Shades of gray: Conscientious objection in medical assistance in dying

Pesut, Barbara; Thorne, Sally; Greig, Madeleine

doi:10.1111/nin.12308

Cited by 21 publications

(28 citation statements)

References 26 publications

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“…Specific ways in which nurses might go about developing these moral foundations include examining their moral intuitions, their decision in the context of relational ethics, and their moral coherence across end-of-life decisions 48. This idea of examining moral coherence may be particularly impactful.…”

Section: Discussionmentioning

confidence: 99%

Ethical, Policy, and Practice Implications of Nurses' Experiences With Assisted Death

Pesut

Thorne

Greig

et al. 2019

Advances in Nursing Science

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The conceptualization of assisted death as an act performed by physicians has resulted in a lack of attention to nurses' roles and experiences with the processes that surround an assisted death. In this article, we synthesize evidence from 6 articles focusing on the experiences of 55 nurses from Canada, Belgium, and the Netherlands, with relevant ethical and policy implications derived from the literature. Nurses have a central role in negotiating inquiries about assisted death and in providing wraparound care for patients, families, and other health care providers. This role is impactful for nurses and requires significant personal and professional moral work.

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Section: Discussionmentioning

confidence: 99%

Ethical, Policy, and Practice Implications of Nurses' Experiences With Assisted Death

Pesut

Thorne

Greig

et al. 2019

Advances in Nursing Science

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“…The role of ethical norms in relation to assisted dying has been a focus of research since 1987, 31 predating empirical studies of nurses' attitudes by more than 5 years. 40 The literature of nurses' ethical decision-making shows that when nurses are confronted with ethically challenging situations, their choices are often shaped by social expectations, 34,41,42 'without any conscious awareness of having gone through steps of search[ing], weighing evidence, or inferring a conclusion'.(p. 11).…”

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confidence: 99%

Role of attitude in nurses’ responses to requests for assisted dying

Wilson

Edwards³

et al. 2020

Nurs Ethics

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Background: Legal assisted dying is a rare event, but as legalisation expands, requests for it will likely increase, and the nurse most often receives the informal, initial request. Objectives: To assess the effects of attitude in interaction with normative and control beliefs on an intention to respond to a request for legal assisted dying. Ethical considerations: The study had the lead author’s institutional ethics approval, and participants were informed that participation was both anonymous and voluntary. Methodology: This was a cross-sectional correlational study of 377 Australian registered nurses who completed an online survey. Generalised linear modelling assessed the effects of independent variables against intended responses to requests for legal assisted dying. Results: Compared to nurses who did not support legal assisted dying, nurses who did had stronger beliefs in patient rights, perceived social expectations to refer the request and stronger control in that intention. Nurses who did not support legal assisted dying had stronger beliefs in ethics of duty to the patient and often held dual intentions to discuss the request with the patient but also held an intention to deflect the request to consideration of alternatives. Discussion: This study advances the international literature by developing quantified models explaining the complexity of nurses’ experiences with requests for an assisted death. Attitude was operationalised in interaction with other beliefs and was identified as the strongest influence on intentions, but significantly moderated by ethical norms. Conclusion: The complex of determinants of those intentions to respond to requests for an assisted death suggests they are not isolated from each other. Nurses might have distinct intentions, but they can also hold multiple intentions even when they prioritise one. These findings present opportunities to prepare nurses in a way that enhances moral resilience in the face of complex moral encounters.

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“…In a related paper, we discuss some of the factors for nurses to consider as they engage with questions about their participation in euthanasia, factors such as their intuitional responses, the relational impacts of their decisions and their moral coherence with similar end-of-life decisions. 73 Wrestling with questions such as these will provide important intellectual substance for nursing’s ongoing dialogue around its particular relationship with euthanasia. Articles identified within this review provide a range of arguments from a variety of perspectives for nurses to consider as the development of euthanasia continues to unfold within the international context.…”

Section: Discussionmentioning

confidence: 99%

Nursing and euthanasia: A narrative review of the nursing ethics literature

Pesut¹,

Greig²,

Thorne

et al. 2019

Nurs Ethics

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Background: Medical Assistance in Dying, also known as euthanasia or assisted suicide, is expanding internationally. Canada is the first country to permit Nurse Practitioners to provide euthanasia. These developments highlight the need for nurses to reflect upon the moral and ethical issues that euthanasia presents for nursing practice. Purpose: The purpose of this article is to provide a narrative review of the ethical arguments surrounding euthanasia in relationship to nursing practice. Methods: Systematic search and narrative review. Nine electronic databases were searched using vocabulary developed from a stage 1 search of Medline and CINAHL. Articles that analysed a focused ethical question related to euthanasia in the context of nursing practice were included. Articles were synthesized to provide an overview of the literature of nursing ethics and euthanasia. Ethical Considerations: This review was conducted as per established scientific guidelines. We have tried to be fair and respectful to the authors discussed. Findings: Forty-three articles were identified and arranged inductively into four themes: arguments from the nature of nursing; arguments from ethical principles, concepts and theories; arguments for moral consistency; and arguments from the nature of the social good. Key considerations included nursing’s moral ontology, the nurse–patient relationship, potential impact on the profession, ethical principles and theories, moral culpability for acts versus omissions, the role of intention and the nature of the society in which euthanasia would be enacted. In many cases, the same assumptions, values, principles and theories were used to argue both for and against euthanasia. Discussion: The review identified a relative paucity of literature in light of the expansion of euthanasia internationally. However, the literature provided a fulsome range of positions for nurses to consider as they reflect on their own participation in euthanasia. Many of the arguments reviewed were not nursing-specific, but rather are relevant across healthcare disciplines. Arguments explicitly grounded within the nature of nursing and nurse–patient relationships warrant further exploration.

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Shades of gray: Conscientious objection in medical assistance in dying

Cited by 21 publications

References 26 publications

Ethical, Policy, and Practice Implications of Nurses' Experiences With Assisted Death

Ethical, Policy, and Practice Implications of Nurses' Experiences With Assisted Death

Role of attitude in nurses’ responses to requests for assisted dying

Nursing and euthanasia: A narrative review of the nursing ethics literature

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