University of Toronto, Canada.
Middlebury College, USA.
Health (London). 2023 Jan;27(1):60-77. doi: 10.1177/1363459321996774. Epub 2021 Mar 8.
Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. While it has generated significant academic interest, the experiences of healthcare workers other than physicians remain understudied. This paper reports on a qualitative study of interprofessional Healthcare Providers (HCPs) involved in the provision of MAiD in order to: (1) characterize providers' views about the care they offer in general; (2) examine whether or not they consider MAiD a form of care; and (3) explore their reasons for viewing or not viewing MAiD as care. Semi-structured qualitative interviews were conducted with ten nurses, eight social workers, and three pharmacists with firsthand experience delivering MAiD at an academic hospital in Toronto, Canada. The study was approved by the hospital's REB. Written informed consent was obtained prior to participation. Codebook thematic analysis and template analysis generated four themes: (1) care as advocacy, (2) care as easing suffering, (3) care as psychosocial, and (4) care as relational. Every participant viewed MAiD as a form of care and drew on these four themes to authenticate MAiD as care. Participants consider MAiD a form of care for patients, families, other healthcare workers, and even themselves. In alternating and composite fashion, they describe MAiD in terms of autonomy, easing suffering, and a kind death for the dying (and those entrusted with their care)-a complex choreography of social discourses and moral logics that refuse to settle into a simple dichotomy of "choice versus care." Participants depict MAiD in many of the same terms and imagery they use to describe the care they offer in general. In light of ongoing social controversies surrounding MAiD, HCPs utilize a range of logics strategically to repel negative attention and enable their participation in what they see as a caring end for their patients.
医疗辅助死亡(MAiD)于 2016 年在加拿大合法化。尽管它引起了学术界的极大兴趣,但除医生以外的医疗保健工作者的经验仍未得到充分研究。本文报告了一项对参与提供 MAiD 的跨专业医疗保健提供者(HCP)的定性研究,目的是:(1)描述提供者对他们提供的一般护理的看法;(2)检查他们是否认为 MAiD 是一种护理形式;(3)探讨他们将 MAiD 视为或不视为护理的原因。在加拿大多伦多的一家学术医院,对十名护士、八名社会工作者和三名有直接提供 MAiD 经验的药剂师进行了半结构化的定性访谈。该研究得到了医院 REB 的批准。参与者在参与之前获得了书面知情同意。代码本主题分析和模板分析生成了四个主题:(1)护理即倡导,(2)护理即缓解痛苦,(3)护理即心理社会,(4)护理即关系。每位参与者都将 MAiD 视为一种护理形式,并利用这四个主题来证明 MAiD 是一种护理形式。参与者认为 MAiD 是一种为患者、家属、其他医疗保健工作者甚至他们自己提供的护理形式。他们以自主、缓解痛苦和临终者(以及受托照顾他们的人)的体面死亡为依据,以一种复杂的社会话语和道德逻辑的交替和组合方式来描述 MAiD,这些话语和逻辑拒绝简单地划分为“选择与护理”的二分法。参与者用他们用来描述他们提供的一般护理的许多相同的术语和形象来描述 MAiD。鉴于围绕 MAiD 的持续社会争议,HCP 战略性地利用一系列逻辑来回避负面关注,并使他们能够参与他们认为是患者关怀的结束。