Exploring the Prevalence and Impact of Ethical and Religious Barriers to Medical Aid in Dying

Consciousness-Based Barriers to Medical Assistance in Dying: A Survey of Colorado Physicians

Introduction

Recently published research led by the University of Colorado Anschutz Medical Campus examined the prevalence (and impact) of physicians’ ethical or religious barriers to their participation in medical assistance in dying (MAiD), a process of several steps in which a doctor provides a terminally ill, decision-making adult with a lethal dose of medication to end his or her life.

Main summary

The research article, “Awareness-Based Barriers to Medical Assistance in Dying: A Survey of Colorado Physicians,” was published this May 2024, in the Journal of General Internal Medicine. It shows that 26% of physicians surveyed reported high ethical and/or religious barriers to their participation in MAiD.

Despite these barriers, research suggests that these awareness-based barriers do not appear to affect these physicians’ willingness to discuss medical aid in dying with their patients. However, they are much less likely to participate directly in it (being significantly less likely to act as consulting or treating physicians) compared to physicians who do not have these barriers.

Inform public policies

As lawmakers and health leaders across the country continue to debate policies related to medical aid in dying, research like this is vital to making informed decisions.

“Medical aid in dying is being considered in several states, and it comes up every legislative session. You can’t make policy around things that aren’t well understood, so it was critical to collect data to better understand what’s happening.” . says Mika Hamer, PhD, MPH, first author of the paper and a postdoctoral researcher at CU’s Center for Bioethics and Humanities. “It’s important to look at the actual behaviors of doctors. This research essentially offers the first look at what’s happening on the ground in a previously hidden and difficult-to-study population.”

For Hillary Lum, MD, PhD, co-author of the paper and associate professor in CU’s Division of Geriatric Medicine, getting involved in this research was important to her as a geriatrician and palliative medicine physician, given that questions may arise about MAiD. in the care of older adults with serious illnesses.

“Medical aid in dying was legalized in 2016 in Colorado, but the experiences of doctors providing care to patients seeking MAiD were not studied enough,” Lum says.

One reason for the lack of data is that there are extensive privacy protections for doctors and patients. As a result, the vast majority of data that exists comes from qualitative studies or surveys of the general practitioner population.

“There’s a long-standing debate around MAiD – the legality, the ethical appropriateness, the morality – and people have extremely strong opinions about it. But when we let those really strong opinions drive policy, rather than empirical data, we run the risk of implementing the wrong policy that is more in line with the cultural sentiment or social context of the moment,” says Hamer.

To collect data on this important topic, researchers used aggregated, de-identified information on the 554 patients known to have received a MAiD prescription in Colorado between 2017 and 2020 and then identified the most prominent clinical conditions in this patient population. The research team then determined which physicians in Colorado were providing care to patients who were likely to qualify for MAiD based on their clinical conditions and sent them an anonymous survey about their willingness to provide MAiD and their actual prior participation in MAiD. In the end, 300 doctors responded.

The researchers have since published several papers about the study, including:

• A scientific report on the research methodology.
• An analysis of physicians’ attitudes and experiences.
• An examination of their perspectives on disclosure, presence, and eligibility.
• The use and influence of medical assistance in the dying service on doctors’ experiences.

“We felt there was an opportunity to look at this untapped aspect of the survey research. We had a hunch that there was something about ethical or religious barriers that may be different than other types of barriers that physicians face, such as lack of time or fear of stigma,” says Hamer.

“We wanted to understand what these doctors have actually done when faced with these decisions, and we had a unique opportunity to measure it and provide some empirical data on what is a very controversial topic, but is actually quite understudied in terms of hard data. goes,” he adds.

Lum agrees with Hamer and says:

“In the absence of data, it is easy to make assumptions: either there are many doctors who have a conscientious objection to MAiD, or there are few. Therefore, this study was important to actually measure the percentage of doctors who have a religious objection, or ethical reason for not participating in MAiD activities.”

What the research shows

Of the 300 respondents, 26% of physicians likely to care for MAiD-eligible patients in Colorado reported high ethical and/or religious barriers to participating in MAiD activities.

The survey also shows that physicians with longer time in practice and those who identified as non-white were more likely to report these awareness-based barriers.

Hamer said he was surprised that the survey data shows that physicians with these awareness-based barriers are still willing to participate in some aspects of the MAiD process. Specifically, when comparing physicians with and without these barriers, there were no differences in ancillary involvement, that is, having conversations about MAiD or referring patients to other providers.

However, there were significant differences regarding direct participation in MAiD. To be eligible for MAiD, a patient must have decision-making capacity and a life expectancy of less than six months. This prognosis must be independently verified by two doctors: a treating doctor and another consultant.

The survey found that only 5% of doctors with awareness barriers had worked as MAiD consultants, compared to 31% of doctors without awareness barriers. When it came to serving as a MAiD assistant, no clinicians with awareness-based barriers had served in this role compared to 21% of clinicians without these barriers.

“Participation is different for different people. In terms of consulting or assisting, which are much more active roles that may involve writing prescriptions or doing assessments, that’s where we start to see those barriers really appear in terms of behavioral changes,” Hamer said. he says.

Lum says:

“I think this emphasizes the importance of the relationship between doctors and patients. Whether a doctor is willing to discuss, refer, act as a consulting doctor or as an attending MAID doctor is likely to vary. And there may be different reasons and situations related to the individual patient.”

Both Hamer and Lum noted that this study had a limited sample size, highlighting the need for more research. Regarding awareness-based barriers, Hamer says it is important to distinguish that these “There are not necessarily barriers that need to be overcome in the traditional sense of barriers.”

“We really see this as a space where clinicians need accommodation, not intervention to help them change their mind about this barrier,” Hamer says. “It calls for continued protection of physicians’ rights to conscientiously object to or opt out of a service about which they have deeply held and contradictory beliefs.”

There is also a need to better understand what support systems and processes should be implemented in clinics or hospitals to assist physicians who have religious or ethical barriers. For example, perhaps a formal referral process could be created so that clinicians with these barriers can participate in the initial stages of MAiD, but when it comes to more active roles, there is an established team to which the patient can be referred.

“We must have protections and processes in place to support these physicians while ensuring that patients can receive the care they want,” Hamer says. “It’s something that especially needs to be considered as the legality of MAiD potentially expands. We need a balance between protecting doctors’ rights and preserving patient access.”

Attribution/Source(s):

This peer-reviewed publication titled Exploring the prevalence and impact of ethical and religious barriers to medical assistance in dying was selected for publication by the editors of Disabled World due to its relevance to the disability community. While content may have been edited for style, clarity, or brevity, it was originally written by University of Colorado Anschutz Medical Campus and published on 05/31/2024. For more details or clarifications, you can contact University of Colorado Anschutz Medical Campus directly at cuanschutz.edu Disabled World makes no warranty or endorsement related to this article.

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Cite this page (APA): University of Colorado Anschutz Medical Campus. (2024, May 31). Exploring the prevalence and impact of ethical and religious barriers to medical assistance in dying. Disabled world. Retrieved June 1, 2024 from www.disabled-world.com/medical/palliative/ethical-barriers.php

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