Montague Terrence, Nemis-White Joanna, Aylen John, Ahmed Sara, Baxter Sharon, Martin Lesli, Adams Owen, Gogovor Amédé
principal, CareNet Health Management Consulting Ltd., and Adjunct Professor of Medicine, University of Alberta, Edmonton, AB.
Principal, Strive Health Management Consulting Inc., Halifax, NS.
Healthc Q. 2017;20(2):18-21. doi: 10.12927/hcq.2017.25222.
A new dimension has been added to Canadian Medicare ߝ exemption from prosecution for physicians, nurse practitioners and assistants providing medical assistance in dying for competent and informed adult patients with a grievous and irremediable medical condition causing intolerable physical or psychological suffering, irreversible decline in capabilities and reasonably foreseeable natural death. To define stakeholders' perceptions on all contemporary end-of-life care options, we analyzed data from the 2016 Health Care in Canada Survey comprising representative samples of the adult public (n = 1,500), physicians (n = 102), nurses (n = 102), pharmacists (n = 100), administrators (n = 100) and allied health professionals (n = 100). Among the public, enhanced pain management, hospice/palliative care and home/family care were all supported at, or above, the 80th percentile; medically assisted death was supported by 70%. Among all professionals, hospice/palliative care, pain management and home care garnered >90% support; support for medically assisted death ranged from 58% (physicians) to 79% (allied professionals). In terms of priority to implement available options, medically assisted death was rated first by 46% of the public, overall, and by 69% of the sub-group who strongly supported it, followed by enhanced pain management (45%) and home care (42%). Among professionals, top implementation priorities (range: 57ߝ61%) were: enhanced pain management, hospice/palliative care and home care support. Priority for medically assisted death ranged between 25% and 41%, although among professionals who strongly supported it, it was their top priority (52%). When asked to balance patients' right to access assisted death, versus some professionals' reluctance to provide it, 42% of the public and the majority of professionals thought providers should be allowed to opt out if they referred patients to another willing provider. And many professionals perceive some risk of either legal or regulatory reprisal if they assist in patients' deaths. In summary, there is substantial contemporary support for all components of end-of-life care among all stakeholders. However, non-lethal care modalities remain generally preferred, perhaps, at least in part, because medical professionals have a pervasive concern of going in harm's way by participating in assisted death, or by refusing. Things can be better.
加拿大医疗保险增添了一个新层面——对于为患有严重且无法治愈的疾病、遭受难以忍受的身体或心理痛苦、能力出现不可逆转衰退且自然死亡可合理预见的有行为能力且已充分知情的成年患者提供医疗协助死亡的医生、执业护士和助理，免于起诉。为明确利益相关者对所有当代临终关怀选项的看法，我们分析了2016年加拿大医疗保健调查的数据，该调查涵盖成年公众（n = 1500）、医生（n = 102）、护士（n = 102）、药剂师（n = 100）、管理人员（n = 100）和专职医疗人员（n = 百）的代表性样本。在公众中，加强疼痛管理、临终关怀/姑息治疗以及家庭护理的支持率均达到或超过第80百分位；医疗协助死亡的支持率为70%。在所有专业人员中，临终关怀/姑息治疗、疼痛管理和家庭护理获得了超过90%的支持；对医疗协助死亡的支持率从58%（医生）到79%（专职医疗人员）不等。在实施现有选项的优先顺序方面，总体而言，46%的公众将医疗协助死亡列为首选，强烈支持该选项的子群体中有69%将其列为首选，其次是加强疼痛管理（45%）和家庭护理（42%）。在专业人员中，实施的首要优先事项（范围：57%至61%）是：加强疼痛管理、临终关怀/姑息治疗和家庭护理支持。医疗协助死亡的优先率在25%至41%之间，不过在强烈支持该选项的专业人员中，它是他们的首要优先事项（52%）。当被要求权衡患者获得协助死亡的权利与一些专业人员不愿提供协助之间的关系时，42%的公众和大多数专业人员认为，如果提供者将患者转介给另一位愿意提供协助的提供者，应允许他们选择退出。而且许多专业人员认为，如果他们协助患者死亡，可能会面临法律或监管方面的报复风险。总之，所有利益相关者对临终关怀的所有组成部分都有相当大的当代支持。然而，非致命性护理方式通常仍然更受青睐，这可能至少部分是因为医疗专业人员普遍担心因参与协助死亡或拒绝协助而陷入危险境地。情况可以变得更好。
