Canadian French and English Newspapers' Portrayals
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Open access Research BMJ Open: first published as 10.1136/bmjopen-2017-020369 on 1 May 2019. Downloaded from Canadian French and English newspapers’ portrayals of physicians’ role and medical assistance in dying (MAiD) from 1972 to 2016: a qualitative textual analysis Ellen T Crumley,1 Caroline Sheppard,2 Chantelle Bowden,3 Gregg Nelson4 To cite: Crumley ET, ABSTRACT Strengths and limitations of this study Sheppard C, Bowden C, et al. Objective To examine how Canadian newspapers Canadian French and English portrayed physicians’ role and medical assistance in dying ► This study examines a large random sample of print newspapers’ portrayals of (MAiD). physicians’ role and medical and online newspaper articles published in French Design Qualitative textual analysis. assistance in dying (MAiD) from and English. Setting Online and print articles from Canadian French 1972 to 2016: a qualitative ► Some important themes and codes may not have and English newspapers. textual analysis. BMJ Open appeared in the random sample due to sampling Participants 813 newspaper articles published from 2019;9:e020369. doi:10.1136/ bias, culture bias and the halo effect. bmjopen-2017-020369 1972 to 2016. ► Certain publications may be under-represented de- Results Key Canadian events defined five eras. From Prepublication history for pending on whether their publication is available ► 1972 to 1990, newspapers portrayed physician’s MAiD role this paper is available online. online or in databases. as a social issue by reporting supportive public opinion To view these files, please visit ► This study looks at online and print news media only polls and revealing it was already occurring in secret. From the journal online (http:// dx. doi. and does not consider media from television, social 1991 to 1995, newspapers discussed legal aspects of org/ 10. 1136/ bmjopen- 2018- media, external websites, RSS feeds, apps, etc or physicians’ MAiD role including Rodriguez’ Supreme Court 020369). the general decline of print newspapers. of Canada appeal and Federal government Bills. From Received 30 October 2017 1996 to 2004, journalists discussed professional aspects http://bmjopen.bmj.com/ Revised 12 November 2018 of physicians’ MAiD role and the growing split between Accepted 17 December 2018 palliative care and physicians who supported MAiD. They America—and being debated internation- also reported on court cases against Canadian physicians, ally.1 2 Depending on the jurisdiction, MAiD Dr Kevorkian and suffering patients who could not receive may include passive, active, assisted suicide MAiD. From 2005 to 2013, newspapers described political and euthanasia (other relevant definitions aspects including the tabling of MAiD legislation to change include: active euthanasia—accelerating or physicians’ role. Lastly, from 2014 to 2016, newspapers intentionally causing death by means of a again portrayed legal aspects of physicians’ role as the Supreme Court of Canada was anticipated to legalise MAiD single act from a third party; passive eutha- on September 26, 2021 by guest. Protected copyright. and the Québec government passed its own legislation. nasia—withdrawing or withholding life-sus- Remarkably, newspapers kept attention to MAiD over 44 taining care in order to allow a patient to years before it became legal. Articles generally reflected succumb to their medical condition and Canadians’ acceptance of MAiD and physicians were assisted suicide—providing the means or typically portrayed as opposing it, but not all did. circumstances where someone is able to take Conclusions Newspaper portrayals of physicians’ their own life, which sometimes may involve MAiD role discussed public opinion, politicians’ activities a physician3). In Canada, the context of our and professional and legal aspects. Portrayals followed study, the Federal Parliament passed Bill © Author(s) (or their the issue-attention cycle through three of five stages: C-14 Medical Assistance in Dying in June 2016.4 1) preproblem, 2) alarmed discovery and euphoric employer(s)) 2019. Re-use MAiD is a legal option for eligible Canadian permitted under CC BY-NC. No enthusiasm and 3) realising the cost of significant commercial re-use. See rights progress. patients suffering from an incurable medical and permissions. Published by condition to end their life with the help from BMJ. a physician or nurse practitioner (NP) (in For numbered affiliations see the province of Québec physicians can only end of article. INTRODUCTIOn perform euthanasia, not assisted suicide. Correspondence to Medical Assistance in Dying (MAiD) is NPs cannot perform euthanasia in Québec). Professor Ellen T Crumley; currently permitted on four continents— Except in the province of Québec, physicians ecrumley@ dal. ca Europe, Asia, North America and South and NP can legally provide knowledge to Crumley ET, et al. BMJ Open 2019;9:e020369. doi:10.1136/bmjopen-2017-020369 1 Open access BMJ Open: first published as 10.1136/bmjopen-2017-020369 on 1 May 2019. Downloaded from patients about self-administration of death and the means To our knowledge, there is limited research about MAiD for a patient to take their own life (ie, write a prescrip- in Canada (at the 2018 MAiD conference, Dr Wiebe, a tion). They can also legally administer a lethal cocktail Canadian researcher and physician, presented the handful of pharmaceuticals to hasten a patient’s death (while of Canadian MAiD studies that have been published to Canadian patients can self-administer MAiD, 99.8% of date) and only a single study of MAiD and physicians’ 2468 Canadian patients—from June 2016 to December role in Canadian newspapers.34 Existing studies of MAiD 2017—chose to receive MAiD from a physician/NP; only in newspapers have several shortcomings. First, they focus 5 patients underwent self-administered deaths.5 This on a few years of print English articles, usually centred may be because the preferred pharmaceuticals for MAiD around a significant event, such as a court case. Second, self-administration were only approved in Canada in late they do not examine French-language or online newspa- 2017; it is unknown if more patients will choose self-ad- pers. Third, because researchers only analysed a few years ministration6).3 7 8 Although some consider passive eutha- of articles, studies overlook the gradual accumulation nasia MAiD, it was already permitted in Canada and is not of key MAiD events (eg, court cases, bills and polls) that included in the legislation. occurred over the 44 years.36 37 In this study, we attempt Polls from 1968 onwards9 10 showed that Canadians to address some of these shortcomings by investigating supported MAiD, yet it was not legalised for over four MAiD in French and English Canadian newspaper arti- decades. Healthcare budgets in Canada are tight and cles from 1972 to 2016. Our article does ‘not focus on the continually increasing.11 While implementing MAiD merits of the assisted suicide debate nor do we comment could reduce healthcare spending,12 Canadian news- on the intent of the news accounts. Rather, our purpose is papers consistently wrote about MAiD as a way to help to discuss the portrayals the news stories help to create’.38 decrease a patient’s prolonged suffering and give them As MAiD in Canada is a new practice that has a small control over the dying process (ie, autonomy).13 Despite amount of published research,2 39 40 we must examine growing public support for MAiD, physicians and the the information that is available. Given the scarcity of Canadian Medical Association (CMA) have long resisted published medical research, Canadian newspapers are changing their professional role to include it.13–15 a credible data source as journalists have written many When choosing subjects, journalists and editors have stories about MAiD and have been discussing it since a duty to report current events and facts, and decide 1972. Thus, newspaper articles provide important infor- which issues are appealing and newsworthy. Since sensa- mation about MAiD, such as portrayals of events, legisla- tional stories capture the public’s attention, newspapers tion, public opinion polls and physicians’ views. To our generally report on emerging issues—which may or may knowledge, no one has systematically studied portrayals not have much research.16 Newspapers help inform the of MAiD in Canadian newspapers since 1972. Hence, public and may shape their opinion, but may also prolong our objective is to analyse Canadian French and English http://bmjopen.bmj.com/ public misconceptions about an issue.16–22 Whether news- online and print newspaper portrayals of physician’s papers actually influence behaviour change or legislation MAiD role from when suicide was decriminalised in 1972 has been debated in many disciplines.23–26 Research has to its legalisation in 2016. Our research question is: how found that the public relies on newspapers for health do Canadian French and English online and print news- information; however, newspapers may inaccurately papers portray physicians’ role and MAiD? Given Cana- report medical issues27 28 and bias towards positive health dians’ intense interest in physicians’ MAiD role and its coverage has been found.29 30 For example, the Australian recent legalisation, our study gives unique insight into media promoted popular opinion and specific interest how newspapers portrayed it over time. on September 26, 2021 by guest. Protected copyright. groups, and ignored or misinterpreted scientific findings that did not fit into its portrayal