Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

Abstract Background Even as healthcare providers and systems were settling into the processes required for Medical Assistance in Dying (MAID) under Bill C-14, new legislation was introduced (Bill C-7) that extended assisted death to persons whose natural death is not reasonably foreseeable. The purp...

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Autores principales:	Barbara Pesut, Sally Thorne, David Kenneth Wright, Catharine Schiller, Madison Huggins, Gloria Puurveen, Kenneth Chambaere
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Medical assistance in dying End of life Nursing Qualitative Legislation Healthcare systems Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/644ef9acaf6844f68795f3857025a9e2
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spelling	oai:doaj.org-article:644ef9acaf6844f68795f3857025a9e22021-11-07T12:10:54ZNavigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study10.1186/s12913-021-07222-51472-6963https://doaj.org/article/644ef9acaf6844f68795f3857025a9e22021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07222-5https://doaj.org/toc/1472-6963Abstract Background Even as healthcare providers and systems were settling into the processes required for Medical Assistance in Dying (MAID) under Bill C-14, new legislation was introduced (Bill C-7) that extended assisted death to persons whose natural death is not reasonably foreseeable. The purpose of this paper is to describe the experiences of nurses and nurse practitioners with the implementation and ongoing development of this transition. Methods This qualitative longitudinal descriptive study gathered data through semi-structured telephone interviews with nurses from across Canada; cross sectional data from 2020 to 2021 is reported here. The study received ethical approval and all participants provided written consent. Findings Participants included nurses (n = 34) and nurse practitioners (n = 16) with significant experience with MAID. Participants described how MAID had transitioned from a new, secretive, and anxiety-producing procedure to one that was increasingly visible and normalized, although this normalization did not necessarily mitigate the emotional impact. MAID was becoming more accessible, and participants were learning to trust the process. However, the work was becoming increasingly complex, labour intensive, and often poorly remunerated. Although many participants described a degree of integration between MAID and palliative care services, there remained ongoing tensions around equitable access to both. Participants described an evolving gestalt of determining persons’ eligibility for MAID that required a high degree of clinical judgement. Deeming someone ineligible was intensely stressful for all involved and so participants had learned to be resourceful in avoiding this possibility. The required 10-day waiting period was difficult emotionally, particularly if persons worried about losing capacity to give final consent. The implementation of C-7 was perceived to be particularly challenging due to the nature of the population that would seek MAID and the resultant complexity of trying to address the origins of their suffering within a resource-strapped system. Conclusions Significant social and system calibration must occur to accommodate assisted death as an end-of-life option. The transition to offering MAID for those whose natural death is not reasonably foreseeable will require intensive navigation of a sometimes siloed and inaccessible system. High quality MAID care should be both relational and dialogical and those who provide such care require expert communication skills and knowledge of the healthcare system.Barbara PesutSally ThorneDavid Kenneth WrightCatharine SchillerMadison HugginsGloria PuurveenKenneth ChambaereBMCarticleMedical assistance in dyingEnd of lifeNursingQualitativeLegislationHealthcare systemsPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-16 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical assistance in dying End of life Nursing Qualitative Legislation Healthcare systems Public aspects of medicine RA1-1270
spellingShingle	Medical assistance in dying End of life Nursing Qualitative Legislation Healthcare systems Public aspects of medicine RA1-1270 Barbara Pesut Sally Thorne David Kenneth Wright Catharine Schiller Madison Huggins Gloria Puurveen Kenneth Chambaere Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study
description	Abstract Background Even as healthcare providers and systems were settling into the processes required for Medical Assistance in Dying (MAID) under Bill C-14, new legislation was introduced (Bill C-7) that extended assisted death to persons whose natural death is not reasonably foreseeable. The purpose of this paper is to describe the experiences of nurses and nurse practitioners with the implementation and ongoing development of this transition. Methods This qualitative longitudinal descriptive study gathered data through semi-structured telephone interviews with nurses from across Canada; cross sectional data from 2020 to 2021 is reported here. The study received ethical approval and all participants provided written consent. Findings Participants included nurses (n = 34) and nurse practitioners (n = 16) with significant experience with MAID. Participants described how MAID had transitioned from a new, secretive, and anxiety-producing procedure to one that was increasingly visible and normalized, although this normalization did not necessarily mitigate the emotional impact. MAID was becoming more accessible, and participants were learning to trust the process. However, the work was becoming increasingly complex, labour intensive, and often poorly remunerated. Although many participants described a degree of integration between MAID and palliative care services, there remained ongoing tensions around equitable access to both. Participants described an evolving gestalt of determining persons’ eligibility for MAID that required a high degree of clinical judgement. Deeming someone ineligible was intensely stressful for all involved and so participants had learned to be resourceful in avoiding this possibility. The required 10-day waiting period was difficult emotionally, particularly if persons worried about losing capacity to give final consent. The implementation of C-7 was perceived to be particularly challenging due to the nature of the population that would seek MAID and the resultant complexity of trying to address the origins of their suffering within a resource-strapped system. Conclusions Significant social and system calibration must occur to accommodate assisted death as an end-of-life option. The transition to offering MAID for those whose natural death is not reasonably foreseeable will require intensive navigation of a sometimes siloed and inaccessible system. High quality MAID care should be both relational and dialogical and those who provide such care require expert communication skills and knowledge of the healthcare system.
format	article
author	Barbara Pesut Sally Thorne David Kenneth Wright Catharine Schiller Madison Huggins Gloria Puurveen Kenneth Chambaere
author_facet	Barbara Pesut Sally Thorne David Kenneth Wright Catharine Schiller Madison Huggins Gloria Puurveen Kenneth Chambaere
author_sort	Barbara Pesut
title	Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study
title_short	Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study
title_full	Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study
title_fullStr	Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study
title_full_unstemmed	Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study
title_sort	navigating medical assistance in dying from bill c-14 to bill c-7: a qualitative study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/644ef9acaf6844f68795f3857025a9e2
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Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

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