农村医疗保健专业人员参与医疗辅助死亡（MAiD）：超越二元决策。
Rural healthcare professionals' participation in Medical Assistance in Dying (MAiD): beyond a binary decision.
机构信息
Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.
出版信息
BMC Palliat Care. 2024 Apr 25;23(1):107. doi: 10.1186/s12904-024-01440-4.
BACKGROUND
Medical Assistance in Dying (MAiD) was legalized in Canada in 2016 and amended in 2021. At the time that this study was conducted, the federal government was considering expanding the eligibility criteria to include patients whose death was not reasonably foreseeable. The purpose of this study was to better understand rural healthcare professionals' experiences with assisted dying set against the backdrop of legislative expansion.
METHODS
A qualitative exploratory study was undertaken with general rural practice physicians, nurse practitioners, registered nurses, ethicists, patients, and patient families in rural Southern Alberta, Canada. For this paper, data from 18 audio-recorded and transcribed semi-structured interviews with healthcare professionals were analyzed using thematic analysis. Categories and patterns of shared meaning that linked to an overarching theme were identified.
RESULTS
Between the binary positions of full support for and conscientious objection to assisted dying, rural healthcare professionals' decisions to participate in MAiD was based on their moral convictions, various contextual factors, and their participation thresholds. Factors including patient suffering; personal and professional values and beliefs; relationships with colleagues, patients and family, and community; and changing MAiD policy and legislation created nuances that informed their decision-making.
CONCLUSIONS
The interplay of multiple factors and their degree of influence on healthcare professionals' decision-making create multiple decision points between full support for and participation in MAiD processes and complete opposition and/or abstention. Moreover, our findings suggest evolving policy and legislation have the potential to increase rural healthcare professionals' uncertainty and level of discomfort in providing services. We propose that the binary language typically used in the MAiD discourse be reframed to reflect that decision-making processes and actions are often fluid and situational.
背景
2016 年，加拿大将医疗协助死亡（MAiD）合法化，并于 2021 年对其进行了修订。在进行这项研究时，联邦政府正在考虑扩大资格标准，将那些预计无法预见死亡的患者纳入其中。本研究的目的是在立法扩大的背景下，更好地了解农村医疗保健专业人员在协助死亡方面的经验。
方法
在加拿大艾伯塔省南部农村地区，对普通农村执业医生、执业护士、注册护士、伦理学家、患者及其家属进行了一项定性探索性研究。在本文中，对来自 18 名农村医疗保健专业人员的 18 次音频记录和转录的半结构化访谈进行了分析，采用主题分析。确定了与总体主题相关的具有共同意义的类别和模式。
结果
在完全支持和出于良心反对协助死亡的两种立场之间，农村医疗保健专业人员决定参与 MAiD 是基于他们的道德信念、各种背景因素和他们的参与门槛。包括患者的痛苦；个人和职业价值观和信念；与同事、患者和家属以及社区的关系；以及不断变化的 MAiD 政策和立法等因素造成了细微差别，影响了他们的决策。
结论
多种因素的相互作用及其对医疗保健专业人员决策的影响程度，在完全支持和参与 MAiD 流程与完全反对和/或回避之间创造了多个决策点。此外，我们的研究结果表明，不断变化的政策和立法有可能增加农村医疗保健专业人员在提供服务方面的不确定性和不适感。我们建议重新构建 MAiD 话语中常用的二元语言，以反映决策过程和行动通常是灵活和具体情况的。
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