Conscientious objection to medical assistance in dying in rural/remote nursing

Abstract

In 2016, the Supreme Court of Canada legalized medical assistance in dying in Canada. Similar to jurisdictions where this has been a more long-standing option for end-of-life care, the Supreme Court’s decision in Canada included a caveat that no healthcare provider could be compelled to participate in medical assistance in dying. The Canadian Nurses Association, in alignment with numerous ethical guidelines for healthcare providers around the globe, maintains that nurses may opt out of participation in medical assistance in dying if they conscientiously object to this procedure. The realities of implementing medical assistance in dying are still unfolding. One area that has received little attention in the literature thus far is the ability of nurses who aid with, rather than administer, medical assistance in dying to conscientiously object. This is particularly significant in rural and remote areas of Canada where geographic dispersion and limited numbers of nursing staff create conditions that limit the ability to transfer care or call on a designated team. Exercising conscientious objection to medical assistance in dying in rural and remote areas, by way of policies developed with an urban focus, is one example of how the needs of rural nurses and patients may not be met, leading to issues of patient access to medical assistance in dying and retention of nursing staff. To illustrate the complexities of nurses’ conscientious objection to medical assistance in dying in a rural setting, we apply an ethical decision-making framework to a hypothetical case scenario and discuss the potential consequences and implications for future policy. Realizing that conscientious objection may not be a viable option in a rural or remote context has implications for not only medical assistance in dying, but other ethically sensitive healthcare services as well. These considerations have implications for policy in other jurisdictions allowing or considering medically assisted deaths, as well as other rural and remote areas where nurses may face ethical dilemmas.

Rural healthcare professionals’ participation in Medical Assistance in Dying (MAiD): beyond a binary decision

“…Broadly speaking, reasons for when they choose to participate, limit the degree of their participation, or engage in nonparticipation in MAiD processes were rooted in conscience and non-conscience-based reasons. Personal values and ethics and the need for moral coherence created conscience-based reasons and, legal and professional risk, patient factors, personal competence, use of other end-of-life care options, and emotions created non-conscience-based reasons [ 43 ]. Moreover, as Brown et al suggest in their work [ 3 , 32 ], the participants in this study indicated that as they engaged in and integrated new personal and professional knowledge and were exposed to new experiences, their perspectives and actions changed.…”

La objeción de conciencia en el ámbito sanitario: un equilibrio entre derechos y deberes

“…Por eso, es necesario revisar hasta qué punto cuando un profesional hace objeción de conciencia, su negativa condiciona la actividad asistencial de otros trabajadores (Bouthillier & Opatrny, 2019;Wicclair, 2019;McDougall et al, 2022;Myskja, & Magelssen, 2018;Shanawan, 2016). Además, pueden producirse conflictos éticos respecto a la justicia distributiva (Panchuk & Thirsk, 2021;Schiller, 2017;Dobrowolska et al, 2020;Wester, 2015;Eberl, 2019). Si estas problemáticas se producen en un contexto de objeción institucional (Shadd & Shadd 2019;Hempton, 2021), las probabilidades de que se produzcan estos conflictos aumentan.…”

Conscientious Objection and Other Motivations for Refusal to Treat in Hastened Death: A Systematic Review

“…For this reason, it is important to have CO mediators, in order to protect HCPS' right of refusal to treat and ensure that this type of position on the part of HPC has a lesser impact on patients. Moreover, it can also be argued that the refusal to perform certain medical procedures by HCPs can place patients in a situation of unequal access, especially in rural and remote areas, where access to health care is not as in-depth [13].…”