Dr Eliana Close1
1Australian Centre For Health Law Research, Queensland University of Technology
In June 2016, Canada legalized medical assistance in dying (MAiD). From the outset, some institutions (including hospitals, hospices, and residential aged care facilities) have refused to allow MAiD onsite. There have been media reports about these ‘institutional objections’, however very little research has examined their nature and impact.
This presentation reports on findings from 64 semi-structured interviews conducted with 28 MAiD assessors and providers, 5 care coordinators, and 33 family caregivers (discussing 31 patients) on their experiences with institutional objection in British Columbia, Ontario, and Nova Scotia. Data was analysed using inductive thematic analysis informed by Hancher and Moran’s regulatory space theory.
Preliminary themes include: 1) the nature of institutional objections, with participants discussing a wide range of ways that institutional objections manifested; 2) burdens on patients and family caregivers, including the patient not accessing MAiD, forced transfers, and a “postcode” lottery which determined access; 3) impacts on health professionals, with individuals taking on emotional and administrative burdens to try and get patients access, and difficult interprofessional dynamics; and 4) factors leading to improvements in practice.
This paper adds to existing understanding of the impacts of institutional objection, which can inform practical and regulatory solutions in Canada and in other jurisdictions that have legalised MAiD (including Australian states, which have all recently passed voluntary assisted dying laws). A coherent regulatory approach to institutional objection is needed that minimises the negative impacts on patients and their caregivers.
Biography:
Dr Eliana Close is a socio-legal scholar with expertise in law and psychology. She researches end-of-life law, policy, and practice, and is leading a Canadian case study as part of the ARC Future Fellowship project, Enhancing End-of-Life Decision Making: Optimal Regulation of Voluntary Assisted Dying. Eliana has also contributed to the voluntary assisted dying training for practitioners in Victoria, WA, and Queensland.