Nakanishi Allison, Cuthbertson Lauren, Chase Jocelyn
Geriatric Medicine, Vancouver Island Health Authority, Victoria, BC.
Division of Geriatric Medicine, University of British Columbia, Vancouver, BC.
Can Geriatr J. 2021 Jun 1;24(2):82-95. doi: 10.5770/cgj.24.496. eCollection 2021 Jun.
Current Canadian Medical Assistance in Dying (MAiD) legislation requires individuals to have the mental capacity to consent at the time of the procedure. Advance requests for MAiD (ARs for MAiD) could allow individuals to document conditions where MAiD would be desired in the setting of progressive dementia.
Greater Vancouver area dementia care clinicians from family practice, geriatric medicine, geriatric psychiatry, and palliative care were approached to participate in an online survey to assess attitudes around the appropriateness of ARs for MAiD. Quantitative analysis of survey questions and qualitative analysis of open-ended response questions were performed.
Of 630 clinicians approached, 80 were included in the data analysis. 64% of respondents supported legislation allowing ARs for MAiD in dementia. 96% of respondents articulated barriers and concerns, including determination of capacity, protecting the interests of the future individual, navigating conflict among stakeholders, and identifying coercion. 78% of respondents agreed with a mandatory capacity assessment to create an AR, and 59% agreed that consensus between clinicians and substitute decision-makers was required to enact an AR.
The majority of Vancouver dementia care clinicians participating in this study support legislation allowing ARs for MAiD in dementia, while also articulating ethical and logistical concerns with its application.
加拿大现行的医疗协助死亡（MAiD）立法要求个人在接受该程序时具备同意的心智能力。预先提出的医疗协助死亡请求（MAiD的ARs）可以让个人记录在进行性痴呆情况下希望接受MAiD的条件。
研究人员联系了大温哥华地区从事家庭医疗、老年医学、老年精神病学和姑息治疗的痴呆症护理临床医生，邀请他们参与一项在线调查，以评估对MAiD的ARs适当性的态度。对调查问卷问题进行了定量分析，并对开放式回答问题进行了定性分析。
在630名被邀请的临床医生中，80名被纳入数据分析。64%的受访者支持立法允许在痴呆症中进行MAiD的ARs。96%的受访者阐述了障碍和担忧，包括能力的确定、保护未来个人的利益、应对利益相关者之间的冲突以及识别胁迫行为。78%的受访者同意进行强制性能力评估以创建ARs，59%的受访者同意临床医生和替代决策者之间需要达成共识才能制定ARs。
参与本研究的大多数温哥华痴呆症护理临床医生支持立法允许在痴呆症中进行MAiD的ARs，同时也阐述了其应用中的伦理和后勤问题。
