Searching for relief from suffering: A patient-oriented qualitative study on medical assistance in dying for mental illness as the sole underlying medical condition

被引：6

作者：

Bastidas-Bilbao, Hamer ^{[1
]}

Stergiopoulos, Vicky ^{[1
,2
]}

van Kesteren, Mary Rose ^{[1
]}

Stewart, Donna Eileen ^{[2
,3
,4
]}

Cappe, Vivien ^{[1
]}

Gupta, Mona ^{[5
]}

Buchman, Daniel Z. ^{[6
,7
,8
]}

Simpson, Alexander I. F. ^{[2
,9
]}

Castle, David ^{[1
,2
,11
]}

Campbell, Bartholemew Hugh ^{[1
]}

Hawke, Lisa D. ^{[1
,2
,10
]}

机构：

[1] Ctr Addict & Mental Hlth, Toronto, ON, Canada

[2] Univ Toronto, Dept Psychiat, Toronto, ON, Canada

[3] Univ Hlth Network, Ctr Mental Hlth, Toronto, ON, Canada

[4] Univ Hlth Network, Toronto Gen Hosp Res Inst, Toronto, ON, Canada

[5] Ctr Hosp Univ Montreal, Dept Psychiat, Montrel, PQ, Canada

[6] Ctr Addict & Mental Hlth, Educ & Profess Practice Off, Toronto, ON, Canada

[7] Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[8] Univ Toronto, Joint Ctr Bioeth, Toronto, ON, Canada

[9] Ctr Addict & Mental Hlth, Forens Div, Toronto, ON, Canada

[10] 60 Wh Squirrel Way, 316, Toronto, ON M6J 1H4, Canada

[11] Univ Tasmania, Australia & Statewide Mental Hlth Serv, Hobart, Tas, Australia

来源：

SOCIAL SCIENCE & MEDICINE | 2023年 / 331卷

基金：

加拿大健康研究院;

关键词：

Medical assistance in dying; Mental illness; Lived experience; Patient engagement; HEALTH; EXPERIENCE; EUTHANASIA; AUTONOMY; PEOPLE; CARE;

D O I：

10.1016/j.socscimed.2023.116075

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Medical assistance in dying (MAiD) was introduced into Canadian legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is excluded from eligibility; this is expected to change in 2024. Incurability, intolerable suffering, capacity to make healthcare decisions, and suicidality have been publicly debated in connection with mental illness. Few studies have explored the views of persons with mental illness on the introduction and acceptability of MAiD MI-SUMC; this study aimed to fill this gap. Thirty adults, residing in Ontario, Canada, who self-identified as living with mental illness participated. A semi-structured interview including a persona-scenario exercise was designed to discuss participants' views on MAiD MI-SUMC and when it could be acceptable or not. Reflexive thematic analysis was used to inductively analyze data. Codes and themes were developed after extensive familiarization with the dataset. A lived-experience advisory group was engaged throughout the study. We identified six themes: The certainty of suffering; Is there a suffering threshold to be met? The uncertainty of mental illness; My own limits, values, and decisions; MAiD MI-SUMC as acceptable when therapeutic means, and other supports, have been tried to alleviate long-term suffering; and Between relief and rejection. These themes underline how the participants' lived experience comprised negative impacts caused by long-term mental illness, stigma, and in some cases, socioeconomic factors. The need for therapeutic and non-therapeutic supports was highlighted, along with unresolved tensions about the links between mental illness, capacity, and suicidality. Although not all participants viewed MAiD MI-SUMC as acceptable for mental illness, they autonomously embraced limits, values, and decisions of their own along their search for relief. Identifying individual and contextual elements in each person's experience of illness and suffering is necessary to understand diverse perspectives on MAiD MI-SUMC.

引用

页数：9

共 53 条

[51] Why adults with psychiatric conditions request euthanasia: A qualitative interview study of life experiences, motives and preventive factors [J].