Medical assistance in dying in Canada: A review of regulatory practice standards and guidance documents for physicians.

IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES
Palliative Care and Social Practice Pub Date : 2025-06-24 eCollection Date: 2025-01-01 DOI:10.1177/26323524251338859
Eliana Close, Mona Gupta, Jocelyn Downie, Ben P White
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引用次数: 0

Abstract

Background: Medical assistance in dying ("MAiD") became legal across Canada in 2016, and in Québec in 2015. Provincial/territorial regulatory bodies play a critical role in MAiD as they can issue binding requirements on health practitioners. Law and regulatory standards are the "twin pillars" of MAiD regulation, yet the content of MAiD practice standards for physicians is unstudied.

Design: This article analysed MAiD guidance for physicians from Canadian medical regulators (often called the "College of Physicians and Surgeons"), using a qualitative descriptive approach, informed by regulatory space theory.

Methods: We identified MAiD-specific regulatory documents (practice standards and related documents) using web-based searches and follow-up inquiries. We analysed the documents using qualitative descriptive analysis and the Framework Method, facilitated by NVivo. The analysis focused on identifying areas where regulators issued guidance beyond the law.

Results: We identified 15 regulatory documents from 11 of the 13 provinces and territories. We determined that these documents primarily outline the law without detailed guidance on how to apply it. We identified eight areas for which regulators provided guidance that went beyond the MAiD-specific legislation, most relating to core aspects of medical practice, such as competency, documentation, and patient-centred care. The rights and obligations of conscientious objectors were a predominant focus in all documents. The documents largely lacked guidance about the meaning of terms in the legislation. There was also variation in standards between provinces and territories; the documents focused on similar topics but varied in their policy choices. Physicians in each province/territory are therefore subject to differing expectations (to some extent).

Conclusion: This study highlights a gap in guidance on the meaning of legal terms in the Criminal Code MAiD provisions and highlights interprovincial/territorial variability in MAiD practice standards and guidance for physicians. The study demonstrates the risks of fragmentation inherent in polycentric regulation, which can be challenging for physicians to navigate.

加拿大的死亡医疗援助:对医生管理实践标准和指导文件的审查。
背景:医疗协助死亡(MAiD)于2016年在加拿大合法化,2015年在魁省合法化。省级/地区监管机构在MAiD中发挥关键作用,因为它们可以对卫生从业人员发布具有约束力的要求。法律和监管标准是MAiD监管的“双支柱”,但医生MAiD执业标准的内容尚未研究。设计:本文采用定性描述方法,根据监管空间理论,分析了加拿大医疗监管机构(通常称为“内科医生和外科医生学院”)医生的MAiD指南。方法:我们使用基于网络的搜索和随访查询来识别maid特定的监管文件(实践标准和相关文件)。我们使用NVivo提供的定性描述性分析和框架方法分析了这些文件。分析的重点是确定监管机构在法律之外发布指导的领域。结果:我们从13个省和地区中的11个省和地区中鉴定了15份规范性文件。我们认为,这些文件主要概述了法律,而没有详细指导如何适用法律。我们确定了监管机构提供指导的八个领域,这些领域超出了maid特定立法,大多数涉及医疗实践的核心方面,如能力、文件和以患者为中心的护理。依良心拒服兵役者的权利和义务是所有文件的主要焦点。这些文件在很大程度上缺乏对立法中术语含义的指导。各省和地区之间的标准也有所不同;这些文件关注的主题相似,但在政策选择上有所不同。因此,每个省/地区的医生(在某种程度上)受到不同期望的影响。结论:本研究突出了刑法MAiD条款中法律术语含义指导的差距,并突出了MAiD实践标准和医生指导的省际/地区差异。该研究表明,多中心监管存在固有的碎片化风险,这对医生来说是一个挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Palliative Care and Social Practice
Palliative Care and Social Practice Nursing-Advanced and Specialized Nursing
CiteScore
2.90
自引率
0.00%
发文量
37
审稿时长
9 weeks
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