Gina Bravo1,2, Claudie Rodrigue3, Marcel Arcand3,4, Jocelyn Downie5, Marie-France Dubois6,3, Sharon Kaasalainen7, Cees M Hertogh8, Sophie Pautex9, Lieve Van den Block10, Lise Trottier3. 1. Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. Gina.Bravo@USherbrooke.ca. 2. Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 South Belvedere Street, Sherbrooke, QC, Canada. Gina.Bravo@USherbrooke.ca. 3. Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 South Belvedere Street, Sherbrooke, QC, Canada. 4. Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. 5. Schulich School of Law and Faculty of Medicine, Dalhousie University, Halifax, NS, Canada. 6. Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. 7. Department of Family Medicine, School of Nursing, McMaster University, Hamilton, ON, Canada. 8. Department of General Practice and Elderly Care Medicine, Vrije Universiteit Medical Center, and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands. 9. Department of Community Medicine and Primary Care, Geneva University Hospital, Geneva, Switzerland. 10. VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Abstract
OBJECTIVES: To elicit Quebec physicians' attitudes towards extending medical aid in dying (MAiD) to incompetent patients and to compare the attitudes of family physicians to those of other medical specialists. METHODS: We conducted a postal survey among physicians caring for patients with dementia. We used hypothetical vignettes to elicit their attitudes towards MAiD and continuous deep sedation (CDS) to relieve suffering at end of life. Two patients were depicted in the vignettes: one with cancer eligible for MAiD and one with dementia. The generalized estimating equation approach was used to investigate factors associated with attitudes, including the stage of the illness (advanced vs terminal dementia) and the presence or absence of a prior written request. RESULTS: A total of 136 physicians out of 653 returned the questionnaire. Physicians favoured CDS over MAiD for relieving suffering in the cancer vignette (93% vs 79%; p = 0.002). In advanced dementia, 45% of physicians supported giving the patient access to MAiD with a written request and 14% without such request. At the terminal stage of dementia, these proportions increased to 71% and 43%, respectively (p < 0.001), reaching 79% and 52% among family physicians. Support for CDS in terminal dementia was lower than in end-stage cancer (68% vs 93%; p < 0.001) and equal to MAiD with a written request (68% vs 71%; p = 0.623). CONCLUSION: Many Quebec physicians support extending MAiD to incompetent patients with dementia to relieve suffering at the terminal stage. This finding will inform current deliberations as to whether MAiD should be extended to these patients.
OBJECTIVES: To elicit Quebec physicians' attitudes towards extending medical aid in dying (MAiD) to incompetent patients and to compare the attitudes of family physicians to those of other medical specialists. METHODS: We conducted a postal survey among physicians caring for patients with dementia. We used hypothetical vignettes to elicit their attitudes towards MAiD and continuous deep sedation (CDS) to relieve suffering at end of life. Two patients were depicted in the vignettes: one with cancer eligible for MAiD and one with dementia. The generalized estimating equation approach was used to investigate factors associated with attitudes, including the stage of the illness (advanced vs terminal dementia) and the presence or absence of a prior written request. RESULTS: A total of 136 physicians out of 653 returned the questionnaire. Physicians favoured CDS over MAiD for relieving suffering in the cancer vignette (93% vs 79%; p = 0.002). In advanced dementia, 45% of physicians supported giving the patient access to MAiD with a written request and 14% without such request. At the terminal stage of dementia, these proportions increased to 71% and 43%, respectively (p < 0.001), reaching 79% and 52% among family physicians. Support for CDS in terminal dementia was lower than in end-stage cancer (68% vs 93%; p < 0.001) and equal to MAiD with a written request (68% vs 71%; p = 0.623). CONCLUSION: Many Quebec physicians support extending MAiD to incompetent patients with dementia to relieve suffering at the terminal stage. This finding will inform current deliberations as to whether MAiD should be extended to these patients.
Authors: Andrea Jutta Loizeau; Simon M Cohen; Susan L Mitchell; Nathan Theill; Stefanie Eicher; Mike Martin; Florian Riese Journal: Neurodegener Dis Date: 2019-04-23 Impact factor: 2.977
Authors: Arianne Brinkman-Stoppelenburg; Kirsten Evenblij; H Roeline W Pasman; Johannes J M van Delden; Bregje D Onwuteaka-Philipsen; Agnes van der Heide Journal: J Am Geriatr Soc Date: 2020-07-11 Impact factor: 7.538