessica Shaw ◽  
Laura Harper ◽  
Emma Preston ◽  
Alysia Wright ◽  
Michaela Kelly ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Best Practice ◽  
Life Care ◽  
Medical Assistance ◽  
Substance Users ◽  
Assisted Death ◽  
Illicit Substance ◽  
Medical Assistance In Dying ◽  
The Difference

Since medical assistance in dying (MAiD) became legal in Canada in 2016, there have been concerns about vulnerable people feeling pressured to end their lives. It is important to understand what people in marginalized communities know and feel about MAiD in order to help prevent any pressure to hasten death and to prevent any barriers to accessing assisted death. This qualitative study explored the perceptions and experiences of MAiD and other end-of-life care options with 46 people who were illicit substance users, living in poverty, or who worked with marginalized people in these communities. Six broad themes were identified: the importance of family, friends, and community; the effects of the opioid crisis; barriers to accessing end-of-life care services; support for MAiD; the difference between suicide and MAiD; and what constitutes a good death. Findings from this research may be used to help inform future legislation, professional guidelines, and standards of best practice.

Care Considerations in a Patient- and Family-Centered Medical Assistance in Dying Program

2020 ◽  
pp. 082585972095166
Author(s):  
Janine Brown ◽  
Donna Goodridge ◽  
Averi Harrison ◽  
Jordan Kemp ◽  
Lilian Thorpe ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Healthcare Providers ◽  
Anticipatory Guidance ◽  
Interdisciplinary Care ◽  
Life Care ◽  
Care Providers ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Family Centered

Background: Medical Assistance in Dying (MAID) became legal in Canada in June 2016. As part of a project designed to improve end-of-life care for those requesting MAID, qualitative data from patients, families, and providers were used to assess opportunities to enhance patient-and family-centered care (PFCC) in this program. Methods: Thirty interviews were conducted with patients, families, and healthcare providers. Five patients who requested an assessment for MAID, 11 family members, and 14 healthcare providers were interviewed about their experiences in 2017. Comparative coding and thematic analysis were completed with the support of NVivo12. Results: Emotional PFCC considerations included: exploring and validating the emotional journey, navigating the uncertain, judgmental experiences, and the emotional impact on families and the care team. Physical PFCC considerations included: sensitivity in eligibility assessments, weaving in interdisciplinary care, provision of anticipatory guidance, and death location. Spiritual PFCC considerations included: honoring choice, listening to life stories, supporting spiritual needs, and acknowledging loss. Relational PFCC considerations included: defining the circle of support, supporting the circle, and relational investments. Conclusion: Fundamental to a PFCC MAID program, practitioners must be afforded time to provide holistic care. Program-related suggestions include incorporating interdisciplinary care early, and throughout the illness trajectory, consistency in care providers, appropriate anticipatory guidance, and bereavement supports for family, and dedicate space for MAID provisions. Patients and families must be included in the ongoing development and re-evaluation of MAID programs to ensure continued focus on quality end-of-life care.

scholarly journals Medical Assistance in Dying: Canadian Registry Recommendations

2018 ◽  
pp. 55
Author(s):  
Rose M. Carter, Q.C. ◽  
Brandyn Rodgerson ◽  
Dr. Michael Grace
Keyword(s):  
Data Collection ◽  
End Of Life ◽  
Cancer Registry ◽  
End Of Life Care ◽  
Life Care ◽  
National Data ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Area Of Interest ◽  
Registry System

Medical assistance in dying (MAID) is a relatively new phenomenon in Canada, and is therefore a growing area of interest in the legal and medical communities. Research is hampered, however, by the lack of a standardized approach to collecting data on MAID cases. The authors first discuss the importance of having comprehensive data to improving preventative and end-of-life care across Canada. The authors then canvas the existing framework for reporting MAID cases in Canada before noting its deficiencies, most importantly, a lack of comprehensive, nation-wide data collection. The authors then propose a model for national data collection based on the existing Canadian cancer registry system.

scholarly journals Over the Great Wall: A Qualitative Descriptive Study of the Experiences and Preferences of Chinese Immigrant Families when Receiving Hospice Services in New Zealand

2021 ◽  
Author(s):  
◽  
Joanna Clare Hathaway
Keyword(s):  
New Zealand ◽  
End Of Life Care ◽  
Immigrant Families ◽  
Chinese Immigrants ◽  
Descriptive Study ◽  
Sensitive Information ◽  
Chinese Immigrant ◽  
Life Care ◽  
Chinese Immigrant Families ◽  
Qualitative Descriptive

<p>This thesis discusses the background, processes, findings and recommendations of a qualitative descriptive study to explore and describe the experiences and preferences of Chinese immigrant families when receiving hospice services in New Zealand (NZ). The study arose from clinical practice questions about how hospice services were providing end-of-life care to the growing number of Chinese immigrants in NZ. With the assistance of a Cultural Advisor and a team of professional interpreters, eight bereaved Chinese immigrants living in the greater Auckland area who had cared for a terminally ill close family member with hospice service involvement were interviewed using a semi-structured approach. Participants were asked to describe their family support in NZ as well as their experiences of referral to a hospice, the types of care and treatment provided, communication processes between staff and the patient/family, care in the patient's last days of life, comparisons with care provided in their country of origin and suggestions for NZ hospice service improvements. Four key themes emerged: 1) Unfamiliar territory - participants were unfamiliar with the role or services of hospice and staff's lack of awareness of Chinese customs had led to distressing situations; 2) Service experiences and expectations - while some services were deemed useful others were not; participants had expected more medical treatments to manage the patient's symptoms; deaths in in-patient settings were less concerning to families and were preferred to deaths at home; 3) Support to cope - participants wanted more psychological support from hospice and regarded the maintenance of hope as a key component of a good death; 4) Uncovering sensitive information - families wanted to be consulted before sensitive information was discussed with patients and they preferred information to be uncovered slowly and gently to avoid causing the patient psychological harm. Recommendations for hospice service development included: improved access to information for families; greater provision of support services, especially for patients and families at home; education for hospice staff about Chinese culture and customs; options for in-patient admission in the last days of life; and the involvement of families in disclosure decisions. It is hoped that by responding to the experiences and preferences shared by participants, hospice services will be better equipped to address the end-of-life care needs of Chinese immigrant families.</p>

scholarly journals Over the Great Wall: A Qualitative Descriptive Study of the Experiences and Preferences of Chinese Immigrant Families when Receiving Hospice Services in New Zealand

2021 ◽  
Author(s):  
◽  
Joanna Clare Hathaway
Keyword(s):  
New Zealand ◽  
End Of Life Care ◽  
Immigrant Families ◽  
Chinese Immigrants ◽  
Descriptive Study ◽  
Sensitive Information ◽  
Chinese Immigrant ◽  
Life Care ◽  
Chinese Immigrant Families ◽  
Qualitative Descriptive

<p>This thesis discusses the background, processes, findings and recommendations of a qualitative descriptive study to explore and describe the experiences and preferences of Chinese immigrant families when receiving hospice services in New Zealand (NZ). The study arose from clinical practice questions about how hospice services were providing end-of-life care to the growing number of Chinese immigrants in NZ. With the assistance of a Cultural Advisor and a team of professional interpreters, eight bereaved Chinese immigrants living in the greater Auckland area who had cared for a terminally ill close family member with hospice service involvement were interviewed using a semi-structured approach. Participants were asked to describe their family support in NZ as well as their experiences of referral to a hospice, the types of care and treatment provided, communication processes between staff and the patient/family, care in the patient's last days of life, comparisons with care provided in their country of origin and suggestions for NZ hospice service improvements. Four key themes emerged: 1) Unfamiliar territory - participants were unfamiliar with the role or services of hospice and staff's lack of awareness of Chinese customs had led to distressing situations; 2) Service experiences and expectations - while some services were deemed useful others were not; participants had expected more medical treatments to manage the patient's symptoms; deaths in in-patient settings were less concerning to families and were preferred to deaths at home; 3) Support to cope - participants wanted more psychological support from hospice and regarded the maintenance of hope as a key component of a good death; 4) Uncovering sensitive information - families wanted to be consulted before sensitive information was discussed with patients and they preferred information to be uncovered slowly and gently to avoid causing the patient psychological harm. Recommendations for hospice service development included: improved access to information for families; greater provision of support services, especially for patients and families at home; education for hospice staff about Chinese culture and customs; options for in-patient admission in the last days of life; and the involvement of families in disclosure decisions. It is hoped that by responding to the experiences and preferences shared by participants, hospice services will be better equipped to address the end-of-life care needs of Chinese immigrant families.</p>

“Dying with a Smile, Just Knowing that Somebody’s Listened to Me”: End-Of-Life Care and Medical Assistance in Dying in Canadian Prisons

2021 ◽  
pp. 003022282110523
Author(s):  
Jessica Shaw ◽  
Peter Driftmier
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Death And Dying ◽  
Care Program ◽  
Life Care ◽  
Medical Assistance ◽  
Eligibility Criteria ◽  
Medical Assistance In Dying ◽  
Program Support ◽  
Sound Policy

Medical assistance in dying (MAiD) has been legal in Canada since 2016 and some incarcerated patients who are at the end of their lives are eligible for the procedure. Interviews with nine incarcerated men at a federal penitentiary in Canada provide insight into some of the ways that people who are navigating aging and end-of-life in prison think about MAiD. Interview themes are organized around: experience with death and dying; possibilities and barriers related to applications for release from prison at end-of-life; experiences of peer-caregiving in a prison palliative care program; support for MAiD and the expansion of eligibility criteria; what a good death looks like. Themes are contextualized alongside federal guidelines related to end-of-life care (EOLC) and MAiD for prisoners, highlighting that sound policy requires both generalizable principles and attention to nuance. MAiD rests on patient voluntariness, and thus autonomy over EOLC decisions is paramount for prisoners.

scholarly journals Medical assistance in dying legislation: Hospice palliative care providers’ perspectives

2021 ◽  
pp. 096973302110120
Author(s):  
Soodabeh Joolaee ◽  
Anita Ho ◽  
Kristie Serota ◽  
Matthieu Hubert ◽  
Daniel Z Buchman
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Health Providers ◽  
Care Providers ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Care Plans ◽  
Hospice Palliative Care

Background: After over 4 years since medical assistance in dying legalization in Canada, there is still much uncertainty about how this ruling has affected Canadian society. Objective: To describe the positive aspects of medical assistance in dying legalization from the perspectives of hospice palliative care providers engaging in medical assistance in dying. Design: In this qualitative descriptive study, we conducted an inductive thematic analysis of semi-structured interviews with hospice palliative care providers. Participants and setting: Multi-disciplinary hospice palliative care providers in acute, community, residential, and hospice care in Vancouver and Toronto, Canada, who have engaged in end-of-life care planning with patients who have inquired about and/or requested medical assistance in dying. Ethical considerations: The research proposal was approved by University of British Columbia Research Ethics Board in Vancouver and University Health Network in Toronto. Participants were informed regarding the research goals, signed a written consent, and were assigned pseudonyms. Results: The 48 participants included hospice palliative care physicians (n = 22), nurses (n = 15), social workers (n = 7), and allied health providers (n = 4). The average interview length was 50 min. Positive aspects of medical assistance in dying legalization were identified at (1) the individual level: (a) a new end-of-life option, (b) patients’ last chance to express control over their lives, (c) patient and family comfort and relief, and (d) a unique learning experience for hospice palliative care providers; (2) the team level: (a) supportive collegial relationships, (b) broadened discussions about end-of-life and palliative care, and (c) team debriefs provide opportunities for education and support; and (3) the institutional level: (a) improved processes to facilitate the implementation logistics. Conclusion: While being involved in the medical assistance in dying process is complex and challenging, this study sheds light on the positive aspects of medical assistance in dying legalization from the hospice palliative care provider’s perspectives. Medical Assistance in Dying legalization has resulted in improved end-of-life conversations between hospice palliative care providers, patients, and their families. Improved communication leads to a better understanding of patients’ end-of-life care plans and bridges some of the existing gaps between hospice palliative care and medical assistance in dying.

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