Socioeconomic Status and Medical Assistance in Dying: A Regional Descriptive Study

2021 ◽  
pp. 082585972110530
Author(s):  
Manny Tran ◽  
Kimia Honarmand ◽  
Robert Sibbald ◽  
Fran Priestap ◽  
Simon Oczkowski ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Vulnerable Groups ◽  
Income Quintile ◽  
Gis Mapping ◽  
Future Research ◽  
Low Ses ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Mapping Software ◽  
Aid In Dying

Purpose Concerns that medical assistance in dying (MAiD) may harm vulnerable groups unable to access medical treatments and social supports have arisen since the legalization of MAiD on June 17, 2016; however, there is little research on the topic. The purpose of this study is to investigate the socioeconomic status (SES) of patients who request MAiD at the London Health Sciences Centre (LHSC). Methods A retrospective analysis of patients from the LHSC MAiD database between June 6, 2016 and December 20, 2019 was conducted. Patients were linked to income data from the 2016 Canadian Census, and their corresponding income quintile was a proxy for SES. Geographic information system (GIS) mapping software was used to visualize the distribution of income and MAiD requests. Results 39.4% of the LHSC catchment area was classified as low SES. Two hundred thirty-seven (58.1%) MAiD requests came from low SES patients and 171 (41.9%) requests came from high SES patients. Two hundred fifty-nine (63.5%) patients who requested a MAiD assessment did not receive MAiD following their request. Of the 237 lower SES patients, 150 (63.3% [95% CI 57.2-69.3]) did not receive MAiD. Of the 171 higher SES patients, 109 (63.7% [95% CI 56.5-70.9]) did not receive MAiD. Conclusion A disproportionate number of requests for a MAiD assessment at LHSC came from lower SES patients; however, similar proportions of patients who requested MAiD from each SES group received aid in dying. Future research should explore why a disproportionately high number of low SES patients request MAiD at LHSC.

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 Author(iz)ing Death: Medical Aid-in-Dying and the Morality of Suicide

2019 ◽  
Vol 34 (1) ◽  
pp. 53-77 ◽  
Author(s):  
Anita Hannig
Keyword(s):  
Public Discourse ◽  
Medical Assistance ◽  
Death With Dignity ◽  
Assisted Death ◽  
Medical Aid ◽  
Medical Assistance In Dying ◽  
Aid In Dying ◽  
Death With Dignity Act ◽  
Twentieth Anniversary ◽  
Dignity Act

In 2017, Oregon marked the twentieth anniversary of enacting the Death with Dignity Act, allowing terminally ill, mentally competent adult patients to end their life by ingesting a lethal medication prescribed by their physician. In U.S. public discourse, medical aid-in-dying is frequently equated with the terminology and morality of suicide, much to the frustration of those who use and administer the law. This article reflects on the stakes of maintaining a distinction between a medically assisted death and the most common cultural category for self-inflicted death—suicide. It uncovers the complicated dialectic between authorship and authorization that characterizes medical assistance in dying and attendant moralities of purposive death, speaking to broader disciplinary concerns in the cultural study of death and medicine. By stressing the primacy of debilitating, life-limiting illness in an aided death and by submitting such a death to the rationale and management of institutionalized medicine, advocates carve out a form of intentional death that occupies a category of its own. The diffusion of agency onto a patient’s fatal illness, medicine, and the state—both discursively and in practice—enhances the moral and social acceptability of an assisted death, which becomes an authorized form of dying that looks very different from the socially deviant act of suicide.

Mental illness and medical aid in dying

2020 ◽  
Author(s):  
Gali Katznelson ◽  
Jacek Orzylowski
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Disorder ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Medical Condition ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Aid In Dying

A 2017 survey of 529 psychiatrists in Canada found that while 72% of psychiatrists supported medical assistance in dying (MAID) in some cases, only 29.4% supported MAID solely on the basis of mental disorders.  Understanding and addressing the concerns of mental health professionals will be crucial in deciding whether and how to expand MAID solely for a mental disorder in Canada. The report, “The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder Is the Sole Underlying Medical Condition,” authored by The Council of Canadian Academies, highlights some concerns that mental health professionals might harbour. These include potentially feeling that there is a conflict between providing MAID and their duties as mental health care workers, the subjectivity of the current law, and Canada’s inequitable mental health care system.

scholarly journals The provision of medical assistance in dying: protocol for a scoping review

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017888 ◽  
Author(s):  
Simon J W Oczkowski ◽  
Ian Ball ◽  
Carol Saleh ◽  
Gaelen Kalles ◽  
Anatoli Chkaroubo ◽  
...  
Keyword(s):  
Capital Punishment ◽  
Scoping Review ◽  
Assisted Suicide ◽  
Future Research ◽  
Medical Assistance ◽  
Knowledge Gaps ◽  
Eligibility Criteria ◽  
Assisted Death ◽  
Medical Assistance In Dying ◽  
Clinical Trial Registries

IntroductionMedical assistance in dying (MAID), a term encompassing both euthanasia and assisted suicide, was decriminalised in Canada in 2015. Although Bill C-14 legislated eligibility criteria under which patients could receive MAID, it did not provide guidance regarding the technical aspects of providing an assisted death. Therefore, we propose a scoping review to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of MAID, in order to identify knowledge gaps and areas for future research.Methods and analysisWe will search electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO), clinical trial registries, conference abstracts, and professional guidelines and recommendations from jurisdictions where MAID is legal, up to June 2017. Eligible report types will include technical summaries, institutional policies, practice surveys, practice guidelines and clinical studies. We will include all descriptions of MAID provision (either euthanasia or assisted suicide) in adults who have provided informed consent for MAID, for any reason, including reports where patients have provided consent to MAID in advance of the development of incapacity (eg, dementia). We will exclude reports in which patients receive involuntary euthanasia (eg, capital punishment). Two independent investigators will screen and select retrieved reports using pilot-tested screening and eligibility forms, and collect data using standardised data collection forms. We will summarise extracted data in tabular format with accompanying descriptive statistics and use narrative format to describe their clinical relevance, identify knowledge gaps and suggest topics for future research.Ethics and disseminationThis scoping review will map the range and scope of the existing literature on the provision of MAID in jurisdictions where the practice has been decriminalised. The review will be disseminated through conference presentations and publication in a peer-reviewed journal. These results will be useful to clinicians, policy makers and researchers involved with MAID.

scholarly journals Provision of medical assistance in dying: a scoping review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036054
Author(s):  
Max Zworth ◽  
Carol Saleh ◽  
Ian Ball ◽  
Gaelen Kalles ◽  
Anatoli Chkaroubo ◽  
...  
Keyword(s):  
Scoping Review ◽  
Future Research ◽  
Medical Assistance ◽  
Self Administration ◽  
Eligibility Criteria ◽  
Medical Assistance In Dying ◽  
Oral Medications ◽  
Clinical Trial Registries ◽  
Oral Agents

ObjectivesThe purpose of this study is to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of medical assistance in dying (MAID) in order to identify knowledge gaps and areas for future research.DesignScoping review.Search strategyWe searched electronic databases (MEDLINE, EMBASE, PsychINFO, CINAHL and CENTRAL), clinical trial registries, conference abstracts and professional guidelines from jurisdictions where MAID is legal, up to February 2020. Eligible report types included technical summaries, institutional policies, practice surveys, practice guidelines and clinical studies that describe MAID provision in adults who have provided informed consent for MAID.Results163 articles published between 1989 and 2020 met eligibility criteria. 75 studies described details for MAID administered by intravenous medications and 50 studies provided data on oral medications. In intravenous protocols, MAID was most commonly administered using a barbiturate (34/163) or propofol (22/163) followed by a neuromuscular blocker. Oral protocols most often used barbiturates alone (37/163) or in conjunction with an opioid medication (7/163) and often recommended using a prokinetic agent prior to lethal drug ingestion. Complications included prolonged duration of the dying process, difficulty in obtaining intravenous access and difficulty in swallowing oral agents. Most commonly, the role of physicians was prescribing (83/163) and administering medications (75/163). Nurses’ roles included administering medications (17/163) and supporting the patient (16/163) or family (13/163). The role of families involved providing support to the patient (17/163) and bringing medications from the pharmacy for self-administration (4/163).ConclusionsWe identified several trends in MAID provision including common medications and doses for oral and parenteral administration, roles of healthcare professionals and families, and complications that may cause patient, family and provider distress. Future research should aim to identify the medications, dosages, and administration techniques and procedures that produce the most predictable outcomes and mitigate distress for those involved.

“I Understand What They’re Going through”: How Socioeconomic Background Shapes the Student Service-learning Experience

2019 ◽  
Vol 47 (3) ◽  
pp. 204-218 ◽  
Author(s):  
Molly Clever ◽  
Karen S. Miller
Keyword(s):  
Socioeconomic Status ◽  
Service Learning ◽  
Food Insecurity ◽  
Low Socioeconomic Status ◽  
Learning Experience ◽  
Socioeconomic Background ◽  
Future Research ◽  
Low Ses ◽  
Service Learning Pedagogy ◽  
Low Ses Students

Traditional service-learning pedagogy assumes that learning occurs when contact between relatively advantaged students and a relatively disadvantaged service population reduces prejudice. However, little is known about how students whose backgrounds are similar to the populations they serve process this learning experience. This study explores the connections between socioeconomic status and learning trajectories within service-learning. Students provided written reflections on a service-learning experience focused on food insecurity as part of course requirements. Analysis reveals that students with low socioeconomic status (SES) demonstrate different learning processes than medium- and high-SES students. Namely, low-SES students were less likely than high-SES students to hold prejudiced attitudes prior to service, and low-SES students emphasized a systemic understanding of food insecurity and poverty, while medium- and high-SES students were much more likely to emphasize an individualist understanding. We discuss the implications of these findings for future research to improve service-learning pedagogy for students of diverse socioeconomic backgrounds.

scholarly journals Barriers and facilitators to medical assistance in dying (MAID) discussions in primary care

2020 ◽  
Author(s):  
◽  
Daphne Young
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Research Question ◽  
Primary Care Providers ◽  
Barriers And Facilitators ◽  
Future Research ◽  
Care Providers ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Interpersonal Factors

In Canada, medical assistance in dying (MAiD) is an end of life intervention intended to offer increased control to Canadians within the dying process (Brassfield & Buchbinder, 2020). Despite the legalization of MAiD in 2016 and developments in MAiD research, many primary care providers (PCPs) reported feeling reluctant to discuss MAiD with their patients (Otte, Jung, Elger, & Bally, 2017). In Canada, PCPs are typically medical doctors (MDs) or nurse practitioners (NPs) who care for patients in outpatient, non-acute care settings (Statistics Canada, 2019). As limited research has been synthesized on barriers and facilitators of MAiD discussions within the Canadian primary care context, the purpose of this integrative literature review (ILR) was to assess what factors promoted and prevented PCPs from discussing MAiD with their patients. After identifying a research question and related keywords, six databases were searched to identify relevant studies. The initial search yielded 1,874 results, which underwent inclusion and exclusion criteria and resulted in 12 references being included in the review. After collating the data, evaluating it, and summarizing the results, facilitators and barriers that affected the discussion of MAiD between PCPs and patients were divided into intrinsic and interpersonal factors. Intrinsic factors included PCP emotions, values, beliefs, education, and training, while interpersonal factors included communication, relationship, and administrative burdens (Brooks, 2019; Brassfield & Buchbinder, 2020; Selby & Bean, 2019; Kelly & Varghese, 2006; Pasman, Willems, & Onwuteaka-Philipsen, 2013; Hagens, Onwuteaka-Philipsen, & Pasman, 2017). Based on the findings of this review, strategies to promote MAiD discussions between PCPs and patients were outlined. Recommendations included identifying and addressing values, beliefs, and emotions; developing communication skills and strategies; promoting patientii provider relationships; and mitigating administrative burdens (Kelly & Varghese, 2006; Selby & Bean, 2019; Pasman et al., 2013; Brooks, 2019). As MAiD-related research in Canada progresses through its pioneering phase, future research has been suggested to support the development of communication guides specific to MAiD as well as the evaluation of PCP approaches to MAiD discussions within the Canadian primary care setting (Selby & Bean, 2019; Brooks, 2019).

Medical Assistance in Dying in Canada: Implications and Considerations for Music Therapists Around the Globe

2020 ◽  
Author(s):  
Amy Clements-Cortes ◽  
Joyce Yip
Keyword(s):  
Music Therapy ◽  
End Of Life ◽  
Assisted Suicide ◽  
Future Research ◽  
Voluntary Euthanasia ◽  
Healthcare Team ◽  
Medical Assistance ◽  
Music Therapists ◽  
Medical Assistance In Dying ◽  
Medical And Healthcare

Abstract Physician-assisted suicide and voluntary euthanasia are two procedures of Medical Assistance in Dying (MAiD) that are readily requested by patients internationally. In April 2016, the legalization of these procedures occurred in Canada after the pursuit of many jurisdictional cases. Known as Bill C-14, this legislation aims to balance patient autonomy at end-of-life with revised standardizations for medical and healthcare professionals. Music therapists may be included in the medical and healthcare team that can be recommended by patients considering MAiD. At present, there are no written guidelines that empirically outline the role of music therapists in this area. This paper explores the global history of MAiD as well as MAiD in the Canadian healthcare system and its implications. Information on the legislation Bill C-14 will be explained, along with a discussion on the current practices of music therapy at end-of-life and the potential scope of a music therapist during the MAiD procedure. Ethical issues and future research are also presented as recommendations to healthcare and music therapy professionals.

Barriers to Access: A Feminist Analysis of Medically Assisted Dying and the Experience of Marginalized Groups

2019 ◽  
pp. 003022281987377
Author(s):  
Tina Sikka
Keyword(s):  
Health Care Providers ◽  
Implicit Bias ◽  
Future Research ◽  
Institutional Research ◽  
Care Providers ◽  
Medical Assistance ◽  
Patient Centered ◽  
Medical Assistance In Dying ◽  
Marginalized Groups ◽  
Barriers To Access

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.

Impact of medical assistance in dying (MAiD) on family caregivers

2019 ◽  
pp. bmjspcare-2018-001686
Author(s):  
Rachel Goldberg ◽  
Rinat Nissim ◽  
Ekaterina An ◽  
Sarah Hales
Keyword(s):  
Family Caregivers ◽  
Terminal Illness ◽  
Well Being ◽  
Moral Dilemmas ◽  
Future Research ◽  
Anticipatory Grief ◽  
Medical Assistance ◽  
Loved One ◽  
Medical Assistance In Dying ◽  
The Impact

Medical assistance in dying (MAiD) is a globally polarising topic which often sparks debate surrounding the ethical and moral dilemmas that arise with a life-ending intervention. To gain a better understanding of this intervention, it is important to explore the experience of those most intimately affected by MAiD. Family caregivers of those with a terminal illness are the backbone of the healthcare and support team, often providing a substantial amount of informal care while at the same time coping with their own distress and anticipatory grief. However, we know the least about how MAiD impacts the psychosocial well-being of these same individuals. The aim of this article is to explore the experience of MAiD from the family caregiver perspective, namely their beliefs and opinions about the intervention, how the process of MAiD impacts them, how the intervention shapes their view of their loved one’s quality of death, and the psychosocial outcomes after the passing of their loved one. Beyond the literature, challenges within both the clinical and research realms will be discussed and future directions will be offered. While MAiD is currently legal in only a small number of countries, a better understanding of the impact of MAiD will help inform policy and legislation as they are developed in other jurisdictions. Further, this article aims to inform future research and clinical interventions in order to better understand and support those seeking MAiD and their families.

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