Clinicians’ Perspectives on the Duty to Inform Patients About Medical Aid-in-Dying

Brassfield, Elizabeth R.; Buchbinder, Mara

doi:10.1080/23294515.2019.1695016

Cited by 10 publications

(50 citation statements)

References 34 publications

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“…Finally, it is important to distinguish the role of educating versus counseling patients when discussing MAiD. In Canada, professionally regulated MDs and NPs (not just assessors and prescribers) are currently the only professionals permitted to initiate the discussion of MAiD with patients by presenting it as an end of life option (Brassfield & Buchbinder, 2020). Though other health care professionals, such as nurses, social workers, psychologists, psychiatrists, and therapists are permitted to educate patients on the lawful provision of MAiD, counseling an individual to die by suicide is an indictable offence with the possibility of imprisonment for up to 14 years (Bill C-14, 2016, § 241).…”

Section: Primary Care and Primary Care Providers (Pcp)mentioning

confidence: 99%

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“…After collating the data, evaluating it, and summarizing the results, facilitators and barriers that affected the discussion of MAiD between PCPs and patients were divided into intrinsic and interpersonal factors. Intrinsic factors included PCP emotions, values, beliefs, education, and training, while interpersonal factors included communication, relationship, and administrative burdens (Brooks, 2019;Brassfield & Buchbinder, 2020;Selby & Bean, 2019;Kelly & Varghese, 2006;Pasman, Willems, & Onwuteaka-Philipsen, 2013;Hagens, Onwuteaka-Philipsen, & Pasman, 2017).…”

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“…-Physician Quote, Brassfield & Buchbinder, 2020 In Canada, the landscape of medical assistance in dying (MAiD) has evolved significantly within the past few decades (Brooks, 2019). Medical assistance in dying is an end of life intervention that allows individuals to regain some element of control within the dying process (Brassfield & Buchbinder, 2020). From the 1990s, the evolution of public opinion, increased discussion, and political activism concerning MAiD led to the 2015 landmark case of Carter v. Canada and subsequent legalization of MAiD in 2016 (Brooks, 2019).…”

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Barriers and facilitators to medical assistance in dying (MAID) discussions in primary care

Young¹

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In Canada, medical assistance in dying (MAiD) is an end of life intervention intended to offer increased control to Canadians within the dying process (Brassfield & Buchbinder, 2020). Despite the legalization of MAiD in 2016 and developments in MAiD research, many primary care providers (PCPs) reported feeling reluctant to discuss MAiD with their patients (Otte, Jung, Elger, & Bally, 2017). In Canada, PCPs are typically medical doctors (MDs) or nurse practitioners (NPs) who care for patients in outpatient, non-acute care settings (Statistics Canada, 2019). As limited research has been synthesized on barriers and facilitators of MAiD discussions within the Canadian primary care context, the purpose of this integrative literature review (ILR) was to assess what factors promoted and prevented PCPs from discussing MAiD with their patients. After identifying a research question and related keywords, six databases were searched to identify relevant studies. The initial search yielded 1,874 results, which underwent inclusion and exclusion criteria and resulted in 12 references being included in the review. After collating the data, evaluating it, and summarizing the results, facilitators and barriers that affected the discussion of MAiD between PCPs and patients were divided into intrinsic and interpersonal factors. Intrinsic factors included PCP emotions, values, beliefs, education, and training, while interpersonal factors included communication, relationship, and administrative burdens (Brooks, 2019; Brassfield & Buchbinder, 2020; Selby & Bean, 2019; Kelly & Varghese, 2006; Pasman, Willems, & Onwuteaka-Philipsen, 2013; Hagens, Onwuteaka-Philipsen, & Pasman, 2017). Based on the findings of this review, strategies to promote MAiD discussions between PCPs and patients were outlined. Recommendations included identifying and addressing values, beliefs, and emotions; developing communication skills and strategies; promoting patientii provider relationships; and mitigating administrative burdens (Kelly & Varghese, 2006; Selby & Bean, 2019; Pasman et al., 2013; Brooks, 2019). As MAiD-related research in Canada progresses through its pioneering phase, future research has been suggested to support the development of communication guides specific to MAiD as well as the evaluation of PCP approaches to MAiD discussions within the Canadian primary care setting (Selby & Bean, 2019; Brooks, 2019).

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confidence: 99%

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Barriers and facilitators to medical assistance in dying (MAID) discussions in primary care

Young¹

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Opening the Door: Rethinking “Difficult Conversations” about Living and Dying with Dementia

Buchbinder,

Berlinger

2024

Hastings Center Report

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This essay looks closely at metaphors and other figures of speech that often feature in how Americans talk about dementia, becoming part of cultural narratives: shared stories that convey ideas and values, and also worries and fears. It uses approaches from literary studies to analyze how cultural narratives about dementia may surface in conversations with family members or health care professionals. This essay also draws on research on a notable social effect of legalizing medical aid in dying: patients may find it easier to bring up a range of concerns, regardless of whether they have any interest in hastening their own death. The essay proposes that health care professionals rethink an idea prominent within their own culture: that conversations about the end of a person's life are inherently difficult. This framing may make it hard for people facing dementia to bring up their concerns about what lies ahead. We suggest a different way to think about these conversations, using the metaphor of “opening the door” to represent inviting a patient to bring up issues of deepest concern.

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Physicians’ Attitudes and Experiences with Medical Aid in Dying in Colorado: a “Hidden Population” Survey

et al. 2022

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Background Approximately 20% of the US population live in states where MAiD is a legal, though highly contentious, practice. Little generalizable data exists on the experiences of MAiD providers who comprise a small, and intentionally hidden, population. Objective To examine the nature, extent, and consequences of physicians’ participation in MAiD. Design An anonymous, multi-wave, mailed survey (RR= 55%). Participants An enriched sample ( n =583) of Colorado physicians caring for potential MAiD patients. Main Measures Physician willingness, preparedness, and participation in a continuum of MAiD activities. Other outcomes include the effects of providing MAiD and the barriers physicians face related to MAiD. Key Results Overall, 81.1% of respondents were willing to discuss MAiD with a patient, 88.3% to refer for MAiD, 46.3% to be a consultant, and 28.1% to be an attending. Fewer felt prepared to discuss MAiD (54.4%), provide a MAiD referral (62.8%), be a consultant (30.7%), or be an attending (18.0%). More than half of respondents (52.3%) had discussed MAiD with a patient, 27.3% provided a MAiD referral, 12.8% had been a MAiD consultant, and 8.5% had been a MAiD attending. Among MAiD consultants and attendings, 75% reported that their most recent MAiD case was emotionally fulfilling and professionally rewarding, though 75% also reported that it was time consuming and 46.9% reported that it was ethically challenging. Common barriers to physician participation in MAiD include lack of knowledge about MAiD (46.8%), the emotional (45.6%) and time (41.7%) investments, and ethical concerns (41.7%). Conclusions Many physicians in our sample are both willing and prepared to discuss MAiD with patients and to provide MAiD referrals. Fewer are prepared and willing to serve as an attending or consultant and fewer have provided these services. MAID consultants and attendings largely report the experience to be emotionally fulfilling and professionally rewarding, but all respondents reported multiple barriers to participation. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07300-8.

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Clinicians’ Perspectives on the Duty to Inform Patients About Medical Aid-in-Dying

Cited by 10 publications

References 34 publications

Barriers and facilitators to medical assistance in dying (MAID) discussions in primary care

Barriers and facilitators to medical assistance in dying (MAID) discussions in primary care

Opening the Door: Rethinking “Difficult Conversations” about Living and Dying with Dementia

Physicians’ Attitudes and Experiences with Medical Aid in Dying in Colorado: a “Hidden Population” Survey

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