Role of attitude in nurses’ responses to requests for assisted dying

Abstract

Background: Legal assisted dying is a rare event, but as legalisation expands, requests for it will likely increase, and the nurse most often receives the informal, initial request. Objectives: To assess the effects of attitude in interaction with normative and control beliefs on an intention to respond to a request for legal assisted dying. Ethical considerations: The study had the lead author’s institutional ethics approval, and participants were informed that participation was both anonymous and voluntary. Methodology: This was a cross-sectional correlational study of 377 Australian registered nurses who completed an online survey. Generalised linear modelling assessed the effects of independent variables against intended responses to requests for legal assisted dying. Results: Compared to nurses who did not support legal assisted dying, nurses who did had stronger beliefs in patient rights, perceived social expectations to refer the request and stronger control in that intention. Nurses who did not support legal assisted dying had stronger beliefs in ethics of duty to the patient and often held dual intentions to discuss the request with the patient but also held an intention to deflect the request to consideration of alternatives. Discussion: This study advances the international literature by developing quantified models explaining the complexity of nurses’ experiences with requests for an assisted death. Attitude was operationalised in interaction with other beliefs and was identified as the strongest influence on intentions, but significantly moderated by ethical norms. Conclusion: The complex of determinants of those intentions to respond to requests for an assisted death suggests they are not isolated from each other. Nurses might have distinct intentions, but they can also hold multiple intentions even when they prioritise one. These findings present opportunities to prepare nurses in a way that enhances moral resilience in the face of complex moral encounters.

Nurses' Values and Perspectives on Medical Aid in Dying

“…This is different than in a study of 377 nurses from Australia, where 83% agreed with MAiD. 24 The difference may be explained by difference in sample size, geography, or religious affiliation as there were fewer participants in Australia with declared religious affiliation. Direct comparison is difficult because data on religion were collected differently between the studies.…”

“…Consistent with previous research, 25 our study demonstrated that the personal (49%) and professional (57%) values related to MAiD were similar. In the future, it is recommended that the question regarding “professional support of MAiD” be deleted to decrease research burden of participants as the answers are no different from “personal support.” Nurses may experience harm if their personal values and beliefs are ignored or violated when professionally involved in situations involving MAiD 11,24,26 . Our findings illustrated a wide range in personal values.…”

“…Nurses may experience harm if their personal values and beliefs are ignored or violated when professionally involved in situations involving MAiD. 11,24,26 Our findings illustrated a wide range in personal values. Therefore, managers may expect some nurses to embrace participation in the care of these patients, whereas others will conscientiously object.…”

“…Other studies from nurses worldwide have shown a significant positive relationship between religious or ideological affiliation and attitudes toward MAiD 17,24 . Roman Catholics were more often opposed to MAiD; of those nurses who opposed the legalization of MAiD, 42% cited religious reasons 17 .…”

“…Other studies from nurses worldwide have shown a significant positive relationship between religious or ideological affiliation and attitudes toward MAiD. 17,24 Roman Catholics were more often opposed to MAiD; of those nurses who opposed the legalization of MAiD, 42% cited religious reasons. 17 The results of the study of US nurses from the state of Washington concurred with international data demonstrating that nurses opposing MAiD most often objected for religious reasons.…”