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Medical assistance in dying in hospice: A qualitative study
  1. James Mellett1,2 and
  2. Mary Ellen Macdonald3
  1. 1John Dossetor Health Ethics Centre, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  2. 2Biomedical Ethics Unit, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
  3. 3Division of Oral Health and Society, McGill University, Montreal, Quebec, Canada
  1. Correspondence to James Mellett, John Dossetor Health Ethics Centre, University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB T6G 2T4, Canada; jmellett{at}ualberta.ca

Abstract

Objectives The modern hospice movement has historically opposed assisted dying. The 2016 legalisation of medical assistance in dying (MAID) in Canada has created a new reality for Canadian hospices. There have been few studies examining how the legalisation of MAID has affected Canadian hospices. Our objective was to identify the challenges and opportunities hospice workers think MAID brings to a hospice.

Methods This qualitative descriptive study included four focus groups and four semistructured interviews with Canadian hospice workers at two hospices, one which allowed MAID on site, and one which did not. Thematic analysis was used to understand and report these challenges and opportunities.

Results We constructed five themes. These themes detailed participants’ beliefs in the abilities of hospice care, and how they felt MAID challenged these abilities. Further, participants felt that MAID itself created challenging situations for patients and families, and that local policies and practices led to additional institutional challenges. Some participants also felt that allowing MAID in hospice provided opportunities for more extensive end-of-life options.

Conclusions The legalisation of MAID in Canada has created both challenges and opportunities for Canadian hospices. A balancing of these challenges and opportunities may provide a path for Canadian hospices to navigate their new reality. Increasing demand for MAID means that hospices are likely to continue to encounter requests for MAID, and should enact supports to ensure staff are able to manage these challenges and make best use of the opportunities.

  • ethics
  • hospice care

Data availability statement

Data are available on reasonable request. Reasonable requests for study data should be directed to the corresponding author, or to the Institutional Review Board at McGill University’s Faculty of Medicine (514-398-8302).

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Data availability statement

Data are available on reasonable request. Reasonable requests for study data should be directed to the corresponding author, or to the Institutional Review Board at McGill University’s Faculty of Medicine (514-398-8302).

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Footnotes

  • Contributors This manuscript was developed from the MSc (Bioethics) thesis of JM, supervised by MEM. JM designed the design, generated the data, led the data analysis and completed the first draft of the manuscript. MEM supervised the study design and process, contributed both substantively and editorially to the manuscript. JM is the guarantor of this submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JEM declares a competing interest as he has volunteered at one of the hospice sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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