A qualitative study of physicians' conscientious objections to medical aid in dying.
Identifieur interne : 000682 ( Main/Exploration ); précédent : 000681; suivant : 000683A qualitative study of physicians' conscientious objections to medical aid in dying.
Auteurs : Marie-Eve Bouthillier [Canada] ; Lucie Opatrny [Canada]Source :
- Palliative medicine [ 1477-030X ] ; 2019.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Attitude du personnel soignant (MeSH), Auto-efficacité (MeSH), Charge de travail (MeSH), Compétence clinique (MeSH), Conscience morale (MeSH), Déontologie médicale (MeSH), Femelle (MeSH), Humains (MeSH), Mâle (MeSH), Médecins (psychologie), Québec (MeSH), Recherche qualitative (MeSH), Refus de traiter (MeSH), Suicide assisté (psychologie), Suicide assisté (éthique).
- MESH :
English descriptors
- KwdEn :
- Adult (MeSH), Attitude of Health Personnel (MeSH), Clinical Competence (MeSH), Conscience (MeSH), Ethics, Medical (MeSH), Female (MeSH), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Physicians (psychology), Qualitative Research (MeSH), Quebec (MeSH), Refusal to Treat (MeSH), Self Efficacy (MeSH), Suicide, Assisted (ethics), Suicide, Assisted (psychology), Workload (MeSH).
- MESH :
- geographic : Quebec.
- ethics : Suicide, Assisted.
- psychology : Physicians, Suicide, Assisted.
- Adult, Attitude of Health Personnel, Clinical Competence, Conscience, Ethics, Medical, Female, Humans, Male, Middle Aged, Qualitative Research, Refusal to Treat, Self Efficacy, Workload.
Abstract
BACKGROUND
Under Quebec's Act respecting end-of-life care, physicians may refuse to provide medical aid in dying because of personal convictions, also called conscientious objections. Before legalisation, the results of our survey showed that the majority of physicians were in favour of medical aid in dying (76%), but one-third (28%) were not prepared to perform it. After 18 months of legalisation, physicians were refusing far more frequently than the pre-Act survey had anticipated.
AIM
To explore the conscientious objections stated by physicians so as to understand why some of them refuse to get involved in their patients' medical aid in dying requests.
DESIGN/PARTICIPANTS
An exploratory qualitative study based on semi-structured interviews with 22 physicians who expressed a refusal after they received a request for medical aid in dying. Thematic descriptive analysis was used to analyse physicians' motives for their conscientious objections and the reasons behind it.
RESULTS
The majority of physicians who refused to participate did not oppose medical aid in dying. The reason most often cited is not based on moral and religious grounds. Rather, the emotional burden related to this act and the fear of psychological repercussions were the most expressed motivations for not participating in medical aid in dying.
CONCLUSION
The originality of this research is based on what the actual perception is of doing medical aid in dying as opposed to merely a conceptual assent. Further explorations are required in order to support policy decisions such as access to better emotional supports for providers and interdisciplinary support.
DOI: 10.1177/0269216319861921
PubMed: 31280666
Affiliations:
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uniqKey="Bouthillier M" first="Marie-Eve" last="Bouthillier">Marie-Eve Bouthillier</name><affiliation wicri:level="1"><nlm:affiliation>Office of Clinical Ethics, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Office of Clinical Ethics, Faculty of Medicine, University of Montreal, Montreal, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author><author><name sortKey="Opatrny, Lucie" sort="Opatrny, Lucie" uniqKey="Opatrny L" first="Lucie" last="Opatrny">Lucie Opatrny</name><affiliation wicri:level="1"><nlm:affiliation>Ministry of Health and Social Services, Quebec City, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Ministry of Health and Social Services, Quebec City, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author></analytic><series><title level="j">Palliative medicine</title><idno type="eISSN">1477-030X</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Attitude of Health Personnel (MeSH)</term><term>Clinical Competence (MeSH)</term><term>Conscience (MeSH)</term><term>Ethics, Medical (MeSH)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Physicians (psychology)</term><term>Qualitative Research (MeSH)</term><term>Quebec (MeSH)</term><term>Refusal to Treat (MeSH)</term><term>Self Efficacy (MeSH)</term><term>Suicide, Assisted (ethics)</term><term>Suicide, Assisted (psychology)</term><term>Workload (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Attitude du personnel soignant (MeSH)</term><term>Auto-efficacité (MeSH)</term><term>Charge de travail (MeSH)</term><term>Compétence clinique (MeSH)</term><term>Conscience morale (MeSH)</term><term>Déontologie médicale (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Mâle (MeSH)</term><term>Médecins (psychologie)</term><term>Québec (MeSH)</term><term>Recherche qualitative (MeSH)</term><term>Refus de traiter (MeSH)</term><term>Suicide assisté (psychologie)</term><term>Suicide assisté (éthique)</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Quebec</term></keywords><keywords scheme="MESH" qualifier="ethics" xml:lang="en"><term>Suicide, Assisted</term></keywords><keywords scheme="MESH" qualifier="psychologie" xml:lang="fr"><term>Médecins</term><term>Suicide assisté</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Physicians</term><term>Suicide, Assisted</term></keywords><keywords scheme="MESH" qualifier="éthique" xml:lang="fr"><term>Suicide assisté</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Attitude of Health Personnel</term><term>Clinical Competence</term><term>Conscience</term><term>Ethics, Medical</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Qualitative Research</term><term>Refusal to Treat</term><term>Self Efficacy</term><term>Workload</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Attitude du personnel soignant</term><term>Auto-efficacité</term><term>Charge de travail</term><term>Compétence clinique</term><term>Conscience morale</term><term>Déontologie médicale</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Québec</term><term>Recherche qualitative</term><term>Refus de traiter</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Under Quebec's Act respecting end-of-life care, physicians may refuse to provide medical aid in dying because of personal convictions, also called conscientious objections. Before legalisation, the results of our survey showed that the majority of physicians were in favour of medical aid in dying (76%), but one-third (28%) were not prepared to perform it. After 18 months of legalisation, physicians were refusing far more frequently than the pre-Act survey had anticipated.</p></div><div type="abstract" xml:lang="en"><p><b>AIM</b></p><p>To explore the conscientious objections stated by physicians so as to understand why some of them refuse to get involved in their patients' medical aid in dying requests.</p></div><div type="abstract" xml:lang="en"><p><b>DESIGN/PARTICIPANTS</b></p><p>An exploratory qualitative study based on semi-structured interviews with 22 physicians who expressed a refusal after they received a request for medical aid in dying. Thematic descriptive analysis was used to analyse physicians' motives for their conscientious objections and the reasons behind it.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>The majority of physicians who refused to participate did not oppose medical aid in dying. The reason most often cited is not based on moral and religious grounds. Rather, the emotional burden related to this act and the fear of psychological repercussions were the most expressed motivations for not participating in medical aid in dying.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>The originality of this research is based on what the actual perception is of doing medical aid in dying as opposed to merely a conceptual assent. Further explorations are required in order to support policy decisions such as access to better emotional supports for providers and interdisciplinary support.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">31280666</PMID><DateCompleted><Year>2020</Year><Month>06</Month><Day>26</Day></DateCompleted><DateRevised><Year>2020</Year><Month>06</Month><Day>26</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1477-030X</ISSN><JournalIssue CitedMedium="Internet"><Volume>33</Volume><Issue>9</Issue><PubDate><Year>2019</Year><Month>10</Month></PubDate></JournalIssue><Title>Palliative medicine</Title><ISOAbbreviation>Palliat Med</ISOAbbreviation></Journal><ArticleTitle>A qualitative study of physicians' conscientious objections to medical aid in dying.</ArticleTitle><Pagination><MedlinePgn>1212-1220</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1177/0269216319861921</ELocationID><Abstract><AbstractText Label="BACKGROUND">Under Quebec's Act respecting end-of-life care, physicians may refuse to provide medical aid in dying because of personal convictions, also called conscientious objections. Before legalisation, the results of our survey showed that the majority of physicians were in favour of medical aid in dying (76%), but one-third (28%) were not prepared to perform it. After 18 months of legalisation, physicians were refusing far more frequently than the pre-Act survey had anticipated.</AbstractText><AbstractText Label="AIM">To explore the conscientious objections stated by physicians so as to understand why some of them refuse to get involved in their patients' medical aid in dying requests.</AbstractText><AbstractText Label="DESIGN/PARTICIPANTS">An exploratory qualitative study based on semi-structured interviews with 22 physicians who expressed a refusal after they received a request for medical aid in dying. Thematic descriptive analysis was used to analyse physicians' motives for their conscientious objections and the reasons behind it.</AbstractText><AbstractText Label="RESULTS">The majority of physicians who refused to participate did not oppose medical aid in dying. The reason most often cited is not based on moral and religious grounds. Rather, the emotional burden related to this act and the fear of psychological repercussions were the most expressed motivations for not participating in medical aid in dying.</AbstractText><AbstractText Label="CONCLUSION">The originality of this research is based on what the actual perception is of doing medical aid in dying as opposed to merely a conceptual assent. Further explorations are required in order to support policy decisions such as access to better emotional supports for providers and interdisciplinary support.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Bouthillier</LastName><ForeName>Marie-Eve</ForeName><Initials>ME</Initials><Identifier Source="ORCID">0000-0002-7156-057X</Identifier><AffiliationInfo><Affiliation>Office of Clinical Ethics, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Opatrny</LastName><ForeName>Lucie</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Ministry of Health and Social Services, Quebec City, QC, Canada.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2019</Year><Month>07</Month><Day>08</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Palliat Med</MedlineTA><NlmUniqueID>8704926</NlmUniqueID><ISSNLinking>0269-2163</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001291" MajorTopicYN="Y">Attitude of Health Personnel</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002983" MajorTopicYN="N">Clinical Competence</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003242" MajorTopicYN="N">Conscience</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004992" MajorTopicYN="N">Ethics, Medical</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010820" MajorTopicYN="N">Physicians</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D036301" MajorTopicYN="N">Qualitative Research</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011792" MajorTopicYN="N" Type="Geographic">Quebec</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016079" MajorTopicYN="Y">Refusal to Treat</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020377" MajorTopicYN="N">Self Efficacy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017236" MajorTopicYN="N">Suicide, Assisted</DescriptorName><QualifierName UI="Q000941" MajorTopicYN="N">ethics</QualifierName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016526" MajorTopicYN="N">Workload</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">Qualitative research</Keyword><Keyword MajorTopicYN="Y">clinical ethics</Keyword><Keyword MajorTopicYN="Y">euthanasia</Keyword><Keyword MajorTopicYN="Y">medicine</Keyword><Keyword MajorTopicYN="Y">refusal to participate</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>7</Month><Day>10</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>6</Month><Day>27</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>7</Month><Day>9</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">31280666</ArticleId><ArticleId IdType="doi">10.1177/0269216319861921</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Canada</li></country></list><tree><country name="Canada"><noRegion><name sortKey="Bouthillier, Marie Eve" sort="Bouthillier, Marie Eve" uniqKey="Bouthillier M" first="Marie-Eve" last="Bouthillier">Marie-Eve Bouthillier</name></noRegion><name sortKey="Opatrny, Lucie" sort="Opatrny, Lucie" uniqKey="Opatrny L" first="Lucie" last="Opatrny">Lucie Opatrny</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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