Care Considerations in a Patient- and Family-Centered Medical Assistance in Dying Program

Brown, Janine; Goodridge, Donna; Harrison, Averi; Kemp, Jordan; Thorpe, Lilian; Weiler, Robert M.

doi:10.1177/0825859720951661

Cited by 19 publications

(44 citation statements)

References 26 publications

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“…The findings from this study also point to the potential for vulnerabilities family members may experience. Providing MAiD to patients with capacity loss may further complicate the grief they experience [ 8 , 40 , 41 ]. Early, transparent communication with family members about patients’ wishes and follow-up visits with patients and their families can help minimize family members’ risk for complicated grief [ 8 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Providing MAiD to patients with capacity loss may further complicate the grief they experience [ 8 , 40 , 41 ]. Early, transparent communication with family members about patients’ wishes and follow-up visits with patients and their families can help minimize family members’ risk for complicated grief [ 8 , 40 ]. However, such measures require time and resources that many lack [ 32 , 38 ].…”

Section: Discussionmentioning

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: 99%

Section: Discussionmentioning

confidence: 99%

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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“…There was also a need to manage the relational challenges that arose between those who saw MAID as an acceptable moral option and those who did not [19-21, 25, 26]. Caring for families throughout the process and into bereavement has consistently been one of the most challenging aspects of MAID [20,28,29]. Given the potential impact of these factors on the quality of care provided through MAID, and on the ongoing debate about the relationship between MAID and palliative care, it is important to understand how MAID is evolving over time within a larger systems perspective.…”

Section: Request Signed By One Independent Witnessmentioning

confidence: 99%

Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

Pesut

Thorne

Wright

et al. 2021

BMC Health Serv Res

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Background Even as healthcare providers and systems were settling into the processes required for Medical Assistance in Dying (MAID) under Bill C-14, new legislation was introduced (Bill C-7) that extended assisted death to persons whose natural death is not reasonably foreseeable. The purpose of this paper is to describe the experiences of nurses and nurse practitioners with the implementation and ongoing development of this transition. Methods This qualitative longitudinal descriptive study gathered data through semi-structured telephone interviews with nurses from across Canada; cross sectional data from 2020 to 2021 is reported here. The study received ethical approval and all participants provided written consent. Findings Participants included nurses (n = 34) and nurse practitioners (n = 16) with significant experience with MAID. Participants described how MAID had transitioned from a new, secretive, and anxiety-producing procedure to one that was increasingly visible and normalized, although this normalization did not necessarily mitigate the emotional impact. MAID was becoming more accessible, and participants were learning to trust the process. However, the work was becoming increasingly complex, labour intensive, and often poorly remunerated. Although many participants described a degree of integration between MAID and palliative care services, there remained ongoing tensions around equitable access to both. Participants described an evolving gestalt of determining persons’ eligibility for MAID that required a high degree of clinical judgement. Deeming someone ineligible was intensely stressful for all involved and so participants had learned to be resourceful in avoiding this possibility. The required 10-day waiting period was difficult emotionally, particularly if persons worried about losing capacity to give final consent. The implementation of C-7 was perceived to be particularly challenging due to the nature of the population that would seek MAID and the resultant complexity of trying to address the origins of their suffering within a resource-strapped system. Conclusions Significant social and system calibration must occur to accommodate assisted death as an end-of-life option. The transition to offering MAID for those whose natural death is not reasonably foreseeable will require intensive navigation of a sometimes siloed and inaccessible system. High quality MAID care should be both relational and dialogical and those who provide such care require expert communication skills and knowledge of the healthcare system.

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“…29 Therefore, many studies suggested that additional roles and responsibilities can be addressed by an interdisciplinary care team, which includes social workers, spiritual care providers, specialised nurses or even 'death doulas'. 23 24 36 Ultimately, when considering how HCPs can 'support the circle of support,' 24 greater structure, funding and resources are needed. Currently, the full obligation and duration of the relationship between HCPs and family/friends is ambiguous and variable.…”

Section: With Healthcare Providersmentioning

confidence: 99%

Grief and bereavement of family and friends around medical assistance in dying: scoping review

Yan

Bytautas

Isenberg

et al. 2022

BMJ Support Palliat Care

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ObjectivesThe increase in the number of jurisdictions legalising medical assistance in dying (MAiD) has contributed to a growth in the number of family and friends who may face unique elements of grief and bereavement. The aim of this study was to review the literature of grief and bereavement of family and friends following MAiD, and to summarise findings for the development of community resources and programming.MethodsWe performed a scoping review with workshop consultation of stakeholders. Six electronic databases and the grey literature were searched for qualitative, quantitative and review articles. Content-analytical techniques and multidisciplinary discussions led to the development of concepts and a conceptual framework.ResultsTwenty-eight articles met the inclusion criteria. We identified five concepts that impact the grief and bereavement of family/friends: relationships between family/friends and the patient as well as healthcare providers; aspects of MAiD grief which can include secrecy and/or anticipatory grief; preparations which may include family/friends and should be centralised and harmonised; end of life as an opportunity for ceremony; and the aftereffects during which mental health outcomes are studied.ConclusionThis multidisciplinary scoping review incorporates stakeholder consultation to find that support is needed to address the complicated and changing emotions of family/friends before, during and after a MAiD death. Furthermore, additional societal normalisation of MAiD is necessary to reduce secrecy and stigma and improve the accessibility of resources for family/friends.

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Care Considerations in a Patient- and Family-Centered Medical Assistance in Dying Program

Cited by 19 publications

References 26 publications

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

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

Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

Grief and bereavement of family and friends around medical assistance in dying: scoping review

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