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Medical assistance in dying and the meaning of care: Perspectives of nurses, pharmacists, and social workers
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine ( IF 1.9 ) Pub Date : 2021-03-08 , DOI: 10.1177/1363459321996774
Anneliese Mills 1 , Kristin Bright 1, 2 , Rachel Wortzman 1, 3, 4 , Sally Bean 1, 3 , Debbie Selby 1, 3, 4
Affiliation  

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. While it has generated significant academic interest, the experiences of healthcare workers other than physicians remain understudied. This paper reports on a qualitative study of interprofessional Healthcare Providers (HCPs) involved in the provision of MAiD in order to: (1) characterize providers’ views about the care they offer in general; (2) examine whether or not they consider MAiD a form of care; and (3) explore their reasons for viewing or not viewing MAiD as care. Semi-structured qualitative interviews were conducted with ten nurses, eight social workers, and three pharmacists with firsthand experience delivering MAiD at an academic hospital in Toronto, Canada. The study was approved by the hospital’s REB. Written informed consent was obtained prior to participation. Codebook thematic analysis and template analysis generated four themes: (1) care as advocacy, (2) care as easing suffering, (3) care as psychosocial, and (4) care as relational. Every participant viewed MAiD as a form of care and drew on these four themes to authenticate MAiD as care. Participants consider MAiD a form of care for patients, families, other healthcare workers, and even themselves. In alternating and composite fashion, they describe MAiD in terms of autonomy, easing suffering, and a kind death for the dying (and those entrusted with their care)—a complex choreography of social discourses and moral logics that refuse to settle into a simple dichotomy of “choice versus care.” Participants depict MAiD in many of the same terms and imagery they use to describe the care they offer in general. In light of ongoing social controversies surrounding MAiD, HCPs utilize a range of logics strategically to repel negative attention and enable their participation in what they see as a caring end for their patients.



中文翻译:


临终时的医疗救助和护理的意义:护士、药剂师和社会工作者的观点



临终医疗援助 (MAiD) 于 2016 年在加拿大合法化。虽然它引起了学术界的极大兴趣,但除医生之外的医疗保健工作者的经历仍然没有得到充分研究。本文报告了对参与提供 MAiD 的跨专业医疗保健提供者 (HCP) 的定性研究,目的是:(1) 描述提供者对其所提供的护理的总体看法; (2) 检查他们是否认为 MAiD 是一种护理形式; (3) 探讨他们是否将 MAiD 视为护理的原因。我们对 10 名护士、8 名社会工作者和 3 名在加拿大多伦多一家学术医院拥有第一手 MAiD 实施经验的药剂师进行了半结构化定性访谈。该研究得到了医院 REB 的批准。在参与之前获得了书面知情同意书。密码本主题分析和模板分析产生了四个主题:(1)作为倡导的护理,(2)作为减轻痛苦的护理,(3)作为社会心理的护理,以及(4)作为关系的护理。每个参与者都将 MAiD 视为一种护理形式,并利用这四个主题来验证 MAiD 是一种护理。参与者认为 MAiD 是对患者、家庭、其他医护人员甚至他们自己的一种护理形式。他们以交替和复合的方式,用自主、减轻痛苦和对垂死者(以及那些受托照顾的人)的善意死亡来描述 MAiD——社会话语和道德逻辑的复杂编排,拒绝陷入简单的二分法“选择与关心”。参与者使用许多与他们用来描述他们提供的一般护理相同的术语和图像来描述 MAiD。 鉴于围绕 MAiD 持续存在的社会争议,HCP 战略性地利用一系列逻辑来消除负面关注,并使他们能够参与他们认为是对患者的关怀。

更新日期:2021-03-09
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