Association of socioeconomic status with medical assistance in dying: a case–control analysis

Redelmeier, Donald A.; Ng, Kelvin; Thiruchelvam, Deva; Shafir, Eldar

doi:10.1136/bmjopen-2020-043547

Cited by 15 publications

(7 citation statements)

References 80 publications

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“…[38][39][40] Furthermore, our study demonstrated a lower OR for euthanasia and palliative sedation in the low-income group compared with middle and high-income groups, an association described in previous research. 38,41,42 These patients with a lower SES may feel less empowered and have lower health literacy, potentially leading to reduced self-advocacy and diminished trust in the health care system. [43][44][45] Additionally, it is plausible that despite clinicians' intentions to understand patient preferences, there might be less connection between lowincome patients and their health care clinicians.…”

Section: Discussionmentioning

confidence: 99%

Causes and Ways of Death in Patients With Head and Neck Cancer

van den Besselaar,

Sewnaik,

Hoesseini

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceThere is limited literature on the exact causes and ways of death in patients with head and neck cancer. To provide optimal care, especially in the palliative phase, more information on this is needed.ObjectiveTo provide insights into the causes and ways of death among patients with head and neck cancer.Design, Setting, and ParticipantsThis retrospective cohort study included a consecutive population of patients who received a diagnosis of primary squamous cell carcinoma of the head and neck between January 2006 and December 2013 who were treated in the Erasmus MC. Patient data were merged with nonpublic microdata from Statistics Netherlands. Follow-up time was specified as the date of diagnosis until death or December 3, 2019, whichever came first. The data were checked and reanalyzed in November 2023.Main outcomes and MeasuresCauses (eg, head and neck cancer, other cancer) and ways (eg, natural death, suicide) of death.ResultsA total of 1291 patients (59.2%; 342 women [26.5%]) died during follow-up (median [IQR] follow-up, 2.7 [1.2-5.6] years). The main cause of death was head and neck cancer (557 [43.1%]), followed by the competing cause of other cancers (344 [26.6%]). In total, 240 patients (18.6%) received palliative sedation and 70 patients (5.4%) euthanasia. Compared with patients with head and neck cancer as the underlying cause of death, lower odds ratios (ORs) were observed for receiving palliative sedation (OR, 0.32 vs 0.07; 95% CI, 0.22-0.46 vs 0.03-0.12) and euthanasia (OR, 0.22 vs 0.01; 95% CI, 0.11-0.41 vs 0-0.107) in patients with other causes of death. Patients with a middle and high income had higher ORs for receiving palliative sedation (OR, 1.46 vs 1.86; 95% CI, 1.05-2.04 vs 1.22-2.85) or euthanasia (OR, 2.25 vs 3.37; 95% CI, 1.18-4.3, 1.6-7.12) compared with low-income patients. Retired patients had lower ORs for receiving palliative sedation or euthanasia compared with employed patients (OR, 0.56 vs 0.44; 95% CI, 0.39-0.8 vs 0.24-0.82).Conclusion and RelevanceThe results of this cohort study suggest that more than half of the patients died of competing causes and palliative sedation and euthanasia were more common in patients with head and neck cancer as the underlying cause of death. Patients with a higher socioeconomic status had higher odds of receiving palliative sedation and euthanasia. These insights may support health care professionals in providing patient-centered care, especially for patients in the palliative phase.

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Section: Discussionmentioning

confidence: 99%

Causes and Ways of Death in Patients With Head and Neck Cancer

van den Besselaar,

Sewnaik,

Hoesseini

et al. 2024

JAMA Otolaryngol Head Neck Surg

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“…However, most people who utilize assisted dying services are likely to be financially stable, 41 and as such, these costs are not expected to impede MAiD access. Future research about the sociodemographic characteristics of MAiD-seeking individuals may reveal whether indirect cost burdens affect vulnerable groups differently.…”

Section: Findings and Discussionmentioning

confidence: 99%

Contemplating the Impacts of Canadian Healthcare Institutions That Refuse to Provide Medical Assistance in Dying: A Framework-Based Discussion of Potential Health Access Implications

Knox

Wagg

2023

Am J Hosp Palliat Care

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Introduction Following the historic Canadian legislation on medical assistance in dying (MAiD) in 2016, many implementation challenges and ethical quandaries have formed the focus of further scholarly investigation and policy revisions. Of these, conscientious objections held by some healthcare institutions have involved relatively less scrutiny, despite indicating possible hurdles to the universal availability of MAiD services in Canada. Methods In this paper, we contemplate potential accessibility concerns that pertain specifically to service access, with the hope to trigger further systematic research and policy analysis on this frequently overlooked aspect of MAiD implementation. We organize our discussion using two important health access frameworks: Levesque and colleagues’ Conceptual Framework for Access to Health and the Provisional Framework for MAiD System Information Needs (Canadian Institute for Health Information). Results Our discussion is organized along five framework dimensions through which institutional non-participation may generate or exacerbate inequities in MAiD utilization. Considerable overlaps are revealed across framework domains, indicating the complexity of the problem and the need for further investigation. Conclusion Conscientious dissensions on the part of healthcare institutions form a likely barrier to ethical, equitable, and patient-oriented MAiD service provision. Comprehensive, systematic evidence is urgently needed to understand the nature and scope of resulting impacts. We urge Canadian healthcare professionals, policymakers, ethicists, and legislators to attend to this crucial issue in future research and in policy discussions.

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“…Palliative care providers from Canada suggest that these concerns are valid, reporting significant challenges in providing palliative care after MAiD legalisation with moral ambiguity and provider distress, interprofessional team conflict and a negative impact on the perceived role of palliative care from the public and media [ 22 ]. Conversely, a recent paper from Victoria [ 23 ] argues that there may be “too much safety” with an over-emphasis on safeguarding coming at the expense of equity of access, which is already known to be less for those living rurally [ 18 ] and those of lower socioeconomic status [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Being a safe place: a qualitative study exploring perceptions as to how a rural community hospice could respond to enactment of voluntary assisted dying legislation

Auret

Pikora

Gersbach³

2022

BMC Palliat Care

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Background There is a lack of research to guide the implementation of voluntary assisted dying legislation within a hospice setting. Furthermore, there is limited published information related to the expectations of the community and staff to assist decision making regarding voluntary assisted dying in a community hospice. The aim of this study was to explore the expectations of staff, volunteers and members of the community as how a rural Australian community hospice could respond in relation to imminent enactment of Voluntary Assisted Dying legislation. Methods A total of 63 Hospice staff and volunteers and community members participated in 11 workshops. This qualitative study used the interpretive description method to analyse the workshop transcripts. Results While there was not a consensus view on community expectation, there was agreement among the participants for respect for a patient’s individuality and choices. Furthermore, care offered in hospice needs to remain non-judgemental and patient focused regardless of whether voluntary assisted dying policy was implemented or not. Both opportunities and risks associated with implementation were identified by the participants. Conclusion There was common ground around the respect for the dying person and the ideal of a “safe place” despite opposing views on what this may mean in practice. There is a need for clarity in organisational responses around policy, risk management, education, and staff support.

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Association of socioeconomic status with medical assistance in dying: a case–control analysis

Cited by 15 publications

References 80 publications

Causes and Ways of Death in Patients With Head and Neck Cancer

Causes and Ways of Death in Patients With Head and Neck Cancer

Contemplating the Impacts of Canadian Healthcare Institutions That Refuse to Provide Medical Assistance in Dying: A Framework-Based Discussion of Potential Health Access Implications

Being a safe place: a qualitative study exploring perceptions as to how a rural community hospice could respond to enactment of voluntary assisted dying legislation

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