Driftmier Peter, Shaw Jessica
Faculty of Social Work, University of Calgary, Calgary, Canada.
Health Equity. 2021 Dec 20;5(1):847-853. doi: 10.1089/heq.2021.0117. eCollection 2021.
As of August 2020, 11 patients who were federally incarcerated in a Canadian prison requested medical assistance in dying (MAiD), and three received it. This case study seeks to understand the process of care as described by physicians involved in each of the cases that resulted in MAiD. During the summer of 2020, semistructured interviews were conducted with physicians involved in each known Correctional Service of Canada (CSC) MAiD case. Transcripts were summarized to illuminate details of the care process for each patient, highlighting barriers to patient-centered care. Each case took place in a different province. One MAiD provision took place in a prison hospital, and two provisions took place after the incarcerated patients were transferred to external community hospitals. Case summaries highlight the physicians' efforts and challenges in assuring patient-centered care. Physician experiences illuminate several barriers to care: CSC bureaucratic processes that forced longer wait times than typical for patients in the general public; challenges related to accessing release before MAiD application; knowledge of patient preference for location of death; concerns of voluntariness and confidentiality that are unique to CSC patients; and ethical considerations surrounding the presence of prison guards, police officers, and shackles at the time of assessment or provision. Reporting by the Office of the Correctional Investigator highlights additional challenges in these cases. Further inquiry is necessary to include the perspectives of prisoners and prison staff, and to consider how the evolution of new MAiD legislation will affect MAiD for prisoners.
截至2020年8月，11名被联邦关押在加拿大监狱的囚犯申请了医疗协助死亡（MAiD），其中3人获得了批准。本案例研究旨在了解参与导致MAiD的每个案例的医生所描述的护理过程。2020年夏天，对参与加拿大惩教署（CSC）已知MAiD案例的医生进行了半结构化访谈。对访谈记录进行了总结，以阐明每个患者护理过程的细节，突出以患者为中心的护理障碍。每个案例发生在不同的省份。一次MAiD批准在监狱医院进行，两次批准是在被监禁的患者被转移到外部社区医院后进行的。案例总结突出了医生在确保以患者为中心的护理方面的努力和挑战。医生的经历揭示了护理的几个障碍：CSC的官僚程序导致患者等待时间比普通公众更长；在申请MAiD之前获得释放方面的挑战；对患者死亡地点偏好的了解；CSC患者特有的自愿性和保密性问题；以及在评估或批准时监狱警卫、警察和镣铐在场的伦理考量。惩教调查员办公室的报告突出了这些案例中的其他挑战。有必要进一步调查，纳入囚犯和监狱工作人员的观点，并考虑新的MAiD立法的演变将如何影响囚犯的MAiD。
