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Original research
Of dilemmas and tensions: a qualitative study of palliative care physicians’ positions regarding voluntary active euthanasia in Quebec, Canada
  1. Emmanuelle Bélanger1,
  2. Anna Towers2,
  3. David Kenneth Wright3,
  4. Yuexi Chen4,
  5. Golda Tradounsky5,
  6. Mary Ellen Macdonald6
  1. 1Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
  2. 2Department of Oncology, McGill University, Montreal, Quebec, Canada
  3. 3School of Nursing, University of Ottawa, Ottawa, Canada
  4. 4Palliative Care McGill, McGill University Montreal, Montreal, Quebec, Canada
  5. 5Department of Family Medicine, McGill University, Montreal, Quebec, Canada
  6. 6Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Emmanuelle Bélanger, Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice School of Public Health, Brown University, Providence, RI 02912, USA; emmanuelle_belanger{at}brown.edu

Abstract

Objectives In 2015, the Province of Quebec, Canada passed a law that allowed voluntary active euthanasia (VAE). Palliative care stakeholders in Canada have been largely opposed to euthanasia, yet there is little research about their views. The research question guiding this study was the following: How do palliative care physicians in Quebec position themselves regarding the practice of VAE in the context of the new provincial legislation?

Methods We used interpretive description, an inductive methodology to answer research questions about clinical practice. A total of 18 palliative care physicians participated in semistructured interviews at two university-affiliated hospitals in Quebec.

Results Participants positioned themselves in opposition to euthanasia. Their justifications were framed within their professional commitment to not hasten death, which sat in tension with the value of patients’ autonomy to choose how to die. Participants described VAE as unacceptable if it impeded opportunities to evaluate and alleviate suffering. Further, they contested government rhetoric that positioned VAE as a way to improve end-of-life care. Participants felt that VAE would diminish the potential of palliative care to relieve suffering. Dilemmas were apparent in their narratives, about reconciling respect for patient autonomy with broader palliative care values, and the value of accompanying and not abandoning patients who make requests for VAE while being committed to neither prolonging nor hastening death.

Conclusions This study provides insight into nuanced positions of experienced palliative care physicians in Quebec and confirms expected tensions between an important stakeholder and the practice of VAE as guided by the new legislation.

  • euthanasia
  • palliative care

https://doi.org/10.1136/medethics-2017-104339

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    Footnotes

    • Contributors AT and YC planned the study and conducted the semistructured interviews with the participants. YC conducted the descriptive content analysis of the material. EB conducted the first iteration of interpretive analysis and prepared the material for discussion with all coauthors before the next iteration of analysis. All authors contributed substantially to reporting the work through direct input about organisation of the argumentation, quote selection and discussion of relevant literature. EB and AT are responsible for the overall content of the article as guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent We used the standard consent forms from the IRB that reviewed the study.

    • Ethics approval The Institutional Review Board of the hospitals involved and McGill University Health Centre approved this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.