When a Patient Discusses Assisted Dying

Lehto, Rebecca H.; Olsen, Douglas P.; Chan, Roxanne Raffin

doi:10.1097/njh.0000000000000246

Cited by 6 publications

(4 citation statements)

References 24 publications

(28 reference statements)

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“…Conversations and requests for assistance in death are commonly experienced by healthcare providers, including nurses, and are well documented across a diverse range of clinical settings [ 17 , 22 , 35 ]. For example, approximately 1 in 5 hospice volunteers reported that a patient had initiated discussions about assisted death [ 14 ], while studies of nurses demonstrate the frequent and often morally challenging interactions that exist with patients requesting assistance to end their life [ 26 ]. When reflecting upon the evolving separation that occurs upon a request for MAiD within non-providing hospice contexts, some participants perceived this as a failure or rejection of hospice care provision due to their inability to fully support the patients’ needs.…”

Section: Discussionmentioning

confidence: 99%

Hospice care providers experiences of grappling with medical assistance in dying in a hospice setting: a qualitative descriptive study

2021

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Background Rapid implementation of Medical Assistance in Dying (MAiD) across care settings has challenged providers and organizations, including hospices, to develop and implement new modes of practice. The aim of this study was to examine the effects that legalization of MAiD has had on hospice care provider roles within the non-provider context. Methods Eight in-depth semi-structured interviews were conducted and a qualitative descriptive approach used to examine hospice care providers experiences in a small western Canadian city. In the study context, patients who choose MAiD are cared for until immediately prior to the procedure when they are transferred off-site to undergo MAiD. Inductive and thematic analyses were undertaken. Results Participants experienced practical, philosophical, and professional challenges. Despite the overwhelming desire to support patient autonomy and decision-making, some interpreted patient choice for MAiD as rejection of the natural death experience at the hospice. Patient choice for MAiD initiated a new and different pathway of end-of-life care. While participants felt uncertain how best to support patients undergoing MAiD, they shared mixed optimism on how their care provider roles were evolving as their level of experience broadened. While implementation of MAiD was rapid, the introduction of practical and professional supports has remained slow to materialize, leaving many providers to navigate their own personal and professional positions and practices. Conclusion Care providers require a multi-faceted range of clinical, legal, and logistical supports at the practice, organizational, and health system levels, to facilitate care delivery to those requesting and undergoing MAiD and to promote coordinated and holistic patient-centered care. The different pathway for those who chose MAiD may lead care providers to struggle with relational challenges and interpersonal unease. Further research may address how to support those undergoing MAiD within the hospice context.

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Section: Discussionmentioning

confidence: 99%

Hospice care providers experiences of grappling with medical assistance in dying in a hospice setting: a qualitative descriptive study

2021

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“…It's essential that nurses understand, and clarify with colleagues, that discussions about aid in dying are acceptable and within the nursing role; and that documenting these discussions does not breach patient confidentiality. It's also essential that nurses be well-informed about aid-in-dying resources, since patients may ask; many such resources are in the public domain 24…”

Section: Case Reflections and Nursing Implicationsmentioning

confidence: 99%

“…It's also essential that nurses be well-informed about aid-in-dying resources, since patients may ask; many such resources are in the public domain. 24 The interdisciplinary team. Because Mr. S. was a health care professional, he and his family had the advantage of having trusted, knowledgeable friends and colleagues to whom they could turn for help.…”

Section: Case Reflections and Nursing Implicationsmentioning

confidence: 99%

Medical Aid in Dying: What Every Nurse Needs to Know

Roy

2022

AJN, American Journal of Nursing

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:The number of U.S. states legalizing medical aid in dying for patients with terminal diseases and survival prognoses of six months or less is increasing. At press time, 10 states and the District of Columbia have legalized such aid. But because terminal illnesses without clear prognoses are not covered under these laws, some patients are forced to seek medical aid in dying outside the country.The nurse's role regarding aid in dying is poorly defined, and must be clarified. Currently, nurses and other providers have many misconceptions and fears about providing patients and families with the relevant education. Nurses need to have accurate knowledge and understanding of aid in dying, so they can advocate for those requesting this option; ensure equitable access; and provide them with guidance, support, and resources. An interdisciplinary approach is essential.This article provides background information on aid in dying in the United States, discusses the nurse's role, offers an illustrative case report, and addresses nursing implications.

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“…As nurses are regularly at the bedside of patients and families facing death, they have a voice in this regard, which is linked to the lived experience of caring as individuals and as a profession for any person who suffers, and among them also for those who see death not only as a fate, but as a choice. 18 Nevertheless, this voice is disturbingly silent in the current grand debates, leaving the audience with the task to interpret the ''sounds of silence. ''…”

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confidence: 99%

Editorial

Monteverde

2017

Nurs Ethics

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Death is certain, its hour is uncertain. For centuries, this ancient truism has been a strong motif in the figurative arts, a source of religious and political control, intellectual creativity, and social commitment. It has also been a foundational concept for nursing, long before it became a professional practice and science. Nursing has always had a strong voice in favor of people who are suffering, being present at their bedside and giving empathic care to the living and the dying, helping people to cope with the certitude of death and the uncertainty of its hour. An expression of this ''natural'' endeavor of nursing can be found in the preamble to the code of ethics of the International Council of Nursing, which states that ''. .. Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering,'' 1 and culminates in stating that ''The need for nursing is universal.'' This special issue of Nursing Ethics explores different perspectives and possible future directions of this commitment in the context of assisted dying. There is a need for a deeper analysis from the perspective of nursing ethics in the light of actual and potential legislative changes globally. This editorial includes short summaries of some of these changes from members of the Editorial Board of Nursing Ethics. They reflect the situation of countries where legal provisions and/or societal debates have emerged that necessarily involve the engagement of nurses. Knowing about the finitude of life is particular to human beings. In the context of breathtaking advances in medical science in prolonging biological life, the palliative care approach translated what it meant to alleviate suffering under the conditions of modern medicine. It became a reminder that death and dying are not to be seen as blind spots in a medical system that creates health, but as integral aspects of life that call for a response that is both compassionate and effective. As societies change, truisms become challenges. In industrialized nations, both the certitude of death and the incertitude of its hour seem to be put under scrutiny. One major reason is the success of medicine in avoiding preventable death and in refining constantly what ''preventable'' means. As to the certitude of death, the dispute about the definition of death by neurological criteria is restarted each time some refined understandings about how the brain works are presented. The legal battle of the parents of Jahi McMath in California, who succeeded in questioning the validity of her daughter's death certificate, may be seen as an isolated tragic situation, but it stands as a symbol for the challenges surrounding the declaration of death under the conditions of modern medicine. 2 As to the incertitude of the hour of death, planning one's own end of life turns up as a social imperative alongside the technological imperative of medicine. Many industrialized nations have introduced legislation on advance directives, confirming the validity of...

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When a Patient Discusses Assisted Dying

Cited by 6 publications

References 24 publications

Hospice care providers experiences of grappling with medical assistance in dying in a hospice setting: a qualitative descriptive study

Hospice care providers experiences of grappling with medical assistance in dying in a hospice setting: a qualitative descriptive study

Medical Aid in Dying: What Every Nurse Needs to Know

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