Thesis (M.S.P.H.)--University of Michigan, 1936.

Thesis (M.S.P.H.)--University of Michigan, 1936.

Thesis (M.A. in National Security Affairs)--Naval Postgraduate School, September 2002. / Thesis advisor(s): Jeanne Giraldo, Jeff Knopf. Includes bibliographical references (p. 71-77). Also available online.

Bakgrund: Dödshjälp är i dagsläget olagligt i Sverige, men många andra länder har valt att legalisera det. Det finns i dag två olika former, aktiv dödshjälp går ut på att läkaren administrerar den dödliga dosen av läkemedlet samt den assisterade dödshjälpen som går ut på att läkaren skriver ut den dödliga dosen och patienten själv administrerar det. Denna litteraturstudie fokuseras på den assisterade dödshjälpen, där komplexiteten i frågan utgörs av sjuksköterskans etiska ställningstaganden, religiösa aspekter samt patientens rätt till självbestämmande (autonomi). Syfte: Syftet med studien var att sammanställa evidensbaserad kunskap om sjuksköterskans upplevelser av assisterad dödshjälp. Metod: En litteraturstudie där resultaten från 10 vetenskapliga originalartiklar med kvalitativ ansats sammanställdes. Materialet samlades in från databaserna PubMed och Cinahl. Resultat: När resultatet sammanställdes framkom tre huvudteman kommunikations betydelse, patientens autonomi och sjuksköterskans värderingar och åtta subteman. Resultatet belyser hur viktig den personcentrerade vården och teamarbetet mellan sjuksköterskan och andra professioner är vid den assisterade dödshjälpen. Sjuksköterskans motsättningar till den assisterade dödshjälpen var moraliska och etiska aspekter. Slutsats: Sjuksköterskans värderingar kunde vara en motsättning till den assisterade dödshjälpen, men de flesta sjuksköterskorna skulle inte överge sin patient oavsett om denne valde assisterad dödshjälp eller inte.

All nurses must be adequately prepared to care for individuals requesting Medical Assistance in Dying (MAiD) due to the practical, ethical, personal, and legal ramifications associated with MAiD. Nurses are both professionally and legally obligated to be knowledgeable and skilled in navigating the care of individuals requesting MAiD. This qualitative systematic review explored the knowledge and education needs identified by nurses regarding MAiD. This qualitative systematic review was conducted following the JBI methodology for systematic reviews of qualitative evidence, including critical appraisal, study selection, data extraction and data synthesis. Four themes were identified: 1) ethical and moral challenges, 2) legislation and standards, 3) communication, and 4) mandatory MAiD education. The information and practice recommendations found within this review can be used to support the knowledge and education needs of all nursing students and practicing nurses throughout Canada.

Medical Assistance in Dying (MAID) was legalized in Canada in 2016. In 2021, an update in legislation included changes to MAID eligibility and procedural safeguards. Guided by the Ottawa Decision Support Framework (ODSF), the overall aim was to describe how Canadian patients considering MAID are being supported in making the decision about end-of-life care. Eleven articles were included in the literature review. ODSF themes are evident in MAID literature. Nurses play key roles in end-of-life decision-making. Environmental scan of publicly available MAID resources identified 58 eligible resources. Sixty-nine percent of MAID resources were updated with 2021 legislation. None met the International Patient Decision Aid Standards criteria. Thirty met Patient Education Materials Assessment standard for adequate understandability and 11 for actionability. Although patient decision aids are effective for supporting health care decisions, none exist for MAID and current resources are inadequate for supporting people of lower health literacy.

In 2015, the Supreme Court of Canada ruled in the Carter decision that the prohibitions against physician-assisted dying, as outlined in section 241(b) of the Criminal Code of Canada, were unconstitutional as they violated an individual’s s.7 rights as outlined in the Canadian Charter of Rights and Freedoms. Though the jurisprudence of this landmark decision and subsequent amendments to Canadian law are interesting in and of themselves, what is particularly interesting about Carter is the framework within which physician-assisted dying is conceptualized. The Court shifts from a religiously informed framework for conceptualizing assisted suicide to a non-religious conceptualization of physician-assisted dying. Given that there remains much to be explored about nonreligion, this thesis asks: how is ‘nonreligion’ constructed by law in relation to physician-assisted dying in Canada? Since the Carter decision is not explicitly about religion or nonreligion the analysis in this thesis maps how the concepts life, death, and morality are reconceptualized. The analysis reveals that nonreligion is a phenomenon that is absent of the transcendent and is instead given positive content through a focus on autonomy. The conceptualization of nonreligion as presented in this thesis contributes to the literature that emphasizes that nonreligion is both positive and meaningful and not simply deficit terminology.

This thesis deals with international provided medical assistance services. The goal is to present problems connected to internationally provided assistance services and to offer possible solutions. For this work was drawn up a questionnaire, which was focused on the approach of clients to travelling, to insurance of medical expenses and to assistance companies.

In 2016, Gray and Jones adapted the narrative policy framework (NPF) to a qualitative context. In this research, I build from their resulting Qualitative NPF (Q-NPF) method to analyze 300 randomly selected Canadian media articles published between 2007-2017 on the topic of Medical Assistance In Dying (MAID). I begin by explaining how the concrete procedures of MAID are distinct from other end-of-life practices, and introduce the terminology that will be used throughout this research. I then introduce historic and academic literature relevant to the form and content of the contemporary media narratives to be analyzed, especially drawing theoretically from Rose’s (2013) discussion of biomedical personhood discourses and Butler’s theory of unevenly distributed precarity. I then explain the methodology of qualitative narrative policy analysis (Q-NPF), and apply it to Canada’s MAID debate by dividing the policy positions into what I call the Freedom, Protection, and Fence-sitting narrative policy camps. The Freedom camp advocated for MAID legalization; the Protection camp advocated against MAID legalization; and the Fence-sitting camp avoided advocating either for or against baseline legalization of MAID, instead weighing in only on peripheral issues. I discuss the qualitative differences of narrative content specific to these three camps, highlighting the most prominent narrative trends (by frequency of publication) and discussing the ways in which these findings either accord with or contradict the expectations of the literature review. Finally, I update the reader on Canadian legislative developments since 2017 and identify how the data of 2007-2017 anticipated these developments, demonstrating the salience and predictive power of Q-NPF. I conclude by proposing new directions for potential investigation. / Graduate / 2022-12-13

Le Canada regroupe sous le terme « aide médicale à mourir » les pratiques de suicide assisté et d'euthanasie volontaire. Pratiques sujettes à débat à travers le monde depuis une vingtaine d'années, elles sont légalisées au Canada depuis 2016. En 2020, un projet de loi visant à modifier le Code criminel canadien sur les dispositions de l'aide médicale à mourir est proposé. Il est permis aux citoyens de défendre leur point de vue sur ce projet de loi. Par l'analyse de ces avis (appelés mémoires) et à l'aide de la méthodologie de la théorisation ancrée (grounded theory) formalisée par Glaser et Strauss en 1967 et reprise dans un article par Anne Laperrière (1997), trois figures du médecin praticien de l'aide médicale à mourir émergent. Il en ressort celle du médecin persécuteur qui a pour volonté de tuer les plus vulnérables, celle du médecin victime du système qui lui impose de violer son Serment d'Hippocrate et celle du médecin sauveur qui aide les plus souffrants à mourir, les sauvant, ainsi, de la maladie et de la souffrance.