Implementation of Medical Assistance in Dying: A Scoping Review of Health Care Providers' Perspectives

Fujioka, Jamie; Mirza, Raza; McDonald, P; Klinger, Christopher

doi:10.1016/j.jpainsymman.2018.02.011

Cited by 87 publications

(102 citation statements)

References 47 publications

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“…Of particular interest in this review were findings that moral sense‐making in Canadian nurses was a dynamic process characterised by uncertainty and reflection (Beuthin, Bruce, & Scaia, 2018). Other reviews have focused more generally on the experiences of all healthcare providers but revealed similar findings of the emotional impact of MAiD (Fujioka, Mirza, McDonald, & Klinger, 2018) and the need for support and education for nursing, particularly in the ethical aspects of care and in conducting conversations around hastened death (Suva, Penney, & McPherson, 2019).…”

Section: Introductionmentioning

confidence: 83%

Riding an elephant: A qualitative study of nurses' moral journeys in the context of Medical Assistance in Dying (MAiD)

Pesut

Thorne

Storch

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To describes nurses' moral experiences with Medical Assistance in Dying in the Canadian context. Background Nurses perform important roles in Medical Assistance in Dying in Canada and do so within a unique context in which Medical Assistance in Dying is provided through healthcare services and where accessibility is an important principle. International literature indicates that participating in Medical Assistance in Dying can be deeply impactful for nurses and requires a high degree of moral sense‐making. Design A qualitative interview study guided by Interpretive Description using the COREQ checklist. Results Fifty‐nine nurses from across Canada participated in the study. The decision to participate in Medical Assistance in Dying was influenced by family and community, professional experience and nurses' proximity to the act of Medical Assistance in Dying. Nurses described a range of deep and sometimes conflicting emotional reactions provoked by Medical Assistance in Dying. Nurses used a number of moral waypoints to make sense of their decision including patient choice, control and certainty; an understanding that it was not about the nurse; a commitment to staying with patients through suffering; consideration of moral consistency; issues related to the afterlife; and the peace and gratitude demonstrated by patients and families. Discussion The depth of nurses' intuitional moral responses and their need to make sense of these responses are consistent with Haidt's theory of moral experience in which individuals use reasoning primarily to explain their moral intuition and in which moral change occurs primarily through compassionate social interaction. Further, work on the moral identity of nursing provides robust explanation of how nurses' moral decisions are contextually and relationally mediated and how they seek to guard patient vulnerability, even at their own emotional cost. Conclusion Medical Assistance in Dying is impactful for nurses, and for some, it requires intensive and ongoing moral sense‐making. Relevance to clinical practice There is a need to provide support for nurses' moral deliberation and emotional well‐being in the context of Medical Assistance in Dying care.

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Section: Introductionmentioning

confidence: 83%

Riding an elephant: A qualitative study of nurses' moral journeys in the context of Medical Assistance in Dying (MAiD)

Pesut

Thorne

Storch

et al. 2020

Journal of Clinical Nursing

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“…8 Notwithstanding that what is known about physicians' experiences in the Canadian context remains scant, a growing body of research from other countries is available. In a recent scoping review, Fujioka et al 9 examined the roles of physicians and other health care professionals in decisionmaking related to MAiD and the professional challenges that arise when they are confronted with patient requests. Key challenges reported by physicians included tensions caused by colleagues conscientiously objecting to MAiD.…”

Section: Literature Reviewmentioning

confidence: 99%

Rediscovering the art of medicine, rewards, and risks: Physicians’ experience of providing medical assistance in dying in Canada

Beuthin

Bruce

Hopwood³

et al. 2020

SAGE Open Medicine

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Background: Medical assistance in dying opens up uncharted professional territory for Canadian physicians extending their practices to include assisting and hastening death for eligible patients. Objectives: To understand physicians’ experience of participating in assisted dying and the emotional and professional impact. Methods: An interpretive descriptive methodology and thematic analysis were used for this research. We interviewed eight physicians engaged in assessing and providing medical assistance in dying. Data were collected through audio taped, semi-structured interviews in person or by phone. Results: Three overarching themes included (1) rediscovering the art of medicine, (2) unexpected rewards, and (3) negotiating risks and challenges. Each theme has accompanying sub-themes. Conclusion: Medical assistance in dying is markedly different from other physicians’ practices in that it has an enriched capacity for caring. The process brings deep satisfaction characterized by intimate, personalized contact with patients and families. The professional rewards of providing medical assistance in dying outweigh the challenges, offering an alternative narrative to more publicly accepted views of assisting someone to die.

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“…To date, Canadian research has largely focused on the understanding of end-of-life legislation, cost analysis, and program implementation (Li et al, 2017;Marcoux, Boivin, Arsenault, Toupin, & Youssef, 2015;Trachtenberg & Manns, 2017). Internationally, a majority of the literature on assisted dying is focused on the physician; however, some research has also examined the roles of nurses and psychiatrists (Block & Billings, 1995;Edwards, 2016;Fujioka, Mirza, McDonald, & Klinger, 2018;Groenewoud et al, 1997;Schwarz, 1999). Much of this literature, however, is focused on opinions related to the ethics of assisted dying, and whether or not the practice is justifiable (Braverman, Marcus, Wakim, Mercurio, & Kopf, 2017;Glebock Gawor, & Ostrowski, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Less explored is the experience of health care professionals working with patients, caregivers, and other providers through the process of MAiD. A scoping review by Fujioka et al (2018) recently investigated the roles of providers involved in MAiD, and the challenges faced by providers involved in the provision of MAiD. This review ultimately concluded that, although a variety of providers are involved in assisted dying, most published literature examines the roles and experiences of physicians and nurses (Fujioka et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…A scoping review by Fujioka et al (2018) recently investigated the roles of providers involved in MAiD, and the challenges faced by providers involved in the provision of MAiD. This review ultimately concluded that, although a variety of providers are involved in assisted dying, most published literature examines the roles and experiences of physicians and nurses (Fujioka et al, 2018). Considering the variety of providers involved in Canadian contexts, it is important to understand the perspectives and experiences of all parties involved in the MAiD process.…”

Section: Introductionmentioning

confidence: 99%

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Health Care Provider Experiences of and Perspectives on Medical Assistance in Dying: A Scoping Review of Qualitative Studies

Brooks

2019

Can. J. Aging

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RÉSUMÉUne grande partie des écrits sur l’aide médicale à mourir (AMM) qui traite de la perspective des prestataires de soins de santé est centrée sur le rôle des médecins, et le point de vue des infirmières n’est exprimé que dans quelques-uns d’entre eux. Toutefois, quelques provinces canadiennes ont mis en œuvre des approches multidisciplinaires pour l’AMM. Il serait donc important de mieux comprendre l’expérience des divers prestataires de soins de santé impliqués dans l’AMM, considérant que les plans provinciaux liés à l’AMM sont encore en élaboration. Cet examen de la portée a pour but de résumer les publications qualitatives existantes axées sur l’expérience des prestataires de soins dans l’AMM. Les thèmes clés retrouvés dans ces publications concernent la complexité du processus d’AMM, l’importance des relations et de la communication, les rôles et dynamiques interprofessionnels et le processus d’adaptation. Les résultats de cet examen de la portée démontrent la nécessité de poursuivre la recherche sur les expériences des divers prestataires de l’AMM, particulièrement dans le contexte canadien.

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Implementation of Medical Assistance in Dying: A Scoping Review of Health Care Providers' Perspectives

Cited by 87 publications

References 47 publications

Riding an elephant: A qualitative study of nurses' moral journeys in the context of Medical Assistance in Dying (MAiD)

Riding an elephant: A qualitative study of nurses' moral journeys in the context of Medical Assistance in Dying (MAiD)

Rediscovering the art of medicine, rewards, and risks: Physicians’ experience of providing medical assistance in dying in Canada

Health Care Provider Experiences of and Perspectives on Medical Assistance in Dying: A Scoping Review of Qualitative Studies

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