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首页> 外文期刊>Journal of health services research & policy >Medical assistance in dying: implications for health systems from a scoping review of the literature
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Medical assistance in dying: implications for health systems from a scoping review of the literature

机译：濒临死亡的医疗援助：对文献的范围审查的卫生系统的影响

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Objective Medical assistance in dying (MAiD) is the medical provision of substances to end a patient's life at their voluntary request. While legal in several countries, the implementation of MAiD is met with ethical, legislative and clinical challenges, which are often overshadowed by moral discourse. Our aim was to conduct a scoping review to explore key barriers for the integration of MAiD into existing health systems. Methods We searched electronic databases (CINAHL, Embase, MEDLINE, and PsycINFO) and grey literature sources from 1990 to 2017. Studies discussing barriers and/or challenges to implementing MAiD from a health system's perspective were included. Full-text papers were screened against inclusion/exclusion criteria for article selection. A thematic content analysis was conducted to summarize data into themes to highlight key implementation barriers. Results The final review included 35 articles (see online Appendix 1). Six categories of implementation challenges emerged: regulatory (n = 26), legal (n = 15), social (n = 9), logistical (n = 9), financial (n = 3) and compatibility with palliative care (n = 3). Within four of the six identified implementation barriers (regulatory, legal, social and logistical) were subthemes, which described barriers related to legalizing MAiD in more detail. Conclusion Despite multiple challenges related to its implementation, MAiD remains a requested end-of-life option, requiring careful examination to ensure adequate integration into existing health services. Comprehensive models of care incorporating multidisciplinary teams and regulatory oversight alongside improved clinician education may be effective to streamline MAiD services.
机译：目的在死亡（女仆）的医疗援助是医疗提供物质，以终止患者的自愿请求。虽然在几个国家合法，举行伦理，立法和临床挑战的实施，虽然伦理，立法和临床挑战，但经常被道德话语所掩盖。我们的目标是进行审查审查，以探索将佣人整合到现有的卫生系统中的关键障碍。方法从1990年到2017年搜索了电子数据库（Cinahl，Embase，Medline和Psycinfo）和灰色文学来源的研究。包括从卫生系统的角度来讨论向实施女佣的障碍和/或挑战讨论障碍和/或挑战。筛选全文纸，以防止纳入/排除标准进行物品选择。进行主题内容分析，总结数据以突出关键实施障碍的主题。结果最终审查包括35条（见在线附录1）。出现了六类实施挑战：监管（n = 26），法律（n = 15），社会（n = 9），物流（n = 9），财务（n = 3）和与姑息治疗的兼容性（n = 3 ）。在六个确定的实施障碍中的四个中（法规，法律，社会和后勤）是亚主体，其中更详细地描述了与佣金合法化的障碍。结论尽管有多项挑战与其实施有关，但佣金仍然是一个要求的人寿期权，需要仔细检查，以确保充分融入现有的卫生服务。综合护理模型融入多学科团队和监管监督以及改进的临床医生教育可能有效地简化了女仆服务。

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