Relational influences on experiences with assisted dying: A scoping review

Variath, Caroline; Peter, Elizabeth; Cranley, Lisa; Godkin, Dianne; Just, Danielle

doi:10.1177/0969733020921493

Cited by 21 publications

(35 citation statements)

References 48 publications

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“…This study highlights how healthcare providers’ moral agency, including their decisions to participate in MAiD using written waiver of final consent, is influenced by their personal values and experiences, power dynamics and relationality [ 25 ]. Similarly, previous studies have reported that socio-political, ethical and legal ramifications and lack of support influenced healthcare providers’ decisions to participate in MAiD [ 8 , 32 , 33 ].…”

Section: Discussionmentioning

confidence: 82%

“…An increase in workload to address the potential legal and professional liabilities is predicted. The potential for burden is high due to unclear eligibility criteria and safeguards as well as socio-political constraints such as lack of resources, time, remuneration and support as has been noted in other studies [ 8 , 13 , 32 , 38 , 39 ]. In addition, patients and family members may have unrealistic expectations about access to MAiD and the role of the healthcare providers.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, patients and family members may have unrealistic expectations about access to MAiD and the role of the healthcare providers. Providers are often blamed when the provisions are not possible and are at risk for legal repercussions from objecting family members [ 8 , 13 , 32 ]. Assessors and providers require support from institutions, colleagues, regulatory bodies, patients, and families to provide MAiD using written waiver of final consent agreements [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Belgium, Luxemburg, The Netherlands, and Columbia allow for the provision of MAiD using advance requests made by patients prior to meeting eligibility criteria, to be used when patients suffer from a serious and incurable disorder and have lost decision-making capacity [ 1 ]. There is minimal evidence on the experiences with the implementation of advance requests in these jurisdictions [ 1 , 8 ]. Some have identified challenges with the use of advance requests, specifically with establishing the criteria of suffering following the loss of capacity and patients’ refusal of MAiD [ 9 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Health care providers’ ethical perspectives on waiver of final consent for Medical Assistance in Dying (MAiD): a qualitative study

et al. 2022

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Background With the enactment of Bill C-7 in Canada in March 2021, people who are eligible for medical assistance in dying (MAiD), whose death is reasonably foreseeable and are at risk of losing decision-making capacity, may enter into a written agreement with their healthcare provider to waive the final consent requirement at the time of provision. This study explored healthcare providers’ perspectives on honouring eligible patients’ request for MAiD in the absence of a contemporaneous consent following their loss of decision-making capacity. Method A critical qualitative methodology, using a feminist ethics theoretical lens with its focus on power and relationality, was used to examine how socio-political and environmental contexts influenced healthcare providers' moral agency and perspectives. Semi-structured interviews were conducted with 30 healthcare providers (13 physicians, six nurse practitioners, nine nurses and two social workers) from across Canada who provide MAiD-related care. Results Themes identified include; (1) balancing personal values and professional responsibilities, (2) anticipating strengths and limitations of the proposed waiver of final consent amendment, (3) experiencing ethical influences on decisions to enter into written agreements with eligible patients, (4) recognizing barriers to the enactment of MAiD in the absence of a contemporaneous consent and (5) navigating the potential for increased risks and burden. Discussion To our knowledge, this is the first study in Canada to explore healthcare providers’ perspectives on waiving the final consent for MAiD using a written agreement. Most participants supported expanding eligible people’s access to MAiD following loss of capacity, as they believed it would improve the patients’ comfort and minimize suffering. However, the lack of patients’ input at the time of provision and related ethical and legal challenges may impact healthcare providers’ moral agency and reduce some patients’ access to MAiD. Providers indicated they would enter into written agreements to waive final consent for MAiD on a case-by-case basis. This study highlights the importance of organizational, legal and professional support, adequate resources, clear policies and guidelines for the safety and wellbeing of healthcare providers and to ensure equitable access to MAiD.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Health care providers’ ethical perspectives on waiver of final consent for Medical Assistance in Dying (MAiD): a qualitative study

et al. 2022

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“…However, additional data are needed to evaluate and improve the service (eg, feedback from providers, patients and families, analyses of the process including its policy, functionality, efficiency, effectiveness, impacts and sustainability and so on). 24 Canadian providers and health systems are actively working to improve the MAID experiences of patients, families and professionals, [25][26][27][28] but it remains challenging to improve its implementation without knowing what the process looks like. Studies describing professional roles, expectations and knowledge gaps 9 15 29-32 or how MAID was implemented 4 5 9 33-37 provide few details about the process itself (eg, how work is coordinated between professionals, which professional(s) do which activities and when and so on).…”

Section: Introductionmentioning

confidence: 99%

How is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study

et al. 2021

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ObjectivesThe aims of this study are: (1) to create a flowchart process model of how medical assistance in dying (MAID) occurs in Nova Scotia (NS), Canada and (2) to detail how NS healthcare professionals are involved in each stage of MAID. The research questions are: how is the MAID process carried out and which professionals are involved at which points? and which roles and activities do professionals carry out during MAID?DesignQualitative process model flowchart study with semistructured interviews.SettingPrimary and secondary care in NS, Canada.ParticipantsThirty-two interviewees self-selected to participate (12 physicians, 3 nurse practitioners (NP), 6 nurses, 6 pharmacists and 5 healthcare administrators and advocates). Participants were included if they conduct assessments, provide MAID, fill prescriptions, insert the intravenous lines, organise care and so on.ResultsThe flowchart process model details five stages of how MAID occurs in NS: (1) starting the MAID process, (2) MAID assessments, (3) MAID preparation (hospital in-patient, hospital outpatient, non-hospital), (4) day of MAID and (5) post-MAID (hospital in-patient and outpatient, non-hospital, after leaving setting). Nineteen points where the process could stop or be delayed were identified. MAID differs slightly by location and multiple professionals from different organisations are involved at different points. Some physicians and NP provide MAID for free as they cannot be reimbursed or find it too difficult to be reimbursed.ConclusionsOur study adds knowledge about the MAID activities and roles of NS professionals, which are not documented in the international literature. Clinicians and pharmacists spend significant additional time to participate, raising questions about MAID’s sustainability and uncompensated costs. The process model flowchart identifies where MAID can stop or be delayed, signalling where resources, training and relationship-building may need to occur. Knowing where potential delays can occur can help clinicians, administrators and policymakers in other jurisdictions improve MAID.

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