Wiebe Ellen, Kelly Michaela, McMorrow Thomas, Tremblay-Huet Sabrina, Hennawy Mirna
Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; University of London (Kelly), London School of Hygiene and Tropical Medicine, Department of Epidemiology and Population Health, London, UK; Ontario Tech University (McMorrow), Faculty of Social Science and Humanities, Legal Studies, Oshawa, Ont.; Université de Sherbrooke (Tremblay-Huet), Faculty of Law, Sherbrook, Que.; University of British Columbia (Hennawy), Kelowna, BC
Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; University of London (Kelly), London School of Hygiene and Tropical Medicine, Department of Epidemiology and Population Health, London, UK; Ontario Tech University (McMorrow), Faculty of Social Science and Humanities, Legal Studies, Oshawa, Ont.; Université de Sherbrooke (Tremblay-Huet), Faculty of Law, Sherbrook, Que.; University of British Columbia (Hennawy), Kelowna, BC.
CMAJ Open. 2021 Apr 13;9(2):E358-E363. doi: 10.9778/cmajo.20200136. Print 2021 Apr-Jun.
Under the Canadian , medical assistance in dying (MAiD) requires that patients give informed consent and that their ability to consent is assessed by 2 clinicians. In this study, we intended to understand how Canadian clinicians assessed capacity in people requesting MAiD.
This qualitative study used interviews conducted between August 2019 and February 2020, by phone, video and email, to explore how clinicians assessed capacity in people requesting MAiD, what challenges they had encountered and what tools they used. The participants were recruited from provider mailing listserves of the Canadian Association of MAiD Assessors and Providers and Aide médicale à mourir. Interviews were audio-recorded and transcribed verbatim. The research team met to review transcripts and explore themes as they emerged in an iterative manner. We used abductive reasoning for thematic analysis and coding, and continued to discuss until we reached consensus.
The 20 participants worked in 5 of 10 provinces across Canada, represented different specialties and had experience assessing a total of 2410 patients requesting MAiD. The main theme was that, for most assessments, the participants used the conversation about how the patient had come to choose MAiD to get the information they needed. When the participants used formal capacity assessment tools, this was mostly for meticulous documentation, and they rarely asked for psychiatric consults. The participants described how they approached assessing cases of nonverbal patients and other challenging cases, using techniques such as ensuring a quiet environment and adequate hearing aids, and using questions requiring only "yes" or "no" as an answer.
The participants were comfortable doing MAiD assessments and used their clinical judgment and experience to assess capacity in ways similar to other clinical practices. The findings of this study suggest that experienced MAiD assessors do not routinely require formal capacity assessments or tools to assess capacity in patients requesting MAiD.
在加拿大，医疗协助死亡（MAiD）要求患者给予知情同意，且其同意能力需由两名临床医生进行评估。在本研究中，我们旨在了解加拿大临床医生如何评估申请MAiD者的能力。
这项定性研究采用了2019年8月至2020年2月期间通过电话、视频和电子邮件进行的访谈，以探讨临床医生如何评估申请MAiD者的能力、他们遇到了哪些挑战以及使用了哪些工具。参与者从加拿大MAiD评估者与提供者协会以及医疗协助死亡协会的提供者邮件列表中招募。访谈进行了录音并逐字转录。研究团队开会审查转录本，并以迭代方式探索出现的主题。我们采用归纳推理进行主题分析和编码，并持续讨论直至达成共识。
20名参与者在加拿大10个省中的5个省工作，代表不同专业，共评估了2410名申请MAiD的患者。主要主题是，对于大多数评估，参与者通过与患者讨论其如何选择MAiD来获取所需信息。当参与者使用正式的能力评估工具时，大多是为了进行细致的记录，且他们很少寻求精神科会诊。参与者描述了他们如何处理非言语患者及其他具有挑战性的病例，采用了诸如确保安静环境和配备合适助听器，以及使用只需回答“是”或“否”的问题等技巧。
参与者对进行MAiD评估感到得心应手，并运用他们的临床判断和经验，以与其他临床实践类似的方式评估能力。本研究结果表明，经验丰富的MAiD评估者在评估申请MAiD的患者能力时，通常并不需要常规使用正式的能力评估或工具。
