Providing medically assisted dying in Canada: a qualitative study of emotional and moral impact.

Purpose: Medical assistance in dying (MAiD) in Canada places the medical provider at the centre of the process. The MAiD provider holds primary responsibility for determining eligibility and becomes acquainted with patients' inner desires and expressions of suffering. This is followed by the MAiD procedure of administering the lethal agent and being present at the death of eligible patients.

What do health care professionals want to know about assisted dying? Setting the research agenda in New Zealand.

Background: New Zealand recently introduced law permitting terminally ill people to request and receive assisted dying (AD) in specified circumstances. Given the nature and complexity of this new health service, research is vital to determine how AD is operating in practice.

Objective: To identify research priorities regarding the implementation and delivery of AD in New Zealand.

Dirty work: well-intentioned mental health workers cannot ameliorate harms in offshore detention.

Professional providers of mental health services are motivated to help people, including, or especially, vulnerable people. We analyse the ethical implications of mental health providers accepting employment at detention centres that operate out of the normal regulatory structure of the modern state. Specifically, we examine tensions and moral harms experienced by providers at the Australian immigration detention centre on the island of Nauru.

Winging it: a qualitative study of knowledge-acquisition experiences for early adopting providers of medical assistance in dying.

Background: Medical Assistance in Dying (MAID) was legalized in Canada without a designated period for implementation. Providers did not have access to customary alternatives for training and mentorship during the first 1-3 years after legalization.

Objective: To report on how doctors prepared for their first provision of MAID in the early period after legalization in Canada.

The discursive context of medical aid in dying: A paradox of control?

Individual agency is central to late modern and neoliberal concepts of the self and notions of a good death. Assisted dying can be understood as a reflection of these ideas in that control over death resides with the individual. The aim of this article is to explore individual agency and control and employ concepts of biopower and freedom to illustrate the paradoxes inherent within assisted dying.

The End of Life Choice Act: a proposed implementation and research agenda.

Aim: This article outlines the End of Life Choice Act 2019. It highlights some of the key implementation issues to ensure the system operates safely and equitably after the Act comes into force. It also identifies priorities for research to ensure issues are detected and provision of assisted dying (AD) is monitored.

Because it was new: Unexpected experiences of physician providers during Canada's early years of legal medical assistance in dying.

Implementing newly legalized euthanasia or assisted dying presents challenges. The procedure is high-stakes and irreversible and the context is controversial and associated with high emotions and strong opinions. This qualitative study reports unexpected experiences of twenty-one medical doctors who provided Medical Assistance in Dying (MAID) in the first years after legalization in Canada.

Evaluating an Adolescent's Decision-Making Capacity Whilst in the Harsh World of Detention.

Reports of children participating in hunger strikes while detained in offshore detention centres raise interrelated ethical issues and recognizable challenges for the medical decision-makers at these sites. A composite case study, informed by reports in the public domain, is employed to explore the unique challenges of consent and decision-making in these circumstances and the perennial issues inherent in adolescents' developing capacity and autonomy. We present an amalgamated case of a fourteen-year-old adolescent who refused to consent to medical reversal of her hunger strike protest.

Patients' views on end-of-life practices that hasten death: a qualitative study exploring ethical distinctions.

Background: Assisted dying (AD) is currently of wide interest due to legislative change. Its relationship to other end-of-life practices such as palliative sedation (PS) is the subject of ongoing debate. The aim of this article is to describe the perspectives of a group of New Zealanders with life-limiting illness, who want or would consider AD, on the provision of end of life services, including assisted death, withdrawal of lifeprolonging treatment and symptom management with opioids or PS.

When Parents Refuse: Resolving Entrenched Disagreements Between Parents and Clinicians in Situations of Uncertainty and Complexity.

When shared decision making breaks down and parents and medical providers have developed entrenched and conflicting views, ethical frameworks are needed to find a way forward. This article reviews the evolution of thought about the best interest standard and then discusses the advantages of the harm principle (HP) and the zone of parental discretion (ZPD). Applying these frameworks to parental refusals in situations of complexity and uncertainty presents challenges that necessitate concrete substeps to analyze the big picture and identify key questions.

A young man with spinal muscular atrophy and impending respiratory arrest.

From a statutory standpoint, the decision-making capacity of adolescents differs significantly from that of adults because adolescents are considered to lack the experience and judgment necessary to make legally binding decisions. Furthermore, in the case of minors, the principle of protection of life tends to outweigh the principle of autonomy. Here we present the hypothetical case of a 16-year-old boy with spinalmuscular atrophy type II who was admitted to the intensive care unit for severe respiratory distress.