Medical assistance in dying: implications for health systems from a scoping review of the literature

2019 ◽  
Vol 24 (3) ◽  
pp. 207-216 ◽  
Author(s):  
Jamie K. Fujioka ◽  
Raza M. Mirza ◽  
Christopher A. Klinger ◽  
Lynn P. McDonald
Keyword(s):  
Health Systems ◽  
Scoping Review ◽  
Grey Literature ◽  
Models Of Care ◽  
Careful Examination ◽  
Multidisciplinary Teams ◽  
Medical Assistance ◽  
Implementation Barriers ◽  
Regulatory Oversight ◽  
Medical Assistance In Dying

Objective Medical assistance in dying (MAiD) is the medical provision of substances to end a patient’s life at their voluntary request. While legal in several countries, the implementation of MAiD is met with ethical, legislative and clinical challenges, which are often overshadowed by moral discourse. Our aim was to conduct a scoping review to explore key barriers for the integration of MAiD into existing health systems. Methods We searched electronic databases (CINAHL, Embase, MEDLINE, and PsycINFO) and grey literature sources from 1990 to 2017. Studies discussing barriers and/or challenges to implementing MAiD from a health system’s perspective were included. Full-text papers were screened against inclusion/exclusion criteria for article selection. A thematic content analysis was conducted to summarize data into themes to highlight key implementation barriers. Results The final review included 35 articles (see online Appendix 1). Six categories of implementation challenges emerged: regulatory (n = 26), legal (n = 15), social (n = 9), logistical (n = 9), financial (n = 3) and compatibility with palliative care (n = 3). Within four of the six identified implementation barriers (regulatory, legal, social and logistical) were subthemes, which described barriers related to legalizing MAiD in more detail. Conclusion Despite multiple challenges related to its implementation, MAiD remains a requested end-of-life option, requiring careful examination to ensure adequate integration into existing health services. Comprehensive models of care incorporating multidisciplinary teams and regulatory oversight alongside improved clinician education may be effective to streamline MAiD services.

scholarly journals Artificial intelligence for good health: a scoping review of the ethics literature

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kathleen Murphy ◽  
Erica Di Ruggiero ◽  
Ross Upshur ◽  
Donald J. Willison ◽  
Neha Malhotra ◽  
...  
Keyword(s):  
Public Health ◽  
Artificial Intelligence ◽  
Global Health ◽  
Population Health ◽  
Health Systems ◽  
Scoping Review ◽  
Industrial Revolution ◽  
Ethical Issues ◽  
Grey Literature ◽  
Ethical Implications

Abstract Background Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective? Methods Eight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed. Results Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs). Conclusions The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.

scholarly journals Type and use of digital technology in learning health systems: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026204
Author(s):  
Lysanne Lessard ◽  
Agnes Grudniewicz ◽  
Antoine Sauré ◽  
Agnieszka Szczotka ◽  
James King ◽  
...  
Keyword(s):  
Health Systems ◽  
Scoping Review ◽  
Digital Technology ◽  
Technology Use ◽  
Data Extraction ◽  
Grey Literature ◽  
Future Research ◽  
Efficiency And Effectiveness ◽  
Ethical Approval ◽  
Review Protocol

IntroductionHealth systems in North America and Europe have been criticised for their lack of safety, efficiency and effectiveness despite rising healthcare costs. In response, healthcare leaders and researchers have articulated the need to transform current health systems into continuously and rapidly learning health systems (LHSs). While digital technology has been envisioned as providing the transformational power for LHSs by generating timely evidence and supporting best care practices, it remains to be ascertained if it is indeed playing this role in current LHS initiatives. This paper presents a protocol for a scoping review that aims at providing a comprehensive understanding of how and to what extent digital technology is used within LHSs. Results will help to identify gaps in the literature as a means to guide future research on this topic.Methods and analysisMultiple databases and grey literature will be searched with terms related to learning health systems. Records selection will be done in duplicate by two reviewers applying pre-defined inclusion and exclusion criteria. Data extraction from selected records will be done by two reviewers using a piloted data charting form. Results will be synthesised through a descriptive numerical summary and a mapping of digital technology use onto types of LHSs and phases of learning within LHSs.Ethics and disseminationEthical approval is not required for this scoping review. Preliminary results will be shared with stakeholders to account for their perspectives when drawing conclusions. Final results will be disseminated through presentations at relevant conferences and publications in peer-reviewed journals.

scholarly journals Artificial Intelligence for Good Health: A Scoping Review of the Ethics Literature

2020 ◽  
Author(s):  
Kathleen Murphy ◽  
Erica Di Ruggiero ◽  
Ross Upshur ◽  
Donald J. Willison ◽  
Neha Malhotra ◽  
...  
Keyword(s):  
Public Health ◽  
Artificial Intelligence ◽  
Global Health ◽  
Population Health ◽  
Health Systems ◽  
Scoping Review ◽  
Industrial Revolution ◽  
Ethical Issues ◽  
Grey Literature ◽  
Ethical Implications

Abstract Background Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have the potential to advance health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective? Methods Eight electronic databases were searched for peer reviewed and grey literature using the overarching concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data abstraction form, and a descriptive and thematic analysis was performed. Results Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability, and bias. Largely missing from the reviewed literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs). Conclusions The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.

scholarly journals Medical assistance in dying: A gendered issue in Canada?

Spectrum ◽  
2020 ◽  
Author(s):  
Freya Hammond-Thrasher
Keyword(s):  
Human Life ◽  
Grey Literature ◽  
Gender Issues ◽  
Personal Choice ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Liberal Democratic ◽  
People With Mental Illness ◽  
Women's Lives ◽  
Controversial Topic

Medical assistance in dying (MAiD) remains a controversial topic in Canada despite its legalization in 2015. Opponents of MAiD legislation often cite ‘pro-life’ or ‘pro-choice’ arguments which emphasize the value of human life. While all eligible adults are currently able to request MAiD, scholars, citizens, and religious organizations have expressed concerns that women, as a marginalized group, are at risk to request assisted dying due to gendered circumstances rather than personal choice. My research investigates the claim that women’s lives are threatened by MAiD legislation and analyzes the ways in which MAiD is a gendered issue. Drawing from seventeen academic, government, and grey literature sources, I identify and challenge three key discursive categories used to present women as vulnerable under MAiD legislation. I argue that opponents of MAiD legislation co-opt feminist discourses to make normative claims which resonate with the values of individualism in Canadian liberal democratic society. In doing so, opponents of MAiD reproduce the same gender issues they claim to oppose and risk endangering women’s access to MAiD in Canada. I conclude with recommendations relevant to the next stage of MAiD legislation in Canada, which will debate whether other populations considered to be vulnerable, including mature minors and people with mental illness, will have access to MAiD.

scholarly journals Artificial Intelligence for Good Health: A Scoping Review of the Ethics Literature

2021 ◽  
Author(s):  
Kathleen Murphy ◽  
Erica Di Ruggiero ◽  
Ross Upshur ◽  
Donald J. Willison ◽  
Neha Malhotra ◽  
...  
Keyword(s):  
Public Health ◽  
Artificial Intelligence ◽  
Global Health ◽  
Population Health ◽  
Health Systems ◽  
Scoping Review ◽  
Industrial Revolution ◽  
Ethical Issues ◽  
Grey Literature ◽  
Ethical Implications

Abstract Background: Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective? Methods: Eight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed. Results: Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs). Conclusions: The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.

scholarly journals Primary care-based models of care for osteoarthritis: a scoping review protocol

2021 ◽  
Vol 4 ◽  
pp. 48
Author(s):  
Joice Cunningham ◽  
Frank Doyle ◽  
Jennifer M. Ryan ◽  
Barbara Clyne ◽  
Cathal Cadogan ◽  
...  
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Grey Literature ◽  
Models Of Care ◽  
Current Evidence ◽  
Future Research ◽  
Local Health ◽  
Prevalence Of Obesity ◽  
Specific Care ◽  
Local Health System

Background: The burden of osteoarthritis (OA) to individuals and health systems is substantial and is expected to increase due to population ageing and rising prevalence of obesity and multimorbidity. Primary care-based models of care (MoCs) are being increasingly developed in response to this growing burden. However, these MoCs have yet to be formally reviewed. A MoC can be defined as an ‘evidence-informed strategy, framework or pathway that outlines the optimal manner in which condition-specific care should be delivered to consumers within a local health system’. Objective: To identify and describe the available research regarding the extent, nature and characteristics of MoCs for OA that have been developed or evaluated in primary care. Methods: A scoping review will be conducted in accordance with the Arksey and O’Malley scoping review framework and the PRISMA-ScR guidelines. Systematic literature searches of MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and LILACs will be conducted from 2010 to present, aligning with publication dates of recent clinical guidelines. A structured iterative search of grey literature will be conducted. Full-text original quantitative or mixed method studies which describe the development or evaluation of MoCs for OA in primary care will be considered. Data will be charted and synthesised and a narrative synthesis will be conducted. Conclusions: This scoping review will provide a broad overview regarding the extent, nature and characteristics of the available literature on primary care based MoCs for OA. Findings will be used to identify gaps in the current evidence to identify areas for future research.

scholarly journals Models of care for frail older persons who present to the emergency department: a scoping review protocol

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Ya-Ling Huang ◽  
Megan McGonagle ◽  
Rebecca Shaw ◽  
Julie Eastham ◽  
Nemat Alsaba ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Scoping Review ◽  
Older Persons ◽  
Grey Literature ◽  
Models Of Care ◽  
The Body ◽  
Model Of Care ◽  
Frail Older People ◽  
Frail Older Persons

Abstract Background People aged ≥ 65 years comprise around 1 in 5 emergency department (ED) presentations. Many of these presentations occur due to complications associated with chronic diseases and frailty. This review aims to provide a comprehensive understanding of available research regarding models of care for frail older people presenting to the ED. Methods The Joanna Briggs Institute scoping review framework will be used to guide this review. Literature searches will be conducted in the following electronic databases (from January 2009 onwards): CINAHL via EBSCOhost, Ovid MEDLINE, Embase, SocINDEX. Grey literature will be identified through searching Google Scholar. This review will consider primary research studies (including observational and interventional studies) published in English on models of care for frail older people (aged ≥ 65) presenting to the ED. Two researchers will independently screen all citations, full-text articles, and abstract data. Potential disagreements will be resolved through discussion with a third researcher. Data extracted from included studies will include the following: author(s), year of publication, country, research design and aim, time frame of the study, study population and sample size, data collection methods, definition of frailty, model of care, and key findings that pertain to the ability to inform this review. The strength of the body of evidence will be assessed using the National Health and Medical Research Council level of evidence hierarchy body of evidence matrix. Data will be presented in a tabular format and accompanied by a narrative that describes the characteristics of the body of literature. Discussion Despite the increased number of ED presentations for frail older people, there has been no synthesis of the sources of evidence of model of care for frail older people in the setting of emergency care. The results of this scoping review will provide an overview of different models of care and help inform future research in the development of models of care for frail older persons, tailored to the healthcare system in the emergency context. Systematic review registration This scoping review has been registered in the Open Science Framework (osf.io/h2t94).

scholarly journals To what extent do supervised drug consumption services incorporate non-injection routes of administration? A systematic scoping review documenting existing facilities

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Kelsey A. Speed ◽  
Nicole D. Gehring ◽  
Katherine Launier ◽  
Daniel O’Brien ◽  
Sandy Campbell ◽  
...  
Keyword(s):  
Social Services ◽  
Scoping Review ◽  
Grey Literature ◽  
Models Of Care ◽  
Drug Consumption ◽  
Injection Drug ◽  
People Who Use Drugs ◽  
Routes Of Administration ◽  
Supervised Injection ◽  
Alternate Routes

Abstract Background Most of the existing research on supervised consumption services (SCS) is focused on injection drug use. Less is known about the applicability of SCS for people who consume drugs orally, intranasally, or through inhalation. This is problematic because people who use drugs through modes other than injection are also at risk of overdose death and other harm, and experience barriers accessing health and social services. We aimed to describe existing SCS models that accommodate these alternate routes of drug consumption, and synthesize available information on characteristics of program participants. Methods We conducted a systematic scoping review of 9 peer-reviewed and 13 grey literature databases on SCS that incorporate non-injection routes of consumption. We screened 22,882 titles, and excluded 22,843 (99.8%) articles. We ultimately included 39 (0.2%) full-text articles; 28 (72%) of these articles explicitly identified SCS that permit alternate routes of consumption and 21 (54%) discussed characteristics of participants who consume drugs through non-injection routes. Data on study characteristics, terms and definitions, and site and program participant characteristics were extracted and double-coded. Extracted data were analyzed using descriptive statistics and narrative synthesis. Results Included articles describe 48 SCS that permit non-injection routes of consumption, most of which were located in Germany. The majority of these SCS were legally sanctioned and had models of care that were largely comparable to supervised injection services. Notable differences included physical infrastructure such as ventilated rooms or outdoor areas to accommodate inhalation, and shorter time limits on non-injection drug consumption episodes. Program participants engaging in non-injection forms of consumption were typically men over the age of 30 and structurally vulnerable (e.g., experiencing homelessness or unstable housing). Conclusions Extant academic and grey literature indicates that site characteristics and demographics of program participants of SCS that permit non-injection routes of consumption largely reflect those of supervised injection services. Further research on the range of existing SCS that incorporate non-injection routes of consumption is needed to ensure high quality service provision, and improved health outcomes for people who consume drugs via oral, intranasal, and inhalation routes.

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 Reimagining community relationships for organizational learning: a scoping review with implications for a learning health system

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Crystal Milligan ◽  
Whitney Berta
Keyword(s):  
Organizational Learning ◽  
Transformative Learning ◽  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
English Language ◽  
Explicit Knowledge ◽  
Grey Literature ◽  
Specific Patient ◽  
Learning Health System

Abstract Background Communities represent a highly relevant source of knowledge with regard to not only healthcare performance but also sociocultural context, yet their role in learning health systems has not been studied. Situating the learning health system as an organization, this paper explores the phenomenon of organizational learning from or with communities (defined as one of ‘the people,’ such as a town, a specific patient group or another group directly receiving a healthcare service). Methods We conducted a scoping review to determine what is known about organizational learning from or with communities that the organization serves, and to contribute to a more comprehensive evidence base for building and operating learning health systems. In March 2019, we systematically searched six academic databases and grey literature, applying no date limits, for English language materials that described organizational learning in relation to knowledge transfer between an organization and a community. Numerous variables were charted in Excel and synthesized using frequencies and thematic analysis. We updated this search in August 2020. Results In total, 42 documents were included in our analysis. We found a disproportionate emphasis on learning explicit knowledge from community rather than on tacit knowledge or learning in equal partnership with community. Our review also revealed inconsistently defined concepts, tenuously linked with their theoretical and empirical foundations. Our findings provide insight to understand the organization-community learning relationship, including motives and power differentials; types of knowledge to be learned; structures and processes for learning; and transformative learning outcomes. Conclusions Our review makes a singular contribution to organizational learning literatures by drawing from diverse research disciplines such as health services, business and education to map what is known about learning from or with community. Broadly speaking, learning health systems literature would benefit from additional research and theory-building within a sociological paradigm so as to establish key concepts and associations to understand the nature of learning with community, as well as the practices that make it happen.

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