Experiences and perspectives of people who pursued medical assistance in dying: Qualitative study in Vancouver, BC.

OBJECTIVE: To explore the experiences, wishes, fears, and beliefs of people who requested and were eligible for medical assistance in dying (MAID) in Canada in the first year after legalization. DESIGN: Qualitative study using semistructured interviews. SETTING: A clinic in Vancouver, BC, that provides MAID. PARTICIPANTS: People requesting and eligible for MAID between February 6 and December 17, 2016. Family and friends who were identified as the patients' primary support people were also interviewed. METHODS: Semistructured interviews were conducted over the telephone, by e-mail, or in person. The interviews were audiorecorded and transcribed and then analyzed using thematic qualitative analysis. The investigators read the transcripts and created a coding scheme to identify themes in the patients' experiences. The identified themes were compiled and evaluated in the context of what is already known based on current literature. Basic demographic characteristics were recorded for context. MAIN FINDINGS: Of the 23 patients whose experiences were explored, most had a malignancy, a neurologic disorder, or organ failure. A main theme was that patients thought it was important to have autonomy and control over their own end-of-life decisions. Main reasons for requesting MAID were a self-perceived unacceptable quality of life, most commonly owing to loss of independence, mobility, ability to communicate, a sense of purpose, and participation in meaningful activity. Some people expressed fear of future suffering and future disability. Pain was seldom mentioned as a cause of suffering. Some participants believed they could discuss their decision with the people in their lives while others chose to keep it a private matter. Most people were not religious. CONCLUSION: The participants' reasons for choosing to pursue MAID were consistent with those of people in other jurisdictions that have been studied. They felt confident in their decision to pursue MAID and did not have fears about the process.

Exploring the experience of supporting a loved one through a medically assisted death in Canada.

OBJECTIVE: To explore the experience of family and close friends of patients seeking medical assistance in dying (MAID) in Canada. DESIGN: Qualitative study using semistructured interviews. SETTING: A clinic in Vancouver, BC, that provides MAID services. PARTICIPANTS: Eighteen support people for patients seeking MAID. METHODS: Clinic patients seeking MAID identified their primary support people during consultations for an assisted death evaluation. Identified support people were invited to participate in the study, and those who were interested were asked to contact the interviewers. Semistructured interviews were conducted, transcribed, coded, and subjected to content analysis to elucidate common themes. MAIN FINDINGS: All participants were supportive of their loved one's wish for assisted death and they provided emotional and practical support in preparation for MAID. Support persons talked about the journey they went through from their loved one's diagnosis to the MAID request to the actual death. Some were initially opposed but changed their minds after seeing the suffering their loved ones endured. The time before the assisted death involved saying goodbye and, for some, ceremonial rituals (celebration of life, poems, singing, etc). Those interviewed after their loved one's assisted death found the death peaceful and reported that it offered advantages compared with natural death in their loved one's individual circumstances. CONCLUSION: This study provides insight into experiences of support people coping with a loved one who is seeking or has sought MAID in the context of a country unfamiliar with the legal process of a planned and hastened death. Participants were supportive of their loved one's wishes for assistance in death to end suffering and found the process to be peaceful overall.

Providing medical assistance in dying: Practice perspectives.

OBJECTIVE: To explore the experiences of the first cohort of physicians to offer medical assistance in dying (MAID) in British Columbia. DESIGN: Qualitative study using semistructured, one-on-one interviews. SETTING: British Columbia. PARTICIPANTS: Eight physicians who offered MAID in British Columbia in 2016. METHODS: The physicians were interviewed by telephone or by e-mail between 4 and 6 months after MAID was made legal in Canada, with follow-up in January 2017. Interviews were audiorecorded, transcribed, and analyzed through qualitative thematic analysis. MAIN FINDINGS: Participants believed that MAID was rewarding and satisfying work. They explained that some of the structural and emotional challenges related to providing MAID included the following: the refusal of faith-based institutions to provide information about MAID to patients, as well as their refusal to allow assessments or deaths to occur on site; having to deny MAID to patients who did not qualify for it; disagreements with colleagues who did not support the provision of MAID; dealing with the grief of family and friends who were present at the death; and feeling like they were always on call. While a few participants thought that the legislative restrictions of Bill C-14 were appropriate in the beginning when MAID was first available in Canada, most would like to see changes to the legislation to make it more aligned with the intent of the Carter decision, including broadening the eligibility criteria to include mature minors and people with advanced psychiatric diagnoses, having the ability to honour advance directives, and removing the requirement of death being in the reasonably foreseeable future for patients with grievous and irremediable conditions. CONCLUSION: Physicians in this study explained that providing MAID is rewarding work; however, there are many challenges that complicate their ability to offer MAID to patients. The current MAID legislation in Canada should be updated to better serve the needs of patients.

Proteomics of human embryonic stem cells.

Human embryonic stem cells (hESCs) offer exciting potential in regenerative medicine for the treatment of a host of diseases including cancer, Alzheimer's and Parkinson's disease. They also provide insight into human development and disease and can be used as models for drug discovery and toxicity analyses. The key properties of hESCs that make them so promising for medical use are that they have the ability to self-renew indefinitely in culture and they are pluripotent, which means that they can differentiate into any of more than 200 human cell types. Since proteins are the effectors of cellular processes, it is important to investigate hESC expression at the protein level as well as at the transcript level. In addition, post-translational modifications, such as phosphorylation, may influence the activity of pivotal proteins in hESCs, and this information can only be determined by studying the proteome. In this review, we summarize the results obtained from several proteomics analyses of hESCs that have been reported in the last few years.