Abstract
Medical assistance in dying (MAID) processes are complex, shaped by legislated directives, and influenced by the discourse regarding its emergence as an end-of-life care option. Physicians and nurse practitioners (NPs) are essential in determining the patient’s eligibility and conducting MAID provisions. This research explored the exogenous factors influencing physicians’ and NPs’ non-participation in formal MAID processes. Using an interpretive description methodology, we interviewed 17 physicians and 18 NPs in Saskatchewan, Canada, who identified as non-participators in MAID. The non-participation factors were related to (a) the health care system they work within, (b) the communities where they live, (c) their current practice context, (d) how their participation choices were visible to others, (e) the risks of participation to themselves and others, (f) time factors, (g) the impact of participation on the patient’s family, and (h) patient–HCP relationship, and contextual factors. Practice considerations to support the evolving social contact of care were identified.
Highlights
Legislative Directives of Bill C-14Federal Bill C-14 in 2016 identified both the patient eligibility criteria and the legislated procedural imperatives to balance individual autonomy and protect the vulnerable (List 1).As defined within the Bill, an irremediable and grievous condition requires that (a) the disease, disability, or illness is serious and incurable, (b) the individual is in an advanced state of irreversible decline in capability, (c) the disease, disability, or illness causes intolerable and enduring physical or psychological suffering that cannot be relieved through means they find acceptable, and (d) considering all the medical circumstances, the individual’s natural death is reasonably foreseeable
Bill C-14 specified that only nurse practitioners (NPs) and physicians could participate in the formal Medical assistance in dying (MAID) processes of determining patient eligibility and providing MAID, and it confirmed the freedoms of conscience and religion and called for a parliamentary review on the state of Palliative care (PC) in Canada
In response to the vignettes, all health care providers (HCPs) stated they would refer the patient to the MAID program through the provincial referral pathway or direct the patient to speak with an alternative HCP
Summary
Legislative Directives of Bill C-14Federal Bill C-14 in 2016 identified both the patient eligibility criteria and the legislated procedural imperatives to balance individual autonomy and protect the vulnerable (List 1).As defined within the Bill, an irremediable and grievous condition requires that (a) the disease, disability, or illness is serious and incurable, (b) the individual is in an advanced state of irreversible decline in capability, (c) the disease, disability, or illness causes intolerable and enduring physical or psychological suffering that cannot be relieved through means they find acceptable, and (d) considering all the medical circumstances, the individual’s natural death is reasonably foreseeable. Bill C-7 underwent royal assent, which altered the patient eligibility criteria and procedural safeguards, included provisions for final consent waivers and advanced consent, outlined additional reporting/monitoring requirements, and called for additional parliamentary reviews (Government of Canada, 2021). Specific changes include (a) removal of the requirement for a reasonably foreseeable death required, (b) specification of different procedural safeguards for track one requests, when death is deemed reasonably foreseeable, and track two requests, when death is not deemed to be reasonably foreseeable, (c) inclusion of mental illness as the sole illness, disease or disability for the purposes of eligibility on the second anniversary of the Royal Assent (March 16, 2023), (d) provisions for a final consent waiver for those patients who have been assessed and approved for MAID, have set a date for MAID and are concerned about the loss of capacity before that time), and (e) provisions for an advanced consent for those patients who do not die within a specified period after selfadministration of MAID medications, the HCP could proceed with intravenous MAID
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