1 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba.
2 Manitoba Palliative Care Research Unit, CancerCare Manitoba, Manitoba, Winnipeg, Manitoba.
Can J Psychiatry. 2017 Nov;62(11):787-794. doi: 10.1177/0706743717711174. Epub 2017 May 26.
Bill C-14 allows for medical assistance in dying (MAID) for patients who have intolerable physical or psychological suffering that occurs in the context of a reasonably foreseeable death. In Canada, psychiatrist support for MAID on the basis of mental illness and beliefs influencing level of support are unknown. The objectives of this research were to 1) determine if psychiatrists are supportive of MAID under certain conditions and on the basis of mental illness and 2) determine what factors are related to psychiatrist support for MAID on the basis of mental illness.
This cross-sectional study was conducted among 528 psychiatrists in Canada using an online survey platform (February 19 to March 11, 2016).
The response rate was 20.9% ( n = 528). Most psychiatrists supported the legalisation of MAID in some circumstances (72%); however, only 29.4% supported MAID on the basis of mental illness. Factors correlating with decreased support for MAID for mental illness were the belief that MAID for mental illness would change the psychiatrists' commitment to their patients through enduring suffering, having a personal faith, and having had past patients who would have received MAID for mental illness were it legal but instead went on to recover.
This study found that most psychiatrists do not support the legalisation of MAID for mental illness, despite being quite supportive of MAID in general. Objections seemed to be based upon concern for vulnerable patients, personal moral objections, and concern for the effect it would have on the therapeutic alliance.
C-14 法案允许对患有无法忍受的身体或心理痛苦且预期将死亡的患者实施医疗协助自杀(MAID)。在加拿大,精神科医生对 MAID 的支持基于精神疾病以及影响支持程度的信念尚不清楚。本研究的目的是:1)确定精神科医生是否在某些情况下以及基于精神疾病支持 MAID;2)确定哪些因素与精神疾病相关的 MAID 支持有关。
本横断面研究于 2016 年 2 月 19 日至 3 月 11 日在加拿大的 528 名精神科医生中使用在线调查平台进行。
应答率为 20.9%(n=528)。大多数精神科医生支持在某些情况下将 MAID 合法化(72%);但是,只有 29.4%的人支持基于精神疾病的 MAID。与对精神疾病的 MAID 支持减少相关的因素包括认为 MAID 会使精神科医生通过忍受痛苦来改变对患者的承诺、有个人信仰以及有过去的患者如果 MAID 合法,本可以接受 MAID 治疗但最终康复。
本研究发现,尽管大多数精神科医生普遍支持 MAID,但他们并不支持将 MAID 合法化用于治疗精神疾病。反对意见似乎基于对弱势患者的担忧、个人道德反对以及对其对治疗联盟影响的担忧。