Variath Caroline, Peter Elizabeth, Cranley Lisa, Godkin Dianne
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada.Faculty of Health and Human Services, Vancouver Island University, Nanaimo, BC, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, CanadaJoint Centre for Bioethics, University of Toronto, Toronto, ON, Canada.
Palliat Care Soc Pract. 2022 Oct 14;16:26323524221128839. doi: 10.1177/26323524221128839. eCollection 2022.
In Canada, under Bill C-14, patients who met all eligibility requirements were prevented from accessing medical assistance in dying (MAiD) following their loss of decision-making capacity while awaiting MAiD. The changes introduced with Bill C-7 continue to limit access to patients who did not enter a waiver of final consent agreement with their healthcare providers. Little is known about the experiences with patients' loss of capacity to consent and subsequent ineligibility for MAiD. Understanding healthcare providers' experiences has important implications for improving end-of-life care for those with capacity-limiting conditions.
To explore Canadian healthcare providers' experiences with end-of-life of eligible patients who became ineligible for MAiD due to their loss of decision-making capacity to consent and the relational influences on their experiences prior to the implementation of Bill C-7 in Canada.
A critical qualitative methodology and a feminist ethics theoretical lens guided this study. A voice-centred relational approach that allowed an in-depth exploration of how power, relationality and moral agency influenced participants' experiences was used for data analysis. Data consisted of semi-structured interviews with 30 healthcare providers.
The analysis resulted in the following four main themes and corresponding subthemes: (1) identifying factors that may result in ineligibility for MAiD due to capacity loss; (2) maintaining eligibility required to access MAiD; (3) preparing for an alternative end-of-life; (4) experiencing patients' capacity loss.
This study highlights that while MAiD is legally available to eligible Canadians, access to MAiD and care for eligible patients who were unable to access MAiD due to their loss of decision-making varied based on the geographical locations and access to willing MAiD and end-of-life care providers. The availability of high-quality palliative care for patients throughout the MAiD process, including following the loss of capacity to consent and subsequent ineligibility, would improve the end-of-life experience for all those involved. The need to establish a systematic approach to prepare and care for patients and their families following the patients' loss of capacity and subsequent ineligibility for MAiD is also identified.
在加拿大，根据C-14法案，符合所有资格要求的患者在等待医疗协助死亡（MAiD）期间丧失决策能力后，被阻止获得MAiD。C-7法案引入的变更继续限制那些未与医疗服务提供者签订最终同意豁免协议的患者获得MAiD。对于患者丧失同意能力以及随后无资格获得MAiD的经历，人们知之甚少。了解医疗服务提供者的经历对于改善患有能力受限疾病患者的临终护理具有重要意义。
探讨加拿大医疗服务提供者对因丧失决策同意能力而无资格获得MAiD的合格患者临终情况的经历，以及在加拿大C-7法案实施之前，这些经历所受到的关系影响。
本研究采用批判性定性方法和女性主义伦理学理论视角。数据分析采用以声音为中心的关系方法，该方法允许深入探索权力、关系性和道德能动性如何影响参与者的经历。数据包括对30名医疗服务提供者的半结构化访谈。
分析得出以下四个主要主题及相应子主题：（1）确定因能力丧失可能导致无资格获得MAiD的因素；（2）维持获得MAiD所需的资格；（3）为替代临终方案做准备；（4）经历患者能力丧失。
本研究强调，虽然MAiD在法律上可供符合条件的加拿大人使用，但由于决策能力丧失而无法获得MAiD的合格患者获得MAiD和护理的情况因地理位置以及能否获得愿意提供MAiD和临终护理的提供者而有所不同。在整个MAiD过程中，包括在患者丧失同意能力及随后无资格获得MAiD之后，为患者提供高质量的姑息治疗，将改善所有相关人员的临终体验。研究还指出，需要建立一种系统的方法，以便在患者丧失能力并随后无资格获得MAiD后为患者及其家属做好准备并提供护理。
