The Relationship of Palliative Care With Assisted Dying Where Assisted Dying is Lawful: A Systematic Scoping Review of the Literature

Abstract

Context. A central approach of palliative care has been to provide holistic care for people who are dying, terminally ill, or facing life-limiting illnesses while neither hastening nor postponing death. Assisted dying laws allow eligible individuals to receive medically administered or self-administered medication from a health provider to end their life. The implementation of these laws in a growing number of jurisdictions therefore poses certain challenges for palliative care.Objectives. To analyze the research literature about the relationship of assisted dying with palliative care, in countries where it is lawful.Methods. A five-stage scoping review process was adapted from the Joanna Briggs Institute. Data sources searched through October 2018 were MEDLINE, CINAHL, PsychINFO, SCOPUS, and ProQuest dissertations and theses, with additional material identified through hand searching. Research studies of any design were included, but editorials or opinion articles were excluded.Results. After reviewing 5778 references from searches, 105 were subject to full-text review. About 16 studies were included: from Belgium (n ¼ 4), Canada (n ¼ 1), Switzerland (n ¼ 2), and the U.S. (n ¼ 9). We found that the relationship between assisted dying and palliative care practices in these locations took varied and sometimes combined forms: supportive, neutral, coexisting, not mutually exclusive, integrated, synergistic, cooperative, collaborative, opposed, ambivalent, and conflicted.Conclusion. The studies in this review cast only partial light on challenges faced by palliative care when assisted dying is legal. There is pressing need for more research on the involvement of palliative care in the developing practices of assisted dying, across a growing number of jurisdictions. J Pain Symptom Manage 2020;59:1287e1303. Ó

Early experience with medical assistance in dying in Ontario, Canada: a cohort study

“…21 Internationally, the relation between MAiD and palliative care providers ranges from synergistic and cooperative to conflicted and opposed. 22 Some palliative care providers in Canada believe that MAiD is an important part of their clinical practice 23 and have integrated MAiD with the provision of palliative care. 24 Others have expressed concern that confusion between MAiD and palliative care might discourage the adoption of a palliative approach for those who could benefit.…”

Impact of Medical Assistance in Dying on palliative care: A qualitative study

“…15,16 Research exploring how Medical Assistance in Dying has impacted palliative care practice is limited, however. 5,7,17–19…”

Medicalisation, suffering and control at the end of life: The interplay of deep continuous palliative sedation and assisted dying

“…The reasons given for the opposition are the ethical principle of respect for life, that governments should prioritise investment in good palliative care, symptom control and social support which reduce requests for assisted dying, and that public demand for legalising assisted dying is fuelled by fundamental misconceptions about suffering at the end of life (Inbadas et al, 2017). Little empirical research exists which actually investigates ways in which palliative care practices interact with the implementation of assisted dying in different cultural and legal contexts (Gerson et al, 2020). The present study was conducted in Quebec, Flanders and Health 00(0) Oregon, three jurisdictions where assisted dying is lawful.…”