背景:2021年,西班牙成为第一个授予和提供安乐死和医疗协助自杀权的南欧国家。根据法律,国家有义务确保通过卫生服务,这意味着医疗保健专业人员的参与至关重要。然而,它的实施不平衡。我们的研究侧重于理解可能的道德冲突,这些冲突塑造了临终医疗援助实践的不同立场,确定哪些核心思想可能是它们的基础,并提出造成这种差距的可能原因。获得的知识有助于理解其复杂性,将光线分成矛盾的轮廓,并制定策略来增加他们的参与。
方法:我们通过半结构化访谈(1小时)与25名初级保健医生和护士(12)进行了探索性定性研究。医院护理(7)姑息治疗(6),17个女人和8个男人,从马德里招募来的,加泰罗尼亚,2023年3月至5月之间的安达卢西亚。采访被记录下来,转录,并编码在Atlas中。ti软件通过主题和解释方法来开发概念模型。
结果:我们确定了MAiD的四种方法:全面支持(FS),条件支持(CS)条件拒绝(CR),完全拒绝(FR)。完全支持和完全拒绝适合MAiD上的传统支持和反对职位。然而,中间有一个灰色区域,由条件轮廓表示,他们的参与无法事先预测。考虑到他们对四个核心思想的不同解释,这些概况是有区别的:临终护理,宗教,专业职责/道义,患者自主性这些想法可以相交,这意味着参与者的位置是多原因和复杂的。配置文件之间的差异可以通过其道德推理中使用的道德权威的不同来源以及其对自治的个人主义或关系方法来解释。
结论:最终没有共识,而是在医疗保健专业人员中对MAiD的多元道德观点共存。了解哪些案件特别难以评估或法律的哪些方面不容易解释,将有助于制定新的战略,澄清法律框架,或指导道德推理和教育,目的是减少不可预测的MAID不参与。
BACKGROUND: In 2021, Spain became the first Southern European country to grant and provide the right to euthanasia and medically assisted suicide. According to the law, the State has the obligation to ensure its access through the health services, which means that healthcare professionals\' participation is crucial. Nevertheless, its implementation has been uneven. Our research focuses on understanding possible ethical conflicts that shape different positions towards the practice of Medical Assistance in Dying, on identifying which core ideas may be underlying them, and on suggesting possible reasons for this disparity. The knowledge acquired contributes to understanding its complexity, shedding light into ambivalent profiles and creating strategies to increase their participation.
METHODS: We conducted an exploratory qualitative research study by means of semi-structured interviews (1 h) with 25 physicians and nurses from primary care (12), hospital care (7), and palliative care (6), 17 women and 8 men, recruited from Madrid, Catalonia, and Andalusia between March and May 2023. Interviews were recorded, transcribed, and coded in Atlas.ti software by means of thematic and interpretative methods to develop a conceptual model.
RESULTS: We identified four approaches to MAiD: Full Support (FS), Conditioned Support (CS), Conditioned Rejection (CR), and Full Rejection (FR). Full Support and Full Rejection fitted the traditional for and against positions on MAiD. Nevertheless, there was a gray area in between represented by conditioned profiles, whose participation cannot be predicted beforehand. The profiles were differentiated considering their different interpretations of four core ideas: end-of-life care, religion, professional duty/deontology, and patient autonomy. These ideas can intersect, which means that participants\' positions are multicausal and complex. Divergences between profiles can be explained by different sources of moral authority used in their moral reasoning and their individualistic or relational approach to autonomy.
CONCLUSIONS: There is ultimately no agreement but rather a coexistence of plural moral perspectives regarding MAiD among healthcare professionals. Comprehending which cases are especially difficult to evaluate or which aspects of the law are not easy to interpret will help in developing new strategies, clarifying the legal framework, or guiding moral reasoning and education with the aim of reducing unpredictable non-participations in MAID.