Nurses play a central role in the process of medical assistance in dying (MAID), even if they bear no responsibility for the act itself, according to the authors of a recent study.1

Researchers interviewed 59 Canadian nurses who had participated in a MAID experience or who chose to not participate. “We felt this study was important for two reasons,” says Barbara Pesut, PhD, RN, Canada research chair in health, ethics, and diversity and a professor in the school of nursing at the University of British Columbia.

First, Canada is the first country to allow nurse practitioners to act as MAID assessors and providers. “As such, it was important to understand their initial experiences with this new role,” Pesut says. Second, researchers suspected that registered nurses were essential to the care provision surrounding MAID. “To date, much of the literature surrounding assisted death has centered around physicians,” Pesut says. Some findings:

There was wide variation in practice supports (policies, procedures, or collegial mentorship) for nurses. “For many nurses, their initial experiences with MAID happened within a practice support void,” Pesut reports. This was most concerning for nurses who had to work alone and who had participated in multiple MAID deaths.

Nurses experienced a wide range of emotional reactions. For some nurses, MAID was one of the most meaningful experiences of their entire careers. For others, it was so emotionally distressing that they felt compelled to leave their jobs — even the profession of nursing altogether, in some cases. “Some nurses described an emotional overload after providing MAID that was difficult to understand,” Pesut says. For others, it faded over time. Certain nurses reported an overload recurrence after each MAID death.

It was not always easy for nurses to conscientiously object to participation in MAID. “Some felt that it might jeopardize their employment if MAID responsibilities were embedded within specialized positions, such as palliative care clinicians, in which there was typically only one nurse in the role,” Pesut says.

Patients request MAID from nurses for a variety of reasons. These requests do not always lead to a MAID death. For some patients, just the option of knowing MAID is available is enough. For others, talking about their suffering brings a degree of resolution so that MAID is no longer required. “However, these are complex conversations that require a high degree of nursing skill and time,” Pesut notes.

Another group of investigators recently examined Canadian medical students’ attitudes toward MAID.2 “There was a lack of empirical, national-level data about the perspectives and intentions of Canada’s next generation of physicians toward MAID,” says James Falconer, the study’s lead author.

This was particularly important to know due to significant changes to Canada’s medical and legal landscape around this issue. MAID was legalized in Canada in 2016. “What existed was a lot of opinion, rhetoric, and policy recommendations in the media and among medical-professional associations,” says Falconer, a PhD candidate in the department of sociology at McGill University at the time of the study.

However, none of this was based on solid evidence. “Our study sought to fill the knowledge gap in the Canadian conversation on this issue, at precisely the time when the law was undergoing a significant change,” Falconer explains.

Researchers surveyed 1,210 Canadian medical students. Notably, there was no statistically significant difference between medical students with rural vs. urban upbringings. “We were aware from the literature review that some individual factors, such as religion and frequency of religious attendance, were associated with opinions on MAID,” Falconer says.

Researchers discovered that despite the range in willingness to provide MAID across regions, there did not appear to be enough of a regional disparity to cause concern about the availability of the service for those who choose it.

Even in Alberta, the region where medical students showed the lowest willingness to provide MAID, 63% of medical students were willing to fulfill a patient’s request for MAID. This, compared to 71% nationwide. “This is an important finding, with implications for the availability of physician-assisted dying across regions,” Falconer suggests.

REFERENCES

  1. Pesut B, Thorne S, Greig M, et al. Ethical, policy, and practice implications of nurses’ experiences with assisted death. ANS Adv Nurs Sci 2019;42:216-230.
  2. Falconer J, Couture F, Demir KK, et al. Perceptions and intentions toward medical assistance in dying among Canadian medical students. BMC Med Ethics 2019;20:22.