Because it was new: Unexpected experiences of physician providers during Canada's early years of legal medical assistance in dying.

Implementing newly legalized euthanasia or assisted dying presents challenges. The procedure is high-stakes and irreversible and the context is controversial and associated with high emotions and strong opinions. This qualitative study reports unexpected experiences of twenty-one medical doctors who provided Medical Assistance in Dying (MAID) in the first years after legalization in Canada. The phrase 'because it was new' occurred multiple times as doctors attributed unanticipated experiences to the lack of individual and collective experience or knowledge. Positively viewed surprises included increased awareness of palliative care and an unexpected personal sense of fulfillment from helping others. Negative surprises were attributed multiple factors including ambiguously phrased legislation, systems issues and individual inexperience. Participants described issues such as technical difficulties around provision, provider anxiety, logistical snags and inability to adequately counsel and guide families. Participants expressed desire for more guidance, mentoring, training, and team communication. This article draws on phenomenological analysis of data to present providers' accounts of their experiences in the Canadian context. This will assist new providers and jurisdictions in anticipating and preparing for circumstances that were unexpected for the first cohort.

'We're kidding ourselves if we say that contraception is accessible': a qualitative study of general practitioners' attitudes towards adolescents' use of long-acting reversible contraceptives (LARC).

INTRODUCTION Adolescents' uptake of long-acting reversible contraceptives (LARCs) in New Zealand is low. We created the concept of a proactive LARC provision programme to overcome barriers to LARC uptake. Previously, this concept was discussed with adolescents and positively received. Lack of provider awareness is a barrier to LARC use identified in previous research and by adolescents. AIM We sought the views of general practitioners (GPs) to gauge whether LARCs and their proactive promotion for use in adolescents may be acceptable to GPs. METHODS Nine New Zealand GPs were interviewed about their contraception provision to adolescents and were then asked to comment on the concept of a proactive LARC provision programme. The data collected were transcribed and analysed using a general inductive approach to identify common themes and ideas. We concurrently interviewed and analysed interviews and continued to recruit GPs until thematic saturation was reached. RESULTS Six themes were identified from the interviews: (1) contraceptive decision making; (2) the GP role; (3) sexual activity; (4) social context; (5) gauging adolescent understanding; and (6) youth. When we proposed the concept of a proactive LARC provision programme, the GPs responded positively. DISCUSSION The research demonstrates that LARC uptake is affected by limited provider awareness. These findings align with other research internationally that identifies barriers to adolescent contraceptive use. The findings of this study suggest that other GPs may support a proactive LARC provision programme in New Zealand.

Maori spiritual beliefs and attitudes towards organ donation.

Organ transplantation is widely agreed to be beneficial to health. Many transplantations involve donation from the deceased. In Aotearoa/New Zealand, Maori both donate and receive proportionally fewer organs than non-Maori. This paper seeks illumination of this fact in unique Maori spiritual beliefs. These spiritual beliefs are not held by all Maori, and their role in an individual's life may vary, nonetheless they constitute a living tradition. Because cadaveric donation involves removal of organs from the dead person as soon after death as possible, considerations arise about customary rules and observances and the movement between the realm of the living and the dead. This may raise concerns for donors, recipients, and their respective whanau (extended family). In some cases, these concerns may form a consideration against donating posthumously.