Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Philosophy and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Gen Intern Med. 2019 Apr;34(4):636-641. doi: 10.1007/s11606-018-4811-1. Epub 2019 Jan 25.
The evolving legal landscape for medical aid-in-dying (AID) in the USA raises clinical and public health challenges and concerns regarding how health care providers will accommodate AID while expanding access to high-quality end-of-life care.
To describe Vermont health care providers' experiences practicing under the "Patient Choice and Control at End of Life" Act.
Qualitative semi-structured interviews analyzed using grounded theory.
The larger study included 144 health care providers, terminally ill patients, caregivers, policy stakeholders, and other Vermont residents working in 10 out of Vermont's 14 counties. This article reports on a subset of 37 providers who had clinical experience with the law.
Themes from interviews.
Physicians were roughly split between hospital and community-based practices. Most were women (68%) and the largest subgroup specialized in internal or family medicine (53%). Most of the nurses and social workers were women (89%) and most worked for hospice and home health agencies (61%). We identified five domains in which participants engaged with AID: (1) clinical communication and counseling; (2) the Act 39 protocol; (3) prescribing medication; (4) planning for death; and (5) professional education. How providers experienced these five domains of clinical practice depended on their practice setting and the supportive resources available.
Health care providers' participation in AID involves clinical tasks outside of responding to patients' requests and writing prescriptions. Research to identify best practices should focus on all domains of clinical practice in order to best prepare providers.
美国医疗辅助自杀（AID）的法律环境不断演变，这给临床和公共卫生带来了挑战和担忧，即医疗保健提供者在扩大高质量临终关怀服务的同时，如何适应 AID。
描述佛蒙特州医疗保健提供者在“患者选择和控制生命末期法案”下的实践经验。
使用扎根理论对定性半结构式访谈进行分析。
更大的研究包括 144 名医疗保健提供者、绝症患者、护理人员、政策利益相关者和其他在佛蒙特州 14 个县中的 10 个县工作的佛蒙特州居民。本文报告了对具有法律经验的 37 名提供者的一个子集。
访谈主题。
医生大致分为医院和社区实践。大多数是女性（68%），最大的亚组专门从事内科或家庭医学（53%）。大多数护士和社会工作者是女性（89%），大多数在临终关怀和家庭健康机构工作（61%）。我们确定了参与者参与 AID 的五个领域：（1）临床沟通和咨询；（2）第 39 号法案协议；（3）开处方；（4）规划死亡；（5）专业教育。提供者如何体验这五个临床实践领域取决于他们的实践环境和可用的支持资源。
医疗保健提供者参与 AID 涉及超出响应患者请求和开处方的临床任务。为了更好地为提供者做准备，应该针对所有临床实践领域进行最佳实践的研究。
