Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review.
Amy Nolen, Rawaa Olwi, Selby Debbie
PMID 34227433WHAT IT FOUND
In a palliative care unit, palliative sedation rose from 4.7% of deaths before MAiD to 14.6% after.
In acute care it stayed about 5%. Agitated delirium and dyspnea were common indications.
Key findings
01Palliative sedation in the palliative care unit rose from 4.7% of deaths before MAiD to 14.6% after.
02In acute care, palliative sedation remained about 5% of deaths before and after MAiD.
03Eight palliative care unit patients who received palliative sedation had prior MAiD documentation; six lost capacity after eligibility and two were never eligible.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It was a single centre study, so the rates may not apply to other hospitals or community settings. It was retrospective, and chart documentation sometimes made it hard to tell whether the intent was full palliative sedation. In acute care, it only included patients followed by the palliative care consult team, so sedation started by other services, especially intensive care, may have been missed. The study period was before the Bill C-7 amendment, so MAiD still required capacity immediately before provision. The study describes patterns in one hospital and does not show that MAiD caused the increase in palliative sedation.
The easy way to misread this
Do not conclude that MAiD legalization caused a hospital-wide rise in palliative sedation. The rise was only in the palliative care unit; acute care stayed about 5%, and the single centre retrospective design cannot prove cause.