“It’s a big difference between having an opinion on something and actively doing it:” physician and nurse practitioner non-participation in medical assistance in dying
Notice bibliographique
Résumé
Medical assistance in dying (MAID) became legal in 2016 with the Royal Assent of Bill C-14. There are numerous considerations and several challenges when developing safe and sustainable MAID programs in Canada. In the face of these challenges, competent and compassionate healthcare practitioners (HCPs) who are willing to participate in the formal MAID processes of patient assessment and MAID provision are essential. This thesis included a scoping review which identified, analyzed, and synthesized the factors that influenced HCPs' non-participation in ethically complex, legally available healthcare and a qualitative exploratory study that illuminated the factors that influenced physicians and nurse practitioners (NPs) when deciding not to participate in the formal MAID processes of determining a patient’s eligibility and providing MAID. \nFive themed factors that influenced HCPs' non-participation in ethically complex, legally available care were identified in the scoping review. While conscientious objection (CO) frequently dominated the discourse regarding HCPs’ non-participation care, it was clear that multiple factors beyond ethical, religious, or core moral belief also influenced HCPs’ non-participation. Thirty-five non-participating HCPs were interviewed over five months in Saskatchewan, Canada in the qualitative exploratory project. Considering Social Contract Theory and Ruggerio’s approach to moral dilemmas and decision-making, the endogenous and exogenous factors that influenced their non-participation threshold were identified. Endogenously HCPs’ were influenced by their (1) previous personal and professional experiences, (2) comfort with death, (3) conceptualization of duty, (4) preferred EOL care approaches, (5) faith or spirituality beliefs, (6) self-accountability, (7) consideration of emotional labour, and (8) concern regarding future emotional impact. Exogenously, HCPs’ non-participation was influenced by (1) the healthcare system they work within, (2) the communities where they live, (3) their current practice context, (4) how their participation choices were visible to others, (5) the risks of participation to themselves and others, (6) time factors, (7) the impact of participation on the patient’s family, and (8) patient relationship and contextual factors. Non-participation in formal MAID processes occurred along a spectrum and was influenced by these complex, interwoven, and diverse endogenous and exogenous factors.\nThis dissertation's key findings are that non-participation in ethically complex, legally available care (including MAID) includes both conscientious objection to care and non-participation in care and culminated in the development of the Model of Non-Participation in Formal MAID Processes. Practice considerations to support patients and HCPs in the evolving social contract of end-of-life care are offered to support safe and satisfying workplaces and patients' access to care.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,002 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».