An examination of the perspectives of Canadian hospice workers regarding medical aid/ assistance in dying
Bibliographic record
Abstract
Background:The modern hospice movement and assisted dying both aim to provide end-of-life patients with a good death. The modern hospice movement has historically opposed assisted dying. It has asserted that its conceptualization of a good death provides patients and families with benefits at the end-of-life while avoiding the harms of assisted dying. As such, hospice communities have been hesitant to integrate assisted dying into the care they provide, often citing conflict with its commitment to neither hasten nor prolong death. However, the good deaths offered by hospice communities and assisted dying have the common aim of providing patients with control over the dying process, and are rooted in the values of patient dignity and the relief of suffering. Proponents of assisted dying and some end-of-life scholars have argued that given these common aims and values, some form of co-operation between hospice communities and assisted dying could improve patient choice for a dignified death. In Canada, the 2016 legalization of medical aid or assistance in dying (MAID) has created a new reality for Canadian hospices in which MAID is now a healthcare option for many end-of-life patients, including for those in hospice care. Literature on hospices in jurisdictions where assisted dying is legal highlighted that legalization has created new challenges for these hospices to navigate, many of which have arisen from the shared and conflicting aims and values between the hospice community and assisted dying. There have been no academic studies exclusively examining how the legalization of MAID has impacted Canadian hospices, including how shared aims and values between the two could create opportunities for these hospices. Aim:This study was designed to understand the new reality in which Canadian hospices find themselves by identifying the challenges and opportunities hospice workers think MAID brings to a hospice.Methods:This qualitative descriptive study included four focus groups and four semi structured interviews with Canadian hospice workers at two hospice sites, one in Alberta and another in Quebec. The Alberta hospice site allows MAID, while the Quebec one does not. A total of 23 staff members were recruited, from professions including managers, physicians, registered nurses, licensed practical nurses, and resident care aides. Participants were asked to discuss the opportunities and challenges MAID brings to hospice practice. Using the theoretical framework of hospice as a place as a sensitizing concept, thematic analysis was used to generate themes that explained these challenges and opportunities. Results:We constructed five themes: 1) The availability of MAID on-site challenges a hospice’s identity; 2) Hospice staff struggle to understand patient interest in MAID given staff beliefs in the abilities of hospice care; 3) The availability of MAID for hospice patients results in challenging clinical situations involving hospice patients and families; 4) Differing hospice responses to the legalization of MAID creates unique challenges; and 5) Allowing MAID on-site provides opportunities for a hospice to improve the end-of-life experience of patients and families.Discussion and Conclusions:The results of this study provide insight into the new situations and possibilities faced by Canadian hospices since the legalization of MAID. These results, in combination with existing literature, suggest that for hospices navigating their new reality, allowing MAID on-site with the understanding that it is not a part of hospice care could be beneficial to patients, while also allowing a hospice to maintain its unique identity. It is hoped that the results of this study will provide guidance to Canadian hospices, while also laying the groundwork for future research
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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 | 0.012 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.075 | 0.018 |
| Scholarly communication | 0.010 | 0.003 |
| Open science | 0.005 | 0.010 |
| Research integrity | 0.006 | 0.010 |
| Insufficient payload (model declined to judge) | 0.005 | 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".