Dutch Healthcare Professionals Experiences of Assisted Dying: A Constructivist Qualitative Study Conducted in a Chronic Disease Care Centre and Hospice.

Abstract

Background: Assisted dying is a contemporary issue, but comprehensive consideration of healthcare professionals’ experiences has been lacking. This study sought to gain a deeper understanding of professionals’ experiences of assisted dying to inform the global debate surrounding its implementation. Methods: This constructivist, qualitative study, recruited twenty-one physicians, nurses and therapists from a Dutch chronic disease care centre and a hospice. Data were gathered in semi-structured interviews, conducted in English. Questioning focused on professionals’ experiences along a clinical trajectory from an initial request to beyond the death. Data were subjected to thematic analysis to identify main and subthemes. Results: Analytical procedures generated four broad themes ‘Assessment and its Challenges’, ‘Preparing Staff and Learners’, ‘Assisting a Death’ and ‘Bereavement Care and Beyond’, supported by subthemes. Assessment of requests involved all professional groups and required open dialogue, exploration of fears, palliative care optimisation and psychological evaluation. Such measures resolved the majority of requests. Assisted deaths were challenging, required careful management and were not perceived as normal. Administration of lethal drugs and reporting procedures were stressful for physicians. Structured debriefing and proactive psychological support were valued by all professionals, but resolving their emotions took time. Some physicians required a recovery period creating equity of access issues. Life and care experience aided the preparation of professionals, but resilience was also needed. Support for the provision of assisted dying was overwhelming, but this was unqualified in only a third of participants. Conclusions: Assisted dying creates significant challenges for healthcare professionals who require preparation and support. This is likely to require enhanced levels of palliative care education, legislative advice, and proactive psychological support to ensure professionals’ own well-being. Meeting these needs will have financial implications which should be addressed prior to implementing legislation which permits assisted dying.

Constructing Good Nursing Practice for Medical Assistance in Dying in Canada: An Interpretive Descriptive Study

“…Even as some nurses described being grateful that they could fulfill patient wishes for a MAiD death, the death itself provoked emotions that could be uncomfortable or disturbing. Studies of nurses’ experiences with assisted death from Belgium ( Bellens et al, 2020 ; Denier, Gastmans, et al, 2010 ), the Netherlands ( Lewis, 2018 ; van de Scheur & van der Arend, 1998 ), and Canada ( Beuthin et al, 2018 ) have similarly described a range of emotions that nurses experience in the context of an assisted death. Furthermore, other authors have noted the same sense of gratitude nurses describe at being part of a care system that provides an opportunity to fulfill patients’ wishes and relieve their suffering ( Bruce & Beuthin, 2019 ).…”

“…Similar to the experiences of nurses in this study, preparing for the MAiD death has been described as highly anxiety producing even in other contexts. For example, nurses from the Netherlands described their supportive role as demanding and nerve-wracking ( Lewis, 2018 ; van de Scheur & van der Arend, 1998 ). Nurses from Belgium described their role as intense, acknowledging that even though their comfort level develops over time, euthanasia is not something they become used to ( Bellens et al, 2020 ; Denier, Dierckx de Casterle, et al, 2010 ).…”

Breaching the stalemate on assisted dying: it’s time to move beyond a medicalised approach

“…Many doctors who support legal reform on assisted dying in the UK acknowledge they do not wish to be directly involved 23. In most countries providing assisted dying, only a minority of doctors are involved,4 with some healthcare professionals reporting that it was “stressful to kill somebody.”5 Pharmacists may be unwilling to dispense drugs as they fear being “complicit” and hospitals are also reluctant to be associated with assisted dying, preferring to discharge patients. Unsurprisingly, bereaved relatives report difficulties in navigating healthcare systems to find a doctor to assist by assessing a patient’s capacity, prognosis, and prescribing the required drugs.…”