Paediatrics & child health · 2026
Medical assistance in dying in pediatrics: a retrospective case study of clinical interactions and implications for team training.
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Martisella Marta, Marquis Marc-Antoine, Stypulkowski Audrey, Payot Antoine, Bourque Claude Julie, Bouthillier Marie-Eve
Аннотация
OBJECTIVES: In Canada, medical assistance in dying (MAiD) has been a legal end-of-life (EOL) option since 2016. Although minors are not legally eligible, pediatric palliative care (PPC) teams can be involved in MAiD-related discussions initiated by patients or parents. However, little is known about how these discussions unfold in pediatrics. This study sought to describe the structure and content of these interactions, with the aim of developing a typology and clinical vignettes to support the preparation and training of pediatric healthcare professionals.
METHODS: We conducted a retrospective and descriptive case study within a single PPC service in a Canadian pediatric academic tertiary hospital. Data were collected from patient's charts (September 2013 to August 2023), including patient demographics, clinical characteristics, palliative care involvement, MAiD-related discussions and EOL details (N = 11). Descriptive statistics, as well as thematic and comprehensive analyses were used.
RESULTS: We identified 11 cases of documented MAiD-related interactions involving patients aged <1 to 18 years. Most interactions were initiated by patients' parents (73%; n = 8), and some by patients themselves (27%; n = 3). We identified three types of MAiD-related interactions: implicit (n = 2), explicit exploratory (n = 5) and explicit direct (n = 4). Based on this typology, we co-developed six clinical vignettes to illustrate these scenarios.
CONCLUSION: Although rare, MAiD-related interactions in pediatric settings are complex and high-stakes, underscoring the need for enhanced training of pediatric healthcare professionals. The proposed typology and vignettes provide a framework to support reflective ethical practice and enhance pediatric teams' preparedness for EOL beyond the specific clinical and legal context of our study.
METHODS: We conducted a retrospective and descriptive case study within a single PPC service in a Canadian pediatric academic tertiary hospital. Data were collected from patient's charts (September 2013 to August 2023), including patient demographics, clinical characteristics, palliative care involvement, MAiD-related discussions and EOL details (N = 11). Descriptive statistics, as well as thematic and comprehensive analyses were used.
RESULTS: We identified 11 cases of documented MAiD-related interactions involving patients aged <1 to 18 years. Most interactions were initiated by patients' parents (73%; n = 8), and some by patients themselves (27%; n = 3). We identified three types of MAiD-related interactions: implicit (n = 2), explicit exploratory (n = 5) and explicit direct (n = 4). Based on this typology, we co-developed six clinical vignettes to illustrate these scenarios.
CONCLUSION: Although rare, MAiD-related interactions in pediatric settings are complex and high-stakes, underscoring the need for enhanced training of pediatric healthcare professionals. The proposed typology and vignettes provide a framework to support reflective ethical practice and enhance pediatric teams' preparedness for EOL beyond the specific clinical and legal context of our study.