7938University of Toronto, Canada.
Nurs Ethics. 2020 Nov;27(7):1501-1516. doi: 10.1177/0969733020921493. Epub 2020 May 21.
Family members and healthcare providers play an integral role in a person's assisted dying journey. Their own needs during the assisted dying journey are often, however, unrecognized and underrepresented in policies and guidelines. Circumstances under which people choose assisted dying, and relational contexts such as the sociopolitical environment, may influence the experiences of family members and healthcare providers.
Ethics approval was not required to conduct this review.
This scoping review aims to identify the relational influences on the experiences of family members and healthcare providers of adults who underwent assisted dying and of those unable to access assisted dying due to the loss of capacity to consent.
A literature search was conducted in four databases, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. The search retrieved 12,074 articles, a number narrowed down to 172 articles for full-text screening. Thirty-six articles met the established inclusion criteria. A feminist relational framework guided the data analysis.
Five key themes on the influences of family members' and healthcare providers' experiences throughout the assisted dying process were synthesized from the data. They include (1) relationships as central to beginning the process, (2) social and political influences on decision making, (3) complex roles and responsibilities of family members and healthcare providers, (4) a unique experience of death, and (5) varying experiences following death.
The feminist relational lens, used to guide analysis, shed light on the effect of the sociopolitical influences and the relationships among patients, families, and healthcare providers on each other's experiences. Addressing the needs of the family members and healthcare providers is vital to improving the assisted dying process. Including families' and healthcare providers' needs within institutional policies and enhancing collaboration and communication among those involved could improve the overall experience.
在一个人的协助死亡过程中，家庭成员和医疗保健提供者起着不可或缺的作用。然而，他们在协助死亡过程中的自身需求在政策和准则中往往未被识别和代表。人们选择协助死亡的情况以及社会政治环境等关系背景可能会影响家庭成员和医疗保健提供者的体验。
进行本次综述不需要伦理批准。
本范围综述旨在确定对经历过协助死亡的成年人的家庭成员和医疗保健提供者以及因丧失同意能力而无法获得协助死亡的成年人的家庭成员和医疗保健提供者的体验产生影响的关系因素。
在四个数据库中进行了文献检索，包括 MEDLINE、EMBASE、护理和联合健康文献累积索引 (CINAHL) 和 PsycINFO。该检索共检索到 12074 篇文章，经过进一步筛选，确定了 172 篇文章进行全文筛选。36 篇文章符合既定的纳入标准。女性主义关系框架指导了数据分析。
从数据中综合出五个关键主题，即家庭成员和医疗保健提供者在协助死亡过程中的体验的影响因素。它们包括：(1) 关系是开始这一过程的核心；(2) 社会和政治因素对决策的影响；(3) 家庭成员和医疗保健提供者的复杂角色和责任；(4) 独特的死亡体验；以及(5) 死亡后的不同体验。
用于指导分析的女性主义关系视角揭示了社会政治影响以及患者、家庭和医疗保健提供者之间的关系对彼此体验的影响。满足家庭成员和医疗保健提供者的需求对于改善协助死亡过程至关重要。在机构政策中纳入家庭和医疗保健提供者的需求，并加强相关人员之间的合作和沟通，可改善整体体验。
