Reflections on the relational ontology of medical assistance in dying

Abstract

Canadian nursing practice has been profoundly influenced by the legalization of medical assistance in dying in 2016, requiring that nurses navigate new and sometimes highly challenging experiences. Findings from our longitudinal studies of nurses' experiences suggest that these include deep emotional responses to medical assistance in dying, an urgency in orchestrating the perfect death, and a high degree of relational impact, both professionally and personally. Here we propose a theoretical explanation for these experiences based upon a relational ontology. Drawing upon the work of Wildman, we understand a relational ontology to be one in which relationships are more fundamentally central than the conceptual entities that provide the context to practice. It is in a relationship that conceptual entities, and their affiliated values, are created and recreated. Seen as causal, relationships have ontological status, with important implications for how we consider the concepts of death, suffering, and time in this context. From a conceptual perspective, suffering is primarily self‐defined based upon personal histories, time reflects the potential remaining until death, and death is primarily biological and amoral, although social discourses of a good and bad death surround the death trajectory. However, within a relational ontology of medical assistance in dying, these understandings shift. Death becomes primarily social rather than biological, suffering is shared, and time until death is now clearly delimited. Accordingly, nurses assume a profound responsibility for influencing outcomes that are authentically person‐centered. These understandings provide important insights into nurses' experiences, enabling us to recognize the causal effects, both intended and unintended, of nurses' relational practices amidst the complexities of assisted death. Drawing on such a perspective, we find implications for how we provide spaces for nurses to reflect on, and have conversations about, their experiences with some of the greatest mysteries of life—death, suffering, and time.

Editorial preface: The role of subjectivity, intersubjectivity, and power relations in the delivery of humane nursing care

“…In their paper, Pesut and Thorne (2023) make a similar case for the relational and interdependency of nursing practice. They argue that the relational interactions of persons, health and environment are fundamentally more important for nursing practice than the conceptual entities of persons, health and environment.…”

“…Finally, Jenkins et al (2023) share Pesut and Thorne's (2023) views concerning relational interactions in constructing conceptual…”

“…Finally, Jenkins et al (2023) share Pesut and Thorne's (2023) views concerning relational interactions in constructing conceptual entities and expand on this to suggest that these are influenced and partly governed by power relations as developed by the politics of capitalist systems and structures in which they operate. They argue that capitalist structures force a collision between ethical care and technological innovations.…”

“…They argue that the relational interactions of persons, health and environment are fundamentally more important for nursing practice than the conceptual entities of persons, health and environment. Moreover, Pesut and Thorne (2023), like Djordjevic (2023), suggest that conceptual entities are (re)shaped by relational interactions and eventually affect the ideas and values nurses hold about the conceptual entities and the overall relational interactions. They focus on relational interactions to analyse how nurses think about death within the medical assistance in the dying framework, whereby physical death is not morally neutral but socially conditioned.…”