A new reality for Canadian hospice

ABSTRACT:

Background

Hospice and assisted dying both aim to provide end-of-life patients with a good death. The two have historically sat in tension as hospice 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 has rejected attempts to integrate the two, often citing conflict with its commitment to neither hasten nor prolong death. However, hospice and assisted dying have the common aim of providing patients with control over the dying process, and are committed to 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 and assisted dying could improve patient access to end-of-life choices. 

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 highlights that the shared aims and values between hospice and assisted dying have created new challenges that these hospices must navigate. 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 hospice. 

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 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 has resulted in challenging clinical situations for staff involving patients and families; 4) Differing hospice responses to the legalization of MAID create unique challenges for their respective hospices; and 5) Allowing MAID in hospice provides opportunities for 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 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.   

AUTHOR BIO: 

James Mellett is a graduate student at McGill University’s Biomedical Ethics Unit and a research trainee at the Palliative Care McGill network. His current research work focuses on how the legalization of medical aid/ assistance in dying affects Canadian hospices. His previous research work has examined the ethics surrounding determination of pediatric best interests. Outside of bioethics, James is an avid hiker who loves spending summers exploring the mountains in his home province of Alberta. 

james.mellett@mail.mcgill.ca 

@mellett_james

INFO: 

This event is part of the Café Bioethics and Canadian Bioethics Society JUNE PARTNERSHIP Series! CB and CBS are collaborating for the first time in an effort to fill the summer conference gap created by the COVID-19 pandemic. We hope to provide students a platform to share their bioethics  research in an accessible manner, all while creating connections and building their network. Be sure to join us for the series!