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.
Highlights
In June 2016, the Parliament of Canada passed federal legislation that allows eligible Canadian adults to request medical assistance in dying (MAID).[1]
We describe the positive aspects of MAID legalization from the perspective of Hospice palliative care providers (HPCPs) who have engaged in end-of-life (EOL) care planning with patients who have inquired about and/or requested MAID
Positive aspects related to MAID legalization were identified at (1) the individual level, (2) the team level, and (3) the institutional level
Summary
In June 2016, the Parliament of Canada passed federal legislation that allows eligible Canadian adults to request medical assistance in dying (MAID).[1] Currently, the legislation allows a physician or nurse practitioner to directly administer a substance that causes the death of the person who has requested it or provide eligible patients with a prescription for a substance they can self-administer to cause their death. This legislation aims to respect the personal autonomy of eligible patients seeking access to MAID while at the same time protecting vulnerable people and the equality rights of all Canadians.[2] On 17 March 2021, changes to Canada’s MAID legislation became law. Positive aspects of medical assistance in dying legalization were identified at (1) the individual level: (a) a new end-oflife option, (b) patients’ last chance to express control over their lives, (c) patient and family comfort and Nursing Ethics XX(X)
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