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

Pesut, Barbara; Thorne, Sally; Schiller, Catharine J.; Greig, Madeleine; Roussel, Josette; Tishelman, Carol

doi:10.1177/2333393620938686

Cited by 19 publications

(16 citation statements)

References 22 publications

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“…Participants also suggested that there was a component of the act that should never feel normal and they continued to feel the emotional impact, similar to what Flemish nurses reported many years after the legalization of euthanasia in Belgium [38]. These findings of calibration stand in contrast to our earlier interviews with nurses, conducted shortly after the legalization of MAID, in which participants described an unprepared healthcare system that left them with few practice supports to do the morally complex work that was required with this new legal responsibility [19,25,27].…”

Section: Cultural Calibrationsupporting

confidence: 65%

“…Accessibility to MAID was influenced by the sometime contentious relationship between those care providers involved in MAID and those in palliative care [19,22,23]. There was a need to support healthcare providers involved in MAID in light of the emotional impact [20,24,25] and a need to provide healthcare providers with the knowledge and skills to assist with, or to assess and provide, MAID, particularly in light of vague eligibility criteria [20,26,27]. There was also a need to manage the relational challenges that arose between those who saw MAID as an acceptable moral option and those who did not [19-21, 25, 26].…”

Section: Request Signed By One Independent Witnessmentioning

confidence: 99%

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Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

Pesut

Thorne

Wright

et al. 2021

BMC Health Serv Res

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Background Even as healthcare providers and systems were settling into the processes required for Medical Assistance in Dying (MAID) under Bill C-14, new legislation was introduced (Bill C-7) that extended assisted death to persons whose natural death is not reasonably foreseeable. The purpose of this paper is to describe the experiences of nurses and nurse practitioners with the implementation and ongoing development of this transition. Methods This qualitative longitudinal descriptive study gathered data through semi-structured telephone interviews with nurses from across Canada; cross sectional data from 2020 to 2021 is reported here. The study received ethical approval and all participants provided written consent. Findings Participants included nurses (n = 34) and nurse practitioners (n = 16) with significant experience with MAID. Participants described how MAID had transitioned from a new, secretive, and anxiety-producing procedure to one that was increasingly visible and normalized, although this normalization did not necessarily mitigate the emotional impact. MAID was becoming more accessible, and participants were learning to trust the process. However, the work was becoming increasingly complex, labour intensive, and often poorly remunerated. Although many participants described a degree of integration between MAID and palliative care services, there remained ongoing tensions around equitable access to both. Participants described an evolving gestalt of determining persons’ eligibility for MAID that required a high degree of clinical judgement. Deeming someone ineligible was intensely stressful for all involved and so participants had learned to be resourceful in avoiding this possibility. The required 10-day waiting period was difficult emotionally, particularly if persons worried about losing capacity to give final consent. The implementation of C-7 was perceived to be particularly challenging due to the nature of the population that would seek MAID and the resultant complexity of trying to address the origins of their suffering within a resource-strapped system. Conclusions Significant social and system calibration must occur to accommodate assisted death as an end-of-life option. The transition to offering MAID for those whose natural death is not reasonably foreseeable will require intensive navigation of a sometimes siloed and inaccessible system. High quality MAID care should be both relational and dialogical and those who provide such care require expert communication skills and knowledge of the healthcare system.

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Section: Cultural Calibrationsupporting

confidence: 65%

Section: Request Signed By One Independent Witnessmentioning

confidence: 99%

Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

Pesut

Thorne

Wright

et al. 2021

BMC Health Serv Res

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“…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).…”

Section: Introductionsupporting

confidence: 54%

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

Pesut

Thorne

Storch

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To describes nurses' moral experiences with Medical Assistance in Dying in the Canadian context. Background Nurses perform important roles in Medical Assistance in Dying in Canada and do so within a unique context in which Medical Assistance in Dying is provided through healthcare services and where accessibility is an important principle. International literature indicates that participating in Medical Assistance in Dying can be deeply impactful for nurses and requires a high degree of moral sense‐making. Design A qualitative interview study guided by Interpretive Description using the COREQ checklist. Results Fifty‐nine nurses from across Canada participated in the study. The decision to participate in Medical Assistance in Dying was influenced by family and community, professional experience and nurses' proximity to the act of Medical Assistance in Dying. Nurses described a range of deep and sometimes conflicting emotional reactions provoked by Medical Assistance in Dying. Nurses used a number of moral waypoints to make sense of their decision including patient choice, control and certainty; an understanding that it was not about the nurse; a commitment to staying with patients through suffering; consideration of moral consistency; issues related to the afterlife; and the peace and gratitude demonstrated by patients and families. Discussion The depth of nurses' intuitional moral responses and their need to make sense of these responses are consistent with Haidt's theory of moral experience in which individuals use reasoning primarily to explain their moral intuition and in which moral change occurs primarily through compassionate social interaction. Further, work on the moral identity of nursing provides robust explanation of how nurses' moral decisions are contextually and relationally mediated and how they seek to guard patient vulnerability, even at their own emotional cost. Conclusion Medical Assistance in Dying is impactful for nurses, and for some, it requires intensive and ongoing moral sense‐making. Relevance to clinical practice There is a need to provide support for nurses' moral deliberation and emotional well‐being in the context of Medical Assistance in Dying care.

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“…Due to the Canadian sociocultural context, the government adopted a new concept for defining euthanasia: "medical aid in dying (MAiD)" to reflect specific values of Canadian culture. [13] The terminology most used internationally is "euthanasia", which refers to "an active and intentional act consisting in bringing death, following the request of a person experiencing unbearable physical or psychological suffering related to incurable and irreversible endof-life medical conditions " [14] while the concept of "medical assistance in dying" is defined as: "medical assistance that it is practised in a context of health care and is administered by a health professional [...] which puts its expertise at the service of the relief of suffering [Free translation]". [15] According to the C-14 Bill, to be eligible for MAiD in Canada, a person must meet the following criteria: (a) be eligible for government-funded health services in Canada; (b) be at least 18 years of age, i.e.…”

Section: Maid In Canada: Implementation Of the Role Of Npsmentioning

confidence: 99%

Medical aid in dying: A foreseen decisive role for the specialized nurse practitioner in Quebec

Król

Hudon²,

Paquet³

2022

JNEP

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The legalisation of the practice of euthanasia is gaining momentum worldwide. This paper dresses the evolution of the legalisation and development of the practice of euthanasia – medical aid in dying (MAiD) – in Canada and especially in the province of Quebec to provide understanding and guidance for health care practitioners, administrators and a larger audience. This literature review explores the phenomenon of the increasing practice of MAiD in the province of Quebec (Canada) and its possible extension into practice by specialised nurse practitioners (SNPs), it also addresses the history and issues of the practice of MAiD in this context. The analysis made it possible to define three themes that make up this phenomenon, namely a) MAiD in Canada: Implementation of the Role of NPs; b) Growing demand for MAiD in Quebec’s province; c) Issues Related to a Possible Practice of MAiD by SPNs in Quebec. Results show the rising of MAiD practised in Canada and, in Quebec, especially for an aging population and those struggling with terminal illness in order to avoid undue prolongation of suffering at the end of life. However, access to end-of-life care (EoLC) and MAiD is undermined by a shortage of doctors, bureaucratic debacles, a lack of interdisciplinary cohesion and practice and, the geographical remoteness of patients. This study also highlights the modest field of research and investigation in this specific area of practice and the need for explicit teaching about the topic of the practice of MAiD for health professionals. Finally, results show that in order to remedy this problems, the governments of Canada and Quebec and various professional orders, namely those of nurses, physicians and pharmacists, have come together to promote access to MAiD by proposing a practice project for SNPs duly trained at Master degree.

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

Cited by 19 publications

References 22 publications

Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

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

Medical aid in dying: A foreseen decisive role for the specialized nurse practitioner in Quebec

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