The rocks and hard places of MAiD: a qualitative study of nursing practice in the context of legislated assisted death

Abstract

Background: Medical Assistance in Dying (MAiD) was legalized in Canada in June, 2016. The Canadian government's decision to legislate assisted dying, an approach that requires a high degree of obligation, precision, and delegation, has resulted in unique challenges for health care and for nursing practice. The purpose of this study was to better understand the implications of a legislated approach to assisted death for nurses' experiences and nursing practice. Methods: The study used a qualitative approach guided by Interpretive Description. Semi-structured interviews were conducted with 59 registered nurses and nurse practitioners. Interviews were audio-recorded, transcribed, and managed using qualitative analysis software. Analysis followed a procedure of data immersion, open coding, constant comparative analysis, and the construction of a thematic and interpretive account. Results: Nurses in this study described great variability in how MAiD had been enacted in their work context and the practice supports available to guide their practice. The development of systems to support MAiD, or lack thereof, was largely driven by persons in influential leadership positions. Workplaces that supported a range of nurses' moral responses to MAiD were most effective in supporting nurses' well-being during this impactful change in practice. Participants cited the importance of teamwork in providing high quality MAiD-related care; although, many worked without the benefit of a team. Nursing work related to MAiD was highly complex, largely because of the need for patient-centered care in systems that were not always organized to support such care. In the absence of adequate practice supports, some nurses were choosing to limit their involvement in MAiD. Conclusions: Data obtained in this study suggested that some workplace contexts still lack the necessary supports for nurses to confidently meet the precision required of a legislated approach to MAiD. Without accessible palliative care, sufficient providers, a supportive team, practice supports, and a context that allowed nurses to have a range of responses to MAiD, nurses felt they were legally and morally at risk. Nurses seeking to provide the compassionate care consistent with such a momentous moment in patients' lives, without suitable supports, find themselves caught between the proverbial rock and hard place.

Riding an elephant: A qualitative study of nurses' moral journeys in the context of Medical Assistance in Dying (MAiD)

“…The purpose of this paper is to report on findings related to nurses' moral experiences in the context of MAiD from a qualitative interview study. This paper complements two other papers from the same set of interviews with 59 nurses in which we reported nurses' views on best practices and their experiences with health system issues (Pesut, Thorne, Schiller, Greig, & Roussel, 2020; Pesut et al., 2020).…”

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

“…We conducted a primary qualitative study of nurses’ experiences. Other papers from this dataset discuss nurses’ moral sense-making (Pesut, Thorne, Storch, et al, 2020) and policy and health system issues that affect their practice (Pesut, Thorne, Schiller, et al, 2020). In this article, we report on the qualitative findings that describe how nurses construct good nursing practice within the context of this new end-of-life option.…”

Rethinking Carper's personal knowing for 21st century nursing

“…To illustrate this, I return to the example of how MAiD is being implemented by nursing in Canada. Regardless of the convictions of individual nurses, or the presence or absence of their declarations of conscientious objection, the nursing collective priority has become creating the envelope of safe and supported care surrounding any patient who may be considering this as an end‐of‐life option (Pesut, Thorne, Schiller, Greig, & Roussel, 2020). Such a collective priority clearly relies on a confident sense of a disciplinary core value, which is the safeguarding of patients and their families, regardless of their end‐of‐life decisions, during such a delicate and complex phase of their lives.…”