Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada

Li, Madeline; Watt, Sarah; Escaf, Marnie; Gardam, Michael; Heesters, Ann; O’Leary, Gerald; Rodin, Gary

doi:10.1056/nejmms1700606

Cited by 158 publications

(92 citation statements)

References 10 publications

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“…One consequence of the 10-day delay that we have observed is that some patients who are at the end of life and experiencing considerable pain and suffering refuse recommended medications such as opioid analgesics in order to maintain capacity to consent. Similar situations have been reported in other provinces as well 11. This is a significant source of ethical concern for clinicians who feel distress in such cases.…”

Section: Resultssupporting

confidence: 73%

Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations

2018

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BackgroundMedical aid in dying (MAiD) was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.MethodsA retrospective chart review of all MAiD requests between December 2015 and June 2017 at two Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.ResultsOf 80 patients requesting MAiD, 54% (43) received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults (32%) came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 (prolongation of life remains a priority) at the time of the MAiD request and 19% were receiving life-prolonging interventions.InterpretationWe highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend.

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Section: Resultssupporting

confidence: 73%

Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations

2018

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“…iiFor example, in Canada, where PAD became legalised in 2016, it is available for patients with a ‘grievous medical condition’ and ‘whose natural death has become reasonably foreseeable’ (see Li et al 27). This seems clearly to include some patients who are not terminally ill. And advocates in Oregon are endeavouring to expand the criteria beyond terminal illness to include patients with a variety of degenerative conditions (see Kuznia28).…”

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confidence: 99%

Drawing the line on physician-assisted death

2018

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Drawing the line on physician assistance in physician-assisted death (PAD) continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that can be accepted by defenders as well as critics of PAD for the terminally ill. The argument appeals to fairness-based paternalism and the social meaning of medical practice. These two considerations interact in various ways, as the paper explains. The right way to think about the social meaning of medical practice bears on fair paternalism as it relates to PAD and vice versa. The paper contends that these considerations have substantial force when directed against proposals to extend PAD to non-terminally ill patients, but considerably less force when directed against PAD for the terminally ill. The paper pays special attention to the case of non-terminally ill patients who suffer from treatment-resistant depression, as these patients present a potentially strong case for extending PAD beyond the terminally ill.

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“…[3] In this report, the authors mention the importance of staff education as well as organizational culture surrounding MAID. [3] Since MAID is now legal in Canada, organizations in each province and territory are attempting to develop policies and guidelines that adhere to ethical, legal and professional standards for both organizations and practitioners, while also trying to meet the needs of patients and families. Given the impact on practice due to this major change in legislation, it is imperative that the development and implementation of these new policies and guidelines are carefully evaluated.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…[3] The authors described conditions of ambiguity when UHN worked to ensure timely access to services while taking into consideration the legal rights of patients and healthcare providers during the implementation phase of MAID. [3] In this report, the authors mention the importance of staff education as well as organizational culture surrounding MAID. [3] Since MAID is now legal in Canada, organizations in each province and territory are attempting to develop policies and guidelines that adhere to ethical, legal and professional standards for both organizations and practitioners, while also trying to meet the needs of patients and families.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of Medical Assistance in Dying: An evaluation of clinician knowledge and perceptions at a large urban multi-site rehabilitation centre in Toronto

Hogg

Nippak

Spalding

2018

JHA

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Objective: Evaluate clinician knowledge and perceptions to ensure the newly implemented Medical Assistance in Dying (MAID) policies and guidelines are understood correctly to help facilitate the best possible experience for patients and their families. Methods: One hundred and twenty-five clinicians completed a survey, developed for this study, to determine their perceptions and knowledge base related to MAID. Results: The average grade on the knowledge-based portion of the survey was 69%. On average, respondents displayed a good understanding (84%) of the legislated eligibility criteria while room for improvement was noted for facility specific policy questions (65%) and general principle questions (71%). Analysis of perception-based questions indicated most respondents were in support of MAID, however, they expressed mixed feelings towards the ease of having MAID related conversations. Respondents expressed mixed opinions in relation to whether the facility was providing adequate training to staff. Sixty-four percent of respondents expressed interest in receiving further training relating to MAID. Conclusions: Education for healthcare providers to ensure they understand the relevant hospital policy and guidelines is critical to improve compliance with the implementation of MAID. It is important to continue to understand and support the perceptions of clinicians to ensure that MAID is administered correctly and as effectively as possible.

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Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada

Cited by 158 publications

References 10 publications

Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations

Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations

Drawing the line on physician-assisted death

Implementation of Medical Assistance in Dying: An evaluation of clinician knowledge and perceptions at a large urban multi-site rehabilitation centre in Toronto

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