Of dilemmas and tensions: a qualitative study of palliative care physicians’ positions regarding voluntary active euthanasia in Quebec, Canada

Abstract

ObjectivesIn 2015, the Province of Quebec, Canada passed a law that allowed voluntary active euthanasia (VAE). Palliative care stakeholders in Canada have been largely opposed to euthanasia, yet there is little research about their views. The research question guiding this study was the following: How do palliative care physicians in Quebec position themselves regarding the practice of VAE in the context of the new provincial legislation?MethodsWe used interpretive description, an inductive methodology to answer research questions about clinical practice. A total of 18 palliative care physicians participated in semistructured interviews at two university-affiliated hospitals in Quebec.ResultsParticipants positioned themselves in opposition to euthanasia. Their justifications were framed within their professional commitment to not hasten death, which sat in tension with the value of patients’ autonomy to choose how to die. Participants described VAE as unacceptable if it impeded opportunities to evaluate and alleviate suffering. Further, they contested government rhetoric that positioned VAE as a way to improve end-of-life care. Participants felt that VAE would diminish the potential of palliative care to relieve suffering. Dilemmas were apparent in their narratives, about reconciling respect for patient autonomy with broader palliative care values, and the value of accompanying and not abandoning patients who make requests for VAE while being committed to neither prolonging nor hastening death.ConclusionsThis study provides insight into nuanced positions of experienced palliative care physicians in Quebec and confirms expected tensions between an important stakeholder and the practice of VAE as guided by the new legislation.

Emotional impact on healthcare providers involved in medical assistance in dying (MAiD): a systematic review and qualitative meta-synthesis

“…Dimension 3: Emotions that resonate with professional values ( studies referenced 28 30 34 39 47–61 )…”

Grief After Euthanasia and Physician-Assisted Suicide

“…Research in this field has focused on various aspects, such as the moral and ethical aspects (Bélanger et al, 2019; Kouwenhoven, van Thiel, van der Heide, Rietjens, https://econtent.hogrefe.com/doi/pdf/10.1027/0227-5910/a000630 - Karl Andriessen <karl.andriessen@gmail.com> -Monday, October 28, 20191:23:46 PM -IP Address:128.250.0.121 & van Delden, 2019Mishara & Weisstub, 2013;Speijer & Diekstra, 1980), public acceptance (Cohen et al, 2006;Frey & Hans, 2016;Marcoux, Mishara, & Durand, 2007;Poma et al, 2015), and the legal status and epidemiology of euthanasia and PAS (Cohen, Dierickx, Penders, Deliens, & Chambaere, 2018;Steck, Egger, Maessen, Reisch, & Zwahlen, 2013). Studies have also looked at the views of individuals requesting medical assistance in dying (Dees, Vernooij-Dassen, Dekkers, Vissers, & Van Weel, 2011;Hendry et al, 2013;Lapierre et al, 2018), family involvement in end-of-life decision-making (Gamondi, 2017;Gamondi, Pott, Preston, & Payne, 2018;Kimsma & Van Leeuwen, 2007;Pott, Dubois, Currat, & Gamondi, 2011), and the perceptions of physicians (Emanuel et al, 2016;Ganzini, Dobscha, Heintz, & Press, 2003) and other professional caregivers (Castelli Dransart, Scozzari, & Voélin, 2017).…”

Nurses' experiences of supporting patients requesting voluntary assisted dying: A qualitative meta‐synthesis

“…Nurses have a unique contribution to end‐of‐life care as the health professional who is often at the bedside in those final moments, and is left to answer the questions that the family may have long after the medical team have finished their part of the procedure (Browall et al, 2014). Much of the existing literature and research in voluntary assisted dying (VAD) has been concerned with health professional attitudes (Terkamo‐Moisio et al, 2019) and the medical professional's role (Bélanger et al, 2019). Little is known about the experiences of nurses in caring for individuals and families of people who make this choice.…”