De l’aide médicale à mourir au Québec : une analyse du contexte et de la pratique infirmière en soins palliatifs

Abstract

Contexte : la pratique de l’aide médicale à mourir (AMM) au Québec est un acte médical pratiqué principalement aux soins palliatifs. Il découle d’une révolution éthique de la société québécoise face aux enjeux de la fin de vie. Toutefois, il existe très peu de données empiriques sur la pratique des infirmières en regard de l’AMM. But : produire une revue des écrits légaux, scientifiques et médiatiques abordant les phénomènes entourant l’expérience de la pratique des infirmières en soins palliatifs auprès des patients ayant demandé l’AMM au Québec. Méthode : la méthode de Burns, Grove, et Sutherland a permis d’analyser six études empiriques sur l’AMM au Québec, identifiées dans la base de données CINAHL, un texte législatif et 17 articles médiatiques documentant l’adoption de la loi encadrant l’AMM. Résultats : une loi stricte encadre cette pratique au Québec depuis 2015, et certains enjeux et événements sociaux ont récemment favorisé son élargissement. L’analyse de littérature empirique a permis d’identifier deux thématiques : 1). les dispositions des infirmières en regard de l’AMM et 2). leurs besoins de formation au sujet de celle-ci. Discussion et conclusion : on soulève la domination du modèle biomédical et l’effondrement du système sanitaire québécois, qui influent négativement sur les pratiques infirmières entourant l’AMM.

Medical aid in dying: A foreseen decisive role for the specialized nurse practitioner in Quebec

“…Although the realisations of Canadian and Quebec's various legal and professional authorities are a worthy step forward the quality of humanistic practices for patients receiving EoLC in palliative care, questions remain on the project for the forthcoming Quebec's SPNs who could practise MAiD considering that Quebec's health system is understaffed and overwhelmed. [2,10] To that end, we conducted a literature review following Grove & al. methodology [11] to identify, analyse the developments and difficulties, and perhaps synthesise explicit and revealing themes to provide a deeper understanding of the phenomenon assessed and therefore give some directions aimed at the promotion of high quality and evidence-informed nursing/NPs/SPNs practice at EoLC and MAiD for the patients and thief families.…”

“…[1] However, there is a noticeable social and professional acceptability for MAiD, as evidenced by the growing demand for this care in Quebec. [2] As of today, seven years after the adoption of the law governing the end of life in Quebec, more than 7,000 MAiDs have been administered, which corresponds to 3% of annual deaths in Quebec in 2020. [17] The annual activity report of the Commission on end-of-life care of the Government of Quebec (2020) predicts that this rate could reach 5% of the 80,000 an-Published by Sciedu Press nual deaths occurring in Quebec.…”

“…[1] The adoption of this law results from a long and polarised ethical, deontological, cultural, social, legal, and professional debate on the social, ethical, and professional question of "dying with dignity". [2] On the other hand, in June 2016, the Canadian federal law concerning MAiD was also legalise [3] d into nursing practice. It is important to acknowledge that Canada is the first country to permit highly trained nurse practitioners (NPs) to assess and provide MAiD but, Canada has 10 provinces and 3 territories, and each entity is governed by its own laws -while under the regulation by some Canadian laws -for the providence of nursing of the end-of-life care (EoLC).…”

“…Despite those legal, social, ethical, and professional developments in favour of MAiD practices in Canada, a gap between the ideals of MAiD governed by these regulations and the practice reality of health settingssomehow refractory and overwhelmed -is still felt. [2] To date in Canada, except in the province of Quebec, specific sections in the regulations allow properly trained NPs in some provinces such as Ontario, British Columbia, or Alberta, to assess the condition, eligibility criteria and eventually to practise MAiD. The time being, not all NPs practicing in Canada have the right to assess and provide MAiD which may hinder the accessibility and quality of nursing care at the end-of-life.…”

“…[1] In the light of these facts, and more particularly in the expectation of a possible and forthcoming practice of MAID by SNPs in Quebec, we conducted this literature review, using Burns and Grove methodology of the literature to take stock of the present regulations, their progress as to consider the future of the practice of MAiD in Quebec by SNPs, while considering the issues and challenges of Quebec's difficult care settings. [2]…”