Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
BMJ Support Palliat Care. 2021 Mar;11(1):59-67. doi: 10.1136/bmjspcare-2019-002018. Epub 2020 Jun 29.
The legalisation of medical assistance in dying in numerous countries over the last 20 years represents a significant shift in practice and scope for many clinicians who have had little-to-no training to prepare them to sensitively respond to patient requests for hastened death.
Our objective was to review the existing qualitative literature on the experiences of healthcare providers responding to requests for hastened death with the aim of answering the question: how do clinicians make sense of, and respond to patients' expressed wishes for hastened death?
We performed a systematic review and meta-synthesis of primary qualitative research articles that described the experiences and perspectives of healthcare professionals who have responded to requests for hastened death in jurisdictions where MAiD (Medical Assistance in Dying) was legal or depenalised. A staged coding process was used to identify and analyse core themes.
Although the response to requests for hastened death varied case-by-case, clinicians formulated their responses by considering seven distinct domains. These include: policies, professional identity, commitment to patient autonomy, personal values and beliefs, the patient-clinician relationship, the request for hastened death and the clinician's emotional and psychological response.
Responding to a request for hastened death can be an overwhelming task for clinicians. An approach that takes into consideration the legal, personal, professional and patient perspectives is required to provide a response that encompasses all the complexities associated with such a monumental request.
在过去的 20 年里，许多国家将医疗协助死亡合法化，这代表着许多临床医生的实践和范围发生了重大转变，他们几乎没有接受过任何培训来准备对患者加速死亡的请求做出敏感回应。
我们的目的是回顾现有的关于医疗保健提供者对加速死亡请求的反应的定性文献，旨在回答以下问题：临床医生如何理解和回应患者对加速死亡的表达意愿？
我们对描述在医疗协助死亡（MAiD）合法或非刑事化的司法管辖区中对加速死亡请求做出回应的医疗保健专业人员的经验和观点的主要定性研究文章进行了系统回顾和元综合。使用分阶段编码过程来识别和分析核心主题。
尽管对加速死亡请求的反应因案例而异，但临床医生通过考虑七个不同的领域来制定他们的反应。这些包括：政策、专业身份、对患者自主权的承诺、个人价值观和信仰、医患关系、加速死亡的请求以及临床医生的情绪和心理反应。
对加速死亡请求的回应可能对临床医生来说是一项艰巨的任务。需要采取一种考虑法律、个人、专业和患者观点的方法，以提供一种回应，涵盖与如此重大请求相关的所有复杂性。
