A new UBCO School of Nursing study examines how nurses and nurse practitioners deal with the ethical issue of medically assisted death.
Whatever your perspective on Canada’s evolving legislation on medical assistance in dying (MAID), actually putting the law into practice is often where ethical dilemmas arise.
This is especially true for the health-care professionals who provide it. Registered nurses and nurse practitioners, in particular, play a large role in medically assisted death. Until recently, their experiences have not been well documented.
Dr. Barb Pesut, Professor in UBC Okanagan’s School of Nursing, recently led a study that describes how nurses are wrestling with the moral complexities of implementing current and future MAID legislation.
“Changes in legislation require changes in practice on the ground,” says Dr. Pesut. “It is important that those affected by those changes have a voice.”
Dr. Pesut’s research, recently published in the Global Qualitative Nursing Research journal, points to how nurses have changed their approach to talking to patients about MAID. When legislation was first passed in 2016, nurses were not permitted to introduce the idea of assisted death unless patients brought it up themselves. Even then, nurses were to respond cautiously so as not to risk being seen to coerce patients, Dr. Pesut explains.
The nurses interviewed in the study say they now take a more person-centred approach rather than a risk-centred one.
“Nurse practitioners felt that the potential for coercion is far more likely if MAID is introduced during times of transition or crisis, such as entry into long-term care or significant health decline,” says Dr. Pesut. “In their view, it’s better to have the conversation on MAID alongside other options during times of stability. Patients can then identify what best meets their needs and aligns with their values.”
Nevertheless, nurses say they are challenged to make the time for these conversations in a busy health-care environment and to communicate patients’ wishes with other health-care providers.
The study also asked nurses about how they are making moral sense of legislation that has expanded MAID eligibility to people for whom death is not reasonably foreseeable—and the potential expansion to people whose sole underlying medical condition is mental illness. The nurses struggled not so much with individual rights and freedoms but rather with issues of health-care equity.
“Patients facing stigma such as those using substances and frequent users of the system might be more likely to believe that MAID is their only viable option,” says Dr. Pesut. “Nurses also expressed concern about the system’s failure to effectively serve those living with chronic medical conditions and disabilities. The legal debate of MAID as a treatment option should deeply consider these realities.”
In fact, in February 2024, the Government of Canada legislated a three-year delay of MAID for those whose sole underlying medical condition is mental illness based on feedback stating the health-care system was not yet ready.
Dr. Pesut’s study found that one of the most important safeguards, particularly for a person whose natural death is not reasonably foreseeable, might be a robust primary care relationship that provides sufficient time and holistic care.
“Despite Canada’s health-care challenges, there are innovative ways to ensure those applying for MAID have access to care providers, including nurses, who can work alongside them to ensure their choice is for the right person, at the right time and for the right reasons.”
