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Clinical discussion of Medical Aid-in-Dying: minimizing harms and ensuring informed choice
Abstract
Objective The implementation of medical aid-in-dying (MAID) poses new challenges for clinical communication and counseling. Among these, health care providers must consider whether to initiate a discussion of MAID with eligible patients who do not directly ask about it. Norms and policies concerning this issue vary tremendously across jurisdictions where MAID is legally authorized, reflecting divergent assumptions about patients' rights to information about end-of-life options and the purpose and potential harms of clinical disclosure.Method This discussion forum essay draws on informed consent doctrine to analyze two policies concerning clinical communication about MAID: the legal prohibition against provider-initiated discussions of MAID in Victoria, Australia, and the Canadian Association of MAID Assessors and Providers (CAMAP) position that providers have an ethical and professional responsibility to inform eligible patients about MAID.Conclusions Informed consent requires that clinicians strike a balance between minimizing potential harms to patients caused by initiating discussions of MAID and the imperative to inform and counsel patients about all of their legally available medical options.Practice implications Clinicians should be aware of both the importance of communication as a tool to inform patients and the potential for clinical language to cause harm to or to unduly influence patients.
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The Canadian Association of MAiD Assessors and Providers supports informing eligible patients about MAiD, highlighting the value of informed consent, the importance of patient autonomy, and the role of clinicians as gatekeepers of clinical information.
“the Canadian Association of MAiD Assessors and Providers supports informing eligible patients about MAiD, highlighting the value of informed consent, the importance of patient autonomy, and the role of clinicians as gatekeepers of clinical information [44].”
The perspective that a MAiD request may be at first considered as "a cry for help" and a two-track approach focusing both "on the life track" by engaging in ongoing treatment and on the "death track" by assessing MAiD eligibility aligns with the study's findings.
“This perspective aligns with literature suggesting that a MAiD request may be at first considered as “a cry for help”, and with a two-track approach focusing both “on the life track” by engaging in ongoing treatment, and on the “death track” by assessing MAiD eligibility [22, 23, 44].”
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Metadata
- Authors
- Brassfield, E. R., & Buchbinder, M.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Brassfield, Elizabeth R.
- Venue
- Patient Education and Counseling
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 104
- Issue
- 3
- Pages
- 671-674
- ISSN
- 0738-3991 (ISSN-L)
- OpenAlex
- W3081959508
- Cited by
- 14
- References
- 12
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 7 · 2023: 1
- FWCI
- 0.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Patient Education and Counseling (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Science Foundation
- Greenwall Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- medical assistance in dying, clinical communication, informed consent, end-of-life care, patient counseling, Victoria, Australia
- MeSH terms
- Australia, Canada, Health Personnel, Humans, Informed Consent, Suicide, Assisted
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