Symposia
Health Psychology / Behavioral Medicine - Adult
Jonathan Singer, Ph.D.
Visiting Assistant Professor
Texas Tech University
Lubbock, Texas
amelia Evans, MA
Graduate Student
Texas Tech University
Lubbock, Texas
Margaret Vugrin, MA
Librarian
Texas Tech University Health Science Center
Lubbock, Texas
Introduction: One argument against medical aid in dying (MAID) is concern that MAID negatively affects family members of individuals who engage in it, resulting in poor bereavement outcomes. However, there is a limited literature that specifically examines the psychological impact. This talk will discuss articles that address the impact of MAID on the mental health of family members of persons who engage in MAID and describe a theoretical model to help advance the field.
Method: Between October to December 2021, PRISMA guidelines were used. Two independent reviewers screened all articles. Disagreements were decided by a third reviewer. 23 studies met criteria. Two independent reviewers conducted a quality assessment using NIH’s quality assessment tool. Of 2,646 publications identified, 23 met criteria. 19 of 23 studies were qualitative, two were mixed methods, two were quantitative and 18 were retrospective. All studies had at least “fair” quality and were kept in the systematic review. The 23 studies were used to build the proposed model.
Results: There were equivocal findings regarding the effects of MAID on mental health of bereaved family members. One study reported bereaved family members experienced high rates of mental health symptoms in response to their grappling with moral dilemmas related to MAID and feelings of isolation due to perceived stigma. Other studies indicated bereaved family members had favorable mental health outcomes due to perceived prevention, reduced burden, and ending of suffering. There were unique factors that impacted the bereaved individual before the loss including certainty of date/time of death, decision making at the end of life, supporting patient autonomy, and sense-making. A model was developed to explain the development from pre-bereavement risk (e.g., decision making) and protective factors (e.g., sense-making) to processing unique elements of having someone engage in MAID (e.g., perceived stigma), which predicts bereavement outcomes.
Conclusions: The bereavement field has been limited in examining mental health outcomes for bereaved family members of those participating in MAID, compared to other types of losses. This talk will highlight the need for prospective studies to further investigate specific mental health outcomes after MAID on bereaved family members and identify unique risk factors for mental health outcomes. The model can be used in future research aimed at developing evidence based theoretical framework of bereavement specific to MAID.