scholarly journals Refusing care as a legal pathway to medical assistance in dying

2019 ◽  
Vol 2 (2) ◽  
pp. 73-82
Author(s):  
Jocelyn Downie ◽  
Matthew J Bowes
Keyword(s):  
Spinal Stenosis ◽  
Healthcare Providers ◽  
Natural Death ◽  
Medical Assistance ◽  
Competent Patient ◽  
Medical Assistance In Dying ◽  
Ethical Implications ◽  
Brain Stroke ◽  
The Right ◽  
Right To Refuse

Can a competent individual refuse care in order to make their natural death reasonably foreseeable in order to qualify for medical assistance in dying (MAiD)? Consider a competent patient with left-side paralysis following a right brain stroke who is not expected to die for many years; normally his cause of death would not be predictable. However, he refuses regular turning, so his physician can predict that pressure ulcers will develop, leading to infection for which he will refuse treatment and consequently die. Is he now eligible for MAiD? Consider a competent patient with spinal stenosis (a non-fatal condition) who refuses food (but not liquids in order not to lose capacity from dehydration). Consequently, her physician can predict death from starvation. Is she now eligible for MAiD? Answering these questions requires that we answer three sub-questions: 1) do competent patients have the right to refuse care?; 2) do healthcare providers have a duty to respect such refusals?; and 3) are deaths resulting from refusals of care natural for the purposes of determining whether a patient is eligible for MAiD? If a competent patient has the right to refuse some particular care, and healthcare providers have a duty to respect that refusal, and if the death that would result from the refusal of that care is natural, then that refusal of care is a legal pathway to MAiD. However, if the competent patient does not have the right to refuse some particular care, or if healthcare providers do not have a duty to respect that refusal, or if the death that would result from the refusal of that care is not natural, then that refusal of care is not a legal pathway to MAiD. In this paper, we explore this complex legal terrain with the most profound of ethical implications – access to MAiD.

scholarly journals P.117 The opinion of Canadian spine surgeons on medical assistance in dying (MAID); a cross-sectional survey of Canadian spine society (CSS) members

2019 ◽  
Vol 46 (s1) ◽  
pp. S44
Author(s):  
E Leck ◽  
S Barry ◽  
S Christie
Keyword(s):  
Cervical Spinal Cord ◽  
Criminal Code ◽  
Supreme Court Of Canada ◽  
Medical Assistance ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical Assistance In Dying ◽  
Cord Injury ◽  
The Right ◽  
Spine Tumour

Background: On February 6, 2015, the Supreme Court of Canada struck down the Criminal Code absolute prohibition on assisted dying, and in June 2016 the new law, Bill C-14, came into effect allowing for medical assistance in dying. We sought to determine the attitudes and opinions of Canadian neurosurgeons and orthopedic spine surgeons regarding MAID. Methods: A cross-sectional survey was sent out to members of the Canadian Spine Society (CSS), which included 21 questions pertaining to opinions regarding MAID. Responses were collected between May-June 2016. Results: A total of 51 surgeons responded to the survey, comprised of a mix of spine surgeons from across the country. The majority of surgeons supported MAID (62.8%), and right of physicians to participate (82.4%). Most surgeons supported the right to conscientious objection (90.1%), but also mandatory duty to refer (49.0%). The conditions most frequently felt to be appropriate for MAID included metastatic spine tumour (76.5%), malignant intramedullary tumour (64.7%), primary malignant spine tumour (54.9%), cervical spinal cord injury with tetraplegia (49.0%) and multiple myeloma (33.3%). Conclusions: This study highlights the complex landscape that exists when discussing MAID, but also the overall support of physicians, and need for ongoing conversations, particularly with issues not addressed by the current legislation.

Canadian neurosurgeons’ views on medical assistance in dying (MAID): a cross-sectional survey of Canadian Neurosurgical Society (CNSS) members

2019 ◽  
Vol 45 (5) ◽  
pp. 309-313 ◽  
Author(s):  
Alwalaa Althagafi ◽  
Chris Ekong ◽  
Brian W Wheelock ◽  
Richard Moulton ◽  
Peter Gorman ◽  
...  
Keyword(s):  
Position Statement ◽  
Conscientious Objection ◽  
Supreme Court Of Canada ◽  
Medical Assistance ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical Assistance In Dying ◽  
Neurosurgical Society ◽  
Views And Perceptions ◽  
The Right

BackgroundThe Supreme Court of Canada removed the prohibition on physicians assisting in patients dying on 6 February 2015. Bill C-14, legalising medical assistance in dying (MAID) in Canada, was subsequently passed by the House of Commons and the Senate on 17 June 2016. As this remains a divisive issue for physicians, the Canadian Neurosurgical Society (CNSS) has recently published a position statement on MAID.MethodsWe conducted a cross-sectional survey to understand the views and perceptions among CNSS members regarding MAID to inform its position statement on the issue. Data was collected from May to June 2016.ResultsOf the 300 active membes of the CNSS who recevied the survey, 89 respondents completed the survey, 71% of whom were attending neurosurgeons and 29% were neurosurgery residents. Most respondents,74.2%, supported the right of physicians to participate in MAID with 7.8% opposing. 37% had current patients in their practice fitting the criteria for MAID. 23.6% had been asked by patients to assist with MAID, but only 11% would consider personally providing it. 84% of neurosurgeons surveyed supported the physicians’ right to conscientious objection to MAID while 21% thought attending surgeons should be removed from the inquiry and decision-making process. 43.8% agreed that the requirment to refer a patient to a MAID service should be mandatory. Glioblastoma multiforme (65%), quadriplegia/quadriparesis secondary to spinal tumour/trauma (54%) and Parkinson’s disease (24%) were the most common suggested potential indications for MAID among the neurosurgical population.ConclusionsOur results demonstrate that most neurosurgeons in Canada are generally supportive of MAID in select patients. However, they also strongly support the physicians’ right to conscientious objection.

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.

Professional experiences of formal healthcare providers in the provision of medical assistance in dying (MAiD): A scoping review

2021 ◽  
pp. 1-15
Author(s):  
Valerie Ward ◽  
Shannon Freeman ◽  
Taylor Callander ◽  
Beibei Xiong
Keyword(s):  
Scoping Review ◽  
Positive Emotions ◽  
Healthcare Providers ◽  
Medical Assistance ◽  
Exclusion Criteria ◽  
Nursing Support ◽  
Team Members ◽  
Medical Assistance In Dying ◽  
Professional Experiences ◽  
The Usa

Abstract Objective This scoping review describes the existing literature which examines the breadth of healthcare providers’ (HCP's) experiences with the provision of medical assistance in dying (MAiD). Method This study employed a scoping review methodology: (1) identify research articles, (2) identify relevant studies, (3) select studies based on inclusion/exclusion criteria, (4) chart the data, and (5) summarize the results. Results In total, 30 papers were identified pertaining to HCP's experiences of providing MAiD. Fifty-three percent of the papers were from Europe (n = 16) and 40% of studies were from the USA or Canada (n = 12). The most common participant populations were physicians (n = 17) and nurses (n = 12). This scoping review found that HCPs experienced a variety of emotional responses to providing or providing support to MAiD. Some HCPs experienced positive emotions through helping patients at the end of the patient's life. Still other HCPs experienced very intense and negative emotions such as immense internal moral conflict. HCPs from various professions were involved in various aspects of MAiD provision such as responding to initial requests for MAiD, supporting patients and families, nursing support during MAiD, and the administration of medications to end of life. Significance of results This review consolidates many of the experiences of HCPs in relation to the provision of MAiD. Specifically, this review elucidates many of the emotions that HCPs experience through participation in MAiD. In addition to describing the emotional experiences, this review highlights some of the roles that HCPs participate in with relation to MAiD. Finally, this review accentuates the importance of team supports and self-care for all team members in the provision of MAiD regardless of their degree of involvement.

scholarly journals What’s suffering got to do with it? A qualitative study of suffering in the context of Medical Assistance in Dying (MAID)

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Barbara Pesut ◽  
David Kenneth Wright ◽  
Sally Thorne ◽  
Margaret I. Hall ◽  
Gloria Puurveen ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Healthcare Providers ◽  
Clinical Encounter ◽  
Assessment Process ◽  
Assisted Death ◽  
Medical Assistance In Dying ◽  
Empirical Inquiry ◽  
Practice Knowledge ◽  
Right Reason ◽  
The Right

Abstract Background Intolerable suffering is a common eligibility requirement for persons requesting assisted death, and although suffering has received philosophic attention for millennia, only recently has it been the focus of empirical inquiry. Robust theoretical knowledge about suffering is critically important as modern healthcare provides persons with different options at end-of-life to relieve suffering. The purpose of this paper is to present findings specific to the understanding and application of suffering in the context of MAID from nurses’ perspectives. Methods A longitudinal qualitative descriptive study using semi-structured telephone interviews. Inductive analysis was used to construct a thematic account. The study received ethical approval and all participants provided written consent. Results Fifty nurses and nurse practitioners from across Canada were interviewed. Participants described the suffering of dying and provided insights into the difficulties of treating existential suffering and the iatrogenic suffering patients experienced from long contact with the healthcare system. They shared perceptions of the suffering that leads to a request for MAID that included the unknown of dying, a desire for predictability, and the loss of dignity. Eliciting the suffering story was an essential part of nursing practice. Knowledge of the story allowed participants to find the balance between believing that suffering is whatever the persons says it is, while making sure that the MAID procedure was for the right person, for the right reason, at the right time. Participants perceived that the MAID process itself caused suffering that resulted from the complexity of decision-making, the chances of being deemed ineligible, and the heighted work of the tasks of dying. Conclusions Healthcare providers involved in MAID must be critically reflective about the suffering histories they bring to the clinical encounter, particularly iatrogenic suffering. Further, eliciting the suffering stories of persons requesting MAID requires a high degree of skill; those involved in the assessment process must have the time and competency to do this important role well. The nature of suffering that patients and family encounter as they enter the contemplation, assessment, and provision of MAID requires further research to understand it better and develop best practices.

scholarly journals “For Their Own Good”: A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) where Mental Illness Is the Sole Underlying Condition

2018 ◽  
Vol 63 (7) ◽  
pp. 451-456 ◽  
Author(s):  
Justine Dembo ◽  
Udo Schuklenk ◽  
Jonathan Reggler
Keyword(s):  
Mental Illness ◽  
Patient Autonomy ◽  
Medical Condition ◽  
Value Of Life ◽  
Natural Death ◽  
Medical Assistance ◽  
Liberal Democracies ◽  
Medical Assistance In Dying ◽  
Underlying Medical Condition

Canada is approaching its federal government’s review of whether patients should be eligible for medical assistance in dying (MAID) where mental illness is the sole underlying medical condition, and when “natural death” is not “reasonably foreseeable”. For those opposed, arguments involve the following themes: capacity, value of life, vulnerability, stigma, irremediability, and the role of physicians. It has also been suggested that those who are able-bodied should have to kill themselves, even though suicide may be painful, lonely, and violent. Opponents of MAID for severe, refractory suffering due to mental illness imply that it is acceptable to remove agency from such patients on paternalistic grounds. After years of efforts to destigmatise mental illness, these kinds of arguments effectively declare all patients with mental illness, regardless of capacity, unable to make considered choices for themselves. The current paper argues that decisions about capacity must be made on an individual-patient basis. Given the rightful importance granted to respect for patient autonomy in liberal democracies, the wholesale removal of agency advocated by opponents of a permissive MAID regime is difficult to reconcile with Canadian constitutional values.

scholarly journals Implementation of Medical Assistance in Dying: An evaluation of clinician knowledge and perceptions at a large urban multi-site rehabilitation centre in Toronto

2018 ◽  
Vol 7 (5) ◽  
pp. 41
Author(s):  
Stephanie Hogg ◽  
Pria Nippak ◽  
Karen Spalding
Keyword(s):  
Healthcare Providers ◽  
Medical Assistance ◽  
Rehabilitation Centre ◽  
Eligibility Criteria ◽  
Hospital Policy ◽  
Medical Assistance In Dying ◽  
Knowledge Based ◽  
Improve Compliance ◽  
Mixed Feelings ◽  
Site Rehabilitation

Objective: Evaluate clinician knowledge and perceptions to ensure the newly implemented Medical Assistance in Dying (MAID) policies and guidelines are understood correctly to help facilitate the best possible experience for patients and their families.Methods: One hundred and twenty-five clinicians completed a survey, developed for this study, to determine their perceptions and knowledge base related to MAID.Results: The average grade on the knowledge-based portion of the survey was 69%. On average, respondents displayed a good understanding (84%) of the legislated eligibility criteria while room for improvement was noted for facility specific policy questions (65%) and general principle questions (71%). Analysis of perception-based questions indicated most respondents were in support of MAID, however, they expressed mixed feelings towards the ease of having MAID related conversations. Respondents expressed mixed opinions in relation to whether the facility was providing adequate training to staff. Sixty-four percent of respondents expressed interest in receiving further training relating to MAID.Conclusions: Education for healthcare providers to ensure they understand the relevant hospital policy and guidelines is critical to improve compliance with the implementation of MAID. It is important to continue to understand and support the perceptions of clinicians to ensure that MAID is administered correctly and as effectively as possible.

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