Clinical discussion of Medical Aid-in-Dying: minimizing harms and ensuring informed choice

Brassfield, Elizabeth R.; Buchbinder, Mara

doi:10.1016/j.pec.2020.08.029

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…They underscored the importance of hope in alleviating suffering and suggested ongoing and additional services and supports to MAiD MI-SUMC applicants throughout the assessment period. This perspective aligns with literature suggesting that a MAiD request may be at first considered as “a cry for help”, and with a two-track approach focusing both “on the life track” by engaging in ongoing treatment, and on the “death track” by assessing MAiD eligibility [ 22 , 23 , 44 ]. Similarly, in keeping with prior research with patients with other health conditions and their families, participants stressed the importance of holistic, interdisciplinary assessments, and the opportunity to tell their story and exercise autonomous health decision making [ 25 , 49 ].…”

Section: Discussionsupporting

confidence: 76%

“…Although there was widespread agreement on the value of clinicians responding to patient-initiated MAiD MI-SUMC questions using a non-judgmental stance, participants voiced conflicting views on clinicians introducing MAiD in goals of care discussions with persons with a mental illness. In balancing potential harms with the right to self-determination, the Canadian Association of MAiD Assessors and Providers supports informing eligible patients about MAiD, highlighting the value of informed consent, the importance of patient autonomy, and the role of clinicians as gatekeepers of clinical information [ 44 ]. Given participant concerns about clinician-initiated MAiD MI-SUMC conversations, care providers will need clear guidance on how best to promote unbiased MAiD MI-SUMC information sharing and person-centred, respectful and inclusive goals of care discussions.…”

Section: Discussionmentioning

confidence: 99%

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Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives

Stergiopoulos,

Bastidas-Bilbao,

Gupta

et al. 2024

BMC Psychiatry

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Background Persons with mental illness as their sole underlying medical condition are eligible to access medical assistance in dying (MAiD) in a small number of countries, including Belgium, the Netherlands, Luxemburg and Switzerland. In Canada, it is anticipated that people experiencing mental illness as their sole underlying medical condition (MI-SUMC) will be eligible to request MAiD as of March 17th 2024. To date, few studies have addressed patient and family perspectives on MAiD MI-SUMC care processes. This study aimed to address this gap and qualitatively explore the perspectives of persons with lived experience of mental illness and family members on care considerations during MI-SUMC implementation. Methods Thirty adults with lived experience of mental illness and 25 adult family members residing in Ontario participated in this study. To facilitate participant engagement, the semi-structured interview used a persona-scenario exercise to discuss perspectives on MAiD MI-SUMC acceptability and care considerations. Framework analysis was used to inductively analyze data using NVivo 12 Pro. Steps, processes, or other care considerations suggested by the participants were charted in a framework matrix after familiarization with the narratives. Key themes were further identified. A lived-experience advisory group participated in every aspect of this study. Results Six themes were developed from the patient and family narratives: (1) Raising MAiD MI-SUMC awareness; (2) Sensitive Introduction of MAiD MI-SUMC in goals of care discussions; (3) Asking for MAiD MI-SUMC: a person-focused response; (4) A comprehensive circle of MAiD MI-SUMC care; (5) A holistic, person-centered assessment process; and (6) Need for support in the aftermath of the decision. These themes highlighted a congruence of views between patient and family members and described key desired process ingredients, including a person-centred non-judgmental stance by care providers, inter-professional holistic care, shared decision making, and the primacy of patient autonomy in healthcare decision making. Conclusions Family and patient perspectives on the implementation of MAiD MI-SUMC offer important considerations for service planning that could complement existing and emerging professional practice standards. These stakeholders’ perspectives will continue to be essential in MAiD MI-SUMC implementation efforts, to better address the needs of diverse communities and inform improvement efforts.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives

Stergiopoulos,

Bastidas-Bilbao,

Gupta

et al. 2024

BMC Psychiatry

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“…We emphasise this must be done sensitively, within the law, and guided by good clinical practice about end-oflife care discussions. 18…”

Section: Advance Care Planning Practices and Systems Need To Recognis...mentioning

confidence: 99%

“…Where it is legally possible to raise voluntary assisted dying (Box 1) and clinically appropriate, informing patients of all possible end‐of‐life choices would facilitate decisions that align with the values, beliefs and preferences at the heart of advance care planning. We emphasise this must be done sensitively, within the law, and guided by good clinical practice about end‐of‐life care discussions 18 …”

Section: Advance Care Planning Practices and Systems Need To Recognis...mentioning

confidence: 99%

Implications of voluntary assisted dying for advance care planning

White,

Archer,

Haining

et al. 2023

Medical Journal of Australia

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Ben P White and Lindy Willmott were engaged by the Victorian, Western Australian and Queensland governments to provide the legislatively required training for doctors (and nurses and nurse practitioners where relevant) involved in voluntary assisted dying. Ben P White and Lindy Willmott have been engaged by the Western Australian Government to be involved in the statutory review of the Voluntary Assisted Dying Act 2019 (WA). Lindy Willmott is also a member of the Queensland Voluntary Assisted Dying Review Board. Madeleine Archer was employed on the Victorian, Western Australian and Queensland voluntary assisted dying training projects. Casey M Haining was employed on the Queensland voluntary assisted dying training project as a legal writer and as a research fellow on the statutory review of the Voluntary Assisted Dying Act 2019 (WA). Casey M Haining is Advance Care Planning Australia's former National Policy Manager; views expressed in this article represent her own views and do not necessarily reflect those of Advance Care Planning Australia.

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Exploring Canadian genetic counselors' perspectives and experiences with discussing medical assistance in dying (MAiD)

Candlish,

Creighton,

Pullman

et al. 2024

Journal of Genetic Counseling

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Medical assistance in dying (MAiD) is the Canadian equivalent of Physician aid‐in‐dying (PAD) in the United States. Through changes to the eligibility criteria for MAiD in 2021, Canada now has one of the most permissive assisted dying regimens in the world. This study describes Canadian genetic counselors' experiences, knowledge, and preparedness to discuss MAiD with their patients. Survey responses were collected from Canadian genetic counselors (n = 44) and were followed by semi‐structured interviews with 14 survey participants. Survey data were analyzed using descriptive statistics, and interview transcripts were analyzed using phronetic iterative analysis and an interpretive description approach. Survey data revealed that genetic counselors have discussed MAiD with patients referred for cancer, neurologic, metabolic, connective tissue, and cardiac indications (n = 18, 40.9%). While most thought that it was important for genetic counselors to be knowledgeable of (n = 41, 93.2%) and prepared to discuss MAiD (n = 43, 97.7%), many were not familiar with the eligibility criteria (n = 27, 61.4%) and the process for accessing MAiD in Canada (n = 29, 65.9%). Interview participants described discussions about MAiD that were initiated by themselves or their patients. Most participants felt prepared to explore a patient's thoughts about MAiD when the patient initiated the discussion but did not feel well‐prepared to share detailed information about MAiD. Participants were interested in education and professional guidance to assist them in preparing to discuss MAiD. Learning objectives were developed based on participants' suggestions to assist genetic counselors in their clinical work and self‐directed research and to aid in the development of professional guidelines and educational materials for practicing genetic counselors and genetic counseling trainees. As genetic counselors continue engaging in discussions about MAiD, it is critical that these sensitive conversations are approached with increased knowledge and awareness of MAiD legislation, the ethical issues surrounding MAiD in Canada, and relevant patient resources.

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Clinical discussion of Medical Aid-in-Dying: minimizing harms and ensuring informed choice

Cited by 7 publications

References 9 publications

Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives

Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives

Implications of voluntary assisted dying for advance care planning

Exploring Canadian genetic counselors' perspectives and experiences with discussing medical assistance in dying (MAiD)

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