Medical assistance in dying and the meaning of care: Perspectives of nurses, pharmacists, and social workers

Abstract

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. While it has generated significant academic interest, the experiences of healthcare workers other than physicians remain understudied. This paper reports on a qualitative study of interprofessional Healthcare Providers (HCPs) involved in the provision of MAiD in order to: (1) characterize providers’ views about the care they offer in general; (2) examine whether or not they consider MAiD a form of care; and (3) explore their reasons for viewing or not viewing MAiD as care. Semi-structured qualitative interviews were conducted with ten nurses, eight social workers, and three pharmacists with firsthand experience delivering MAiD at an academic hospital in Toronto, Canada. The study was approved by the hospital’s REB. Written informed consent was obtained prior to participation. Codebook thematic analysis and template analysis generated four themes: (1) care as advocacy, (2) care as easing suffering, (3) care as psychosocial, and (4) care as relational. Every participant viewed MAiD as a form of care and drew on these four themes to authenticate MAiD as care. Participants consider MAiD a form of care for patients, families, other healthcare workers, and even themselves. In alternating and composite fashion, they describe MAiD in terms of autonomy, easing suffering, and a kind death for the dying (and those entrusted with their care)—a complex choreography of social discourses and moral logics that refuse to settle into a simple dichotomy of “choice versus care.” Participants depict MAiD in many of the same terms and imagery they use to describe the care they offer in general. In light of ongoing social controversies surrounding MAiD, HCPs utilize a range of logics strategically to repel negative attention and enable their participation in what they see as a caring end for their patients.

Medical assistance in dying legislation: Hospice palliative care providers’ perspectives

“…Especially because it's what they want as well." 23 Nurses in Beuthin et al's 19 study found it difficult for them to effectively articulate the paradoxical experience of witnessing MAID deaths as they are simultaneously "sad" and "beautiful." In our study, similarly participants reported experiencing complex emotions involved in caring for patients requesting MAID.…”

“…As one of the nurse participants said, “even though it’s so tough, at the end of the day, I go to bed knowing that person’s suffering is done, and I think that gives me peace. Especially because it’s what they want as well.” 23 Nurses in Beuthin et al’s 19 study found it difficult for them to effectively articulate the paradoxical experience of witnessing MAID deaths as they are simultaneously “sad” and “beautiful.” In our study, similarly participants reported experiencing complex emotions involved in caring for patients requesting MAID. 6 Despite these challenges, most participants told us that they find comfort in witnessing patients’ relief from suffering.…”

The End of Life Choice Act: A Proposed Implementation and Research Agenda

“…Collecting the experiences of health practitioners, both those exercising their freedom of conscience, as well as in-principle supportive providers and conscientious participants 4,41,42 is also useful. When the Act is reviewed in three years, it will be important to know the support, informational and other needs of providers.…”

Hospital Pharmacists’ Experiences with Medical Assistance in Dying: A Qualitative Study

“…16,17 In a recent mapping review, Woods and others 2 demonstrated the absence of studies exploring pharmacists' lived experiences in assisted dying practice, a finding noted by others. 16,18 In Canada, pharmacists' roles, 19 knowledge and attitudes, 11,20 perceptions, 21,22 and positions on conscientious objection 23 have been explored. Few pharmacists have been included in research exploring perceptions of allied health care professionals participating in MAiD, 24 their roles, 15 and the meaning of their roles.…”

“…Few pharmacists have been included in research exploring perceptions of allied health care professionals participating in MAiD, 24 their roles, 15 and the meaning of their roles. 18 Given the increase in legalized assisted dying practices globally and the number of pharmacists involved in this practice, research that explores and reveals the experiences of pharmacists participating in MAiD is overdue.…”