Medical assistance in dying legislation: Hospice palliative care providers’ perspectives

Abstract

Background: After over 4 years since medical assistance in dying legalization in Canada, there is still much uncertainty about how this ruling has affected Canadian society. Objective: To describe the positive aspects of medical assistance in dying legalization from the perspectives of hospice palliative care providers engaging in medical assistance in dying. Design: In this qualitative descriptive study, we conducted an inductive thematic analysis of semi-structured interviews with hospice palliative care providers. Participants and setting: Multi-disciplinary hospice palliative care providers in acute, community, residential, and hospice care in Vancouver and Toronto, Canada, who have engaged in end-of-life care planning with patients who have inquired about and/or requested medical assistance in dying. Ethical considerations: The research proposal was approved by University of British Columbia Research Ethics Board in Vancouver and University Health Network in Toronto. Participants were informed regarding the research goals, signed a written consent, and were assigned pseudonyms. Results: The 48 participants included hospice palliative care physicians (n = 22), nurses (n = 15), social workers (n = 7), and allied health providers (n = 4). The average interview length was 50 min. Positive aspects of medical assistance in dying legalization were identified at (1) the individual level: (a) a new end-of-life option, (b) patients’ last chance to express control over their lives, (c) patient and family comfort and relief, and (d) a unique learning experience for hospice palliative care providers; (2) the team level: (a) supportive collegial relationships, (b) broadened discussions about end-of-life and palliative care, and (c) team debriefs provide opportunities for education and support; and (3) the institutional level: (a) improved processes to facilitate the implementation logistics. Conclusion: While being involved in the medical assistance in dying process is complex and challenging, this study sheds light on the positive aspects of medical assistance in dying legalization from the hospice palliative care provider’s perspectives. Medical Assistance in Dying legalization has resulted in improved end-of-life conversations between hospice palliative care providers, patients, and their families. Improved communication leads to a better understanding of patients’ end-of-life care plans and bridges some of the existing gaps between hospice palliative care and medical assistance in dying.

Paradoxes, nurses’ roles and Medical Assistance in Dying: A grounded theory

“… 4 , 13 , 29 , 32 For the person requesting MAID, deciding the time of death is a way to regain control of their life. 29 This information was reported as a positive aspect of MAID at the individual level in the study of Joolaee Ho 11 and as a way to respect patients' autonomy 33 over the illness. 33…”

“…The first paradox concerns death itself, which confronts nurses who are used to saving lives. This study goes in the same way as Joolaee, Ho 11 for whom participants considered MAID as a form of care for patients and a unique learning experience that was in a different paradigm than the education they had received previously. Our participants referred to the dignity of the patient in providing this care.…”

“…Our results go along other studies that perceive that legislation allows patients to have a new end-of-life option that was not previously available. 11 It is perceived as a new challenge with the ability to do good and a new learning opportunity for HPCP. 11 With the new legislation comes the negative side of uncertainty 12 as unknown 13 and stressful because nobody knows what to expect because few healthcare settings have established a protocol.…”

“… 11 It is perceived as a new challenge with the ability to do good and a new learning opportunity for HPCP. 11 With the new legislation comes the negative side of uncertainty 12 as unknown 13 and stressful because nobody knows what to expect because few healthcare settings have established a protocol. 11 …”

“…The literature appears to be more concerned with the concepts of euthanasia and assisted suicide, which are distinct themes from MAID. Relevant studies indicate that MAID is causing shifts in how palliative and end-of-life care is being perceived by nurses, with effects at ethical, [6][7][8] professional, [9][10][11][12] and personal levels. 4,13,14 This extension of the nursing scope of practice is often met with a moral sensemaking and with some expressing distress 9,10 Mitchell 15 defines living paradox as a "rhythmic shift in perspectives, where awareness arises from experiencing the contradiction of opposites in the daily relationship of value priorities while traveling toward the not-yet."…”