How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers
Background: More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dyi...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2021-11-01
|
| Series: | Palliative Care and Social Practice |
| Online Access: | https://doi.org/10.1177/26323524211045996 |
| _version_ | 1818981312019562496 |
|---|---|
| author | Anita Ho Joshua S. Norman Soodabeh Joolaee Kristie Serota Louise Twells Leeroy William |
| author_facet | Anita Ho Joshua S. Norman Soodabeh Joolaee Kristie Serota Louise Twells Leeroy William |
| author_sort | Anita Ho |
| collection | DOAJ |
| description | Background: More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying. Understanding how end-of-life care discussions between patients and specialist palliative care providers may be affected by such legislation can inform end-of-life care delivery in the evolving socio-cultural and legal environment. Aim: To explore how the Canadian Medical Assistance in Dying legislation affects end-of-life care discussions between patients and multidisciplinary specialist palliative care providers. Design: Qualitative thematic analysis of semi-structured interviews. Participants: Forty-eight specialist palliative care providers from Vancouver (n = 26) and Toronto ( n = 22) were interviewed in person or by phone. Participants included physicians ( n = 22), nurses ( n = 15), social workers ( n = 7), and allied health professionals ( n = 4). Results: Qualitative thematic analysis identified five notable considerations associated with Medical Assistance in Dying affecting end-of-life care discussions: (1) concerns over having proactive conversations about the desire to hasten death, (2) uncertainties regarding wish-to-die statements, (3) conversation complexities around procedural matters, (4) shifting discussions about suffering and quality of life, and (5) the need and challenges of promoting open-ended discussions. Conclusion: Medical Assistance in Dying challenges end-of-life care discussions and requires education and support for all concerned to enable compassionate health professional communication. It remains essential to address psychosocial and existential suffering in medicine, but also to provide timely palliative care to ensure suffering is addressed before it is deemed irremediable. Hence, clarification is required regarding assisted dying as an intervention of last resort. Furthermore, professional and institutional guidance needs to better support palliative care providers in maintaining their holistic standard of care. |
| first_indexed | 2024-12-20T17:29:19Z |
| format | Article |
| id | doaj.art-f63811718f634b1f87ccd9417be3e55f |
| institution | Directory Open Access Journal |
| issn | 2632-3524 |
| language | English |
| last_indexed | 2024-12-20T17:29:19Z |
| publishDate | 2021-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Palliative Care and Social Practice |
| spelling | doaj.art-f63811718f634b1f87ccd9417be3e55f2022-12-21T19:31:26ZengSAGE PublishingPalliative Care and Social Practice2632-35242021-11-011510.1177/26323524211045996How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providersAnita HoJoshua S. NormanSoodabeh JoolaeeKristie SerotaLouise TwellsLeeroy WilliamBackground: More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying. Understanding how end-of-life care discussions between patients and specialist palliative care providers may be affected by such legislation can inform end-of-life care delivery in the evolving socio-cultural and legal environment. Aim: To explore how the Canadian Medical Assistance in Dying legislation affects end-of-life care discussions between patients and multidisciplinary specialist palliative care providers. Design: Qualitative thematic analysis of semi-structured interviews. Participants: Forty-eight specialist palliative care providers from Vancouver (n = 26) and Toronto ( n = 22) were interviewed in person or by phone. Participants included physicians ( n = 22), nurses ( n = 15), social workers ( n = 7), and allied health professionals ( n = 4). Results: Qualitative thematic analysis identified five notable considerations associated with Medical Assistance in Dying affecting end-of-life care discussions: (1) concerns over having proactive conversations about the desire to hasten death, (2) uncertainties regarding wish-to-die statements, (3) conversation complexities around procedural matters, (4) shifting discussions about suffering and quality of life, and (5) the need and challenges of promoting open-ended discussions. Conclusion: Medical Assistance in Dying challenges end-of-life care discussions and requires education and support for all concerned to enable compassionate health professional communication. It remains essential to address psychosocial and existential suffering in medicine, but also to provide timely palliative care to ensure suffering is addressed before it is deemed irremediable. Hence, clarification is required regarding assisted dying as an intervention of last resort. Furthermore, professional and institutional guidance needs to better support palliative care providers in maintaining their holistic standard of care.https://doi.org/10.1177/26323524211045996 |
| spellingShingle | Anita Ho Joshua S. Norman Soodabeh Joolaee Kristie Serota Louise Twells Leeroy William How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers Palliative Care and Social Practice |
| title | How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers |
| title_full | How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers |
| title_fullStr | How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers |
| title_full_unstemmed | How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers |
| title_short | How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers |
| title_sort | how does medical assistance in dying affect end of life care planning discussions experiences of canadian multidisciplinary palliative care providers |
| url | https://doi.org/10.1177/26323524211045996 |
| work_keys_str_mv | AT anitaho howdoesmedicalassistanceindyingaffectendoflifecareplanningdiscussionsexperiencesofcanadianmultidisciplinarypalliativecareproviders AT joshuasnorman howdoesmedicalassistanceindyingaffectendoflifecareplanningdiscussionsexperiencesofcanadianmultidisciplinarypalliativecareproviders AT soodabehjoolaee howdoesmedicalassistanceindyingaffectendoflifecareplanningdiscussionsexperiencesofcanadianmultidisciplinarypalliativecareproviders AT kristieserota howdoesmedicalassistanceindyingaffectendoflifecareplanningdiscussionsexperiencesofcanadianmultidisciplinarypalliativecareproviders AT louisetwells howdoesmedicalassistanceindyingaffectendoflifecareplanningdiscussionsexperiencesofcanadianmultidisciplinarypalliativecareproviders AT leeroywilliam howdoesmedicalassistanceindyingaffectendoflifecareplanningdiscussionsexperiencesofcanadianmultidisciplinarypalliativecareproviders |