Factors Influencing Practitioner Choice in Nonparticipation in Medical Assistance in Dying
Bibliographic record
Abstract
Abstract Canadians aged 65 and older compromised 79% of the individuals who chose a medically assisted death between January 1 – October 31, 2018. Despite public approval for MAID, and positive professional reception, few practitioners are participating in MAID care and the underlying factors influencing this require exploration. What are the factors considered by practitioners when contemplating MAID participation? Interpretive Description guided a qualitative, exploratory project. Data included semi-structured interviews with 35 practitioners who currently did not participate in MAID, interviewer field notes and reflective content. Data was analyzed through open coding, a constant comparative approach and thematic analysis. Participants are contemplating numerous endogenous and exogenous factors in determining care participation. The endogenous factors included philosophy of care, MAID/faith/spirituality congruence, the conceptualization of duty, comfort with death and previous life experiences. Within these factors, participants described knowing if MAID participation was, or was not, possible through a process of self-reconciliation. Those who thought MAID care participation may be possible, but yet were not participating, intentionally contemplated numerous exogenous factors including risk, time and practice factors, patient, family and community considerations, system structures, and visibility. Non-participation in MAID care is important to understand to support the self-determination of older adults who may consider MAID. Contemplating involvement in MAID care is complex with both numerous factors influencing practitioner choice. Practitioners require care options, safe passage, respect, model of care clarity, removal of practice barriers, open conversations, enhanced education opportunities and time to facilitate safe, supportive work environments and client care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.031 | 0.088 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.006 | 0.004 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".