Emotional impact on healthcare providers involved in medical assistance in dying (MAiD): a systematic review and qualitative meta-synthesis

Abstract

BackgroundMedical assistance in dying (MAiD) traverses challenging and emotionally overwhelming territories: healthcare providers (HCPs) across jurisdictions experience myriad of affective responses secondary to possible tensions between normative and interwoven values, such as sanctity of life, dignity in death and dying and duty to care.ObjectiveTo determine the emotional impact on HCPs involved in MAiD.MethodsInclusion restricted to English language qualitative research studies from four databases (OVID Medline, EMBASE, CINAHL and Scopus), from beginning until 30 April 2021, and grey literature up to August 2021 were searched. Key author, citation and reference searches were undertaken. We excluded studies without rigorous qualitative research methodology. Included studies were critically appraised using the Joanna Briggs Institute’s critical appraisal tool. Analysis was conducted using thematic meta-synthesis. The cumulative evidence was assessed for confidence using the Confidence in the Evidence from Reviews of Qualitative Research approach.ResultsThe search identified 4522 papers. Data from 35 studies (393 physicians, 169 nurses, 53 social workers, 22 allied healthcare professionals) employing diverse qualitative research methodologies from five countries were coded and analysed. The thematic meta-synthesis showed three descriptive emotional themes: (1) polarised emotions including moral distress (n=153), (2) reflective emotions with MAiD as a ‘sense-making process’ (n=251), and (3) professional value-driven emotions (n=352).DiscussionThis research attempts to answer the question, ‘what it means at an emotional level’, for a MAiD practitioner. Legislation allowing MAiD for terminal illness only influences the emotional impact: MAiD practitioners under this essential criterion experience more polarised emotions, whereas those practising in jurisdictions with greater emphasis on allaying intolerable suffering experience more reflective emotions. MAiD practitioner’s professional values and their degree of engagement influence the emotional impact, which may help structure future support networks. English language literature restriction and absence of subgroup analyses limit the generalisability of results.

A meta‐synthesis exploring nurses' experiences of assisted dying and participation decision‐making

“…However, the consequences of this mindset, that patients' right to autonomy takes precedence over a nurses' personal beliefs and values, was that nurses risked moral distress as a result. This finding is consistent with other research which concluded, nurses' face ethical dilemmas when dealing with AD and moral distress can result (Dholakia et al, 2022;Freeman et al, 2021;Patel et al, 2021).…”

“…The findings of this meta‐synthesis were consistent with other research that suggests health practitioners require clear policies and procedural guidelines for AD to feel confident and capable in having key discussions and providing quality service (Dholakia et al., 2022; Fujioka et al., 2018; Oliver et al., 2017). Nurses reported feeling afraid of the legal ramifications that could ensue yet also expressed their desire to be prepared for engaging with patients who expressed a desire for a hastened death.…”

“…The personal persuader ‘patient choice and control takes precedence’ described the key aspects that nurses' felt were pivotal in their decision‐making about how they should approach the topic of AD. This demonstrates nurses' often putting the desires or requests of their patients at the forefront of their own moral decision‐making, which can be complex and distressing (Dholakia et al., 2022). In spite of this, nurses described a desire to honour a patient's request for an assisted death as this would offer them control over their own health, irrespective of whether or not the assisted death actually occurred.…”

“…The End of Life Choice Act (2019) does not describe the roles and responsibilities of registered nurses as the majority of involvement in AD is carried out by medical practitioners and NPs. Research has shown that nurses are often the health professionals approached by patients to have the early discussions about AD (Dholakia et al., 2022; Wilson et al., 2019). There is a distinct lack of education or training around navigating these challenging situations and engaging in difficult conversations with patients as requests for AD arises.…”

Medical assistance in dying: A reflection tool for pharmacists

“…8 An individual’s professional values and level of engagement influence the emotional impact of MAiD. 9 Some of the stressors described by health care professionals include a feeling of isolation, a culture of secrecy, lack of support, few opportunities to talk about experiences, challenging relationships with colleagues who object and witnessing the grief of others. 10,11 Pharmacy students have reported concerns regarding the dispensing aspect of MAiD as well as issues they may encounter when practising in direct patient care.…”