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

Abstract

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.

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

“…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].…”

“…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].…”

“I Am Okay With It, But I Am Not Going to Do It”: The Exogenous Factors Influencing Non-Participation in Medical Assistance in Dying

“…They explained that the motivations for participation could be categorized into (a) personal values and identity, (b) professional values and identity, (c) experience with death and dying, and (d) influencing all the social contexts where MAID occurs. Pesut, Thorne, Storch, et al (2020) noted that willingness to participate in MAID was influenced by nurses' (a) family and community influences, (b) professional experiences, and (c) proximity to the act of MAID. Our results (related to both the endogenous and exogenous factors) align with these studies as individuals are choosing their degree of MAID participation based on organizational factors, family and community factors, previous personal and professional experiences, and their values individuals and professionals.…”

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

“…Not only is MAiD a radical practice change, but it is also morally contentious, and hence potentially divisive for nurses. For example, nurses have variously described MAiD as transforming their experiences of vicarious suffering in practice or as a morally wrong act in which they never imagined they would be asked to participate (Pesut, Thorne, Storch, et al, 2020). Such radical and morally divisive practice changes allow us the opportunity to identify and explore nursing’s unique angle of vision (Thorne, 2015).…”

“…We conducted a primary qualitative study of nurses’ experiences. Other papers from this dataset discuss nurses’ moral sense-making (Pesut, Thorne, Storch, et al, 2020) and policy and health system issues that affect their practice (Pesut, Thorne, Schiller, et al, 2020). In this article, we report on the qualitative findings that describe how nurses construct good nursing practice within the context of this new end-of-life option.…”