Medically Assisted Dying in Canada: “Beautiful Death” Is Transforming Nurses’ Experiences of Suffering

Abstract

Background

Nurses witness pain and distress up close and consequently experience their own suffering. A narrative study of Canadian nurses’ participating in medical assistance in dying found nurses’ previous witnessing of unresolved end-of-life suffering has shaped their acceptance of medical assistance in dying. Little is known about the impact of participating in medically assisted dying on nurses’ suffering.

Purpose

To explore how nurses’ overall experience of suffering is shaped by participating in medical assistance in dying.

Methods

Qualitative secondary analysis using narrative inquiry and thematic analysis.

Results

Nurses’ narratives are chronologically organized addressing experiences of suffering before medical assistance in dying was a legal option and after its implementation. An overarching narrative before the availability of medical assistance in dying is (1) a culture of nurses’ taken-for-granted suffering: feeling terrible. After medical assistance in dying, two key narratives describe (2) transformational feelings of a beautiful death and (3) residual discomfort. Nurses found their suffering transformed when participating in medical assistance in dying; end-of-life care was satisfying and gratifying. And yet, unanswered questions due to worries of becoming desensitized and ongoing deeper questioning remain.

Conclusions

Participating in medical assistance in dying has positively impacted nurses and starkly contrasts their previous experiences caring for those with unbearable suffering. Further research is needed to explore becoming desensitized and long-term emotional impact for nurses.

Keywords

Nurses’ suffering end of life nursing medical assistance in dying narrative inquiry

Get full access to this article

View all access options for this article.

References

Ameri

Safavibayatneed

Kavousi

(2016). Moral distress of oncology nurses and morally distressing situations in oncology units. Australian Journal of Advanced Nursing, 33(3), 6–12.

American Nurses Association. (2015). Code of ethics for nurses with interpretative statements. Silver Spring, MD: Author.

An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) (S.C. 2016, c. 3). Retrieved from the Justice Laws website: http://laws-lois.justice.gc.ca/eng/AnnualStatutes/2016_3/FullText.html

Barnett, M. D., Cantu, C., & Clark, K. A. (2019). Multidimensional emotion regulation strategies among hospice nurses. Death Studies, 1--6. doi:10.1080/07481187.2019.1586790

Berger

Polivka

Smoot

E. A.

Owens

(2015). Compassion fatigue in pediatric nurses. Journal of Pediatric Nursing, 30, e11–e17.

Bernhofer

E. I.

Sorrell

J. M.

(2014). Nurses managing patients’ pain may experience moral distress. Clinical Nursing Research, 24(4), 401–414. doi:10.1177/1054773814533124

Beuthin

Bruce

(2019). Inviting compassionate conversations about end of life: Medical assistance in dying (MAiD) in Canada. In McIntyre

McDonald

(Eds.), Realities of Canadian nursing: Professional, practice and power issues (4th ed., pp. 42–63). Philadelphia, PA: Lippincott Williams & Wilkins.

Beuthin

Bruce

Scaia

(2018). Medical assistance in dying (MAiD): Canadian nurses’ experiences. Nursing Forum, 53, 511–520. doi:10.1111/nuf.12280

Bornstein

M. H.

(2018). Good death, The SAGE encyclopedia of lifespan human development. London, England: SAGE.

10.

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. doi:10.1191/1478088706qp063oa

11.

Breaden

Hegarty

Swetenham

Grbich

(2012). Negotiating uncertain terrain: A qualitative analysis of clinicians’ experiences of refractory suffering. Journal of Palliative Medicine, 15(8), 896–890.

12.

Brint

(2017). Obligated to care: A personal narrative of compassion fatigue in an oncology nurse. Journal of Holistic Nursing, 35(3), 296–309. doi:10.1177/0898010116661391

13.

Bruce

Boston

(2011). Relieving existential suffering through palliative sedation: Discussion of an uneasy practice. Journal of Advanced Nursing, 67(12), 2732–2740. doi:10.1111/j.1365-2648.2011.05711.x

14.

Canadian Nurses Association. (2017). National nursing framework on medical assistance in dying in Canada. Retrieved from https://cna-aiic.ca/∼/media/cna/page-content/pdf-en/cna-national-nursing-framework-on-maid.pdf?la=en

15.

Chochinov

(2016). Physician-assisted death in Canada. Journal of the American Medical Association, 315(3), 253–254.

16.

Choe

Kang

Park

(2015). Moral distress in critical care nurses: A phenomenological study. Journal of Advanced Nursing, 71(7), 1684–1693. doi:10.1111/jan.12638

17.

Cody

(2001). Bearing witness-not bearing witness as synergistic individual-community becoming. Nursing Science Quarterly, 14, 94–100.

18.

College of Registered Nurses of BC. (2016, June 10). Practice standard for registered nurses and nurse practitioners: Duty to provide care. Retrieved from https://www.crnbc.ca/Standards/PracticeStandards/Lists/GeneralResources/398DutytoProvideCarePracStd.pdf

19.

College of Registered Nurses of BC. (n.d.). Part 5: Medical assistance in dying. Retrieved from https://crnbc.ca/Standards/RNScopePractice/MAiD/Pages/Default.aspx

20.

Coward

Stajduhar

(2012). Religious understandings of a good death in hospice palliative care. Albany: State University of New York Press.

21.

de Bal

Dierckx de Casterlé

De Beer

Gastmans

(2006). Involvement of nurses in caring for patients requesting euthanasia in Flanders (Belgium): A qualitative study. International Journal of Nursing Studies, 43, 598–599.

22.

de Boer

van Rikxoort

Bakker

A. B.

Smit

B. J.

(2014). Critical incidents among intensive care unit nurses and their need for support: Explorative interviews. Nursing in Critical Care, 19, 166–174. doi:10.1111/nicc.12020

23.

Denier

Dierckx de Casterlé

de Bal

Gastmans

(2010). It’s intense, you know”: Nurses’ experiences in caring for patients requesting euthanasia. Medicine, Health Care and Philosophy, 13(1), 41–48.

24.

De Villers

M. J.

DeVon

(2012). Moral distress and avoidance behavior in nurses working in critical care and noncritical care units. Nursing Ethics, 20(5), 589–603.

25.

Downie

Chandler

J. A.

(2018, March 1). Interpreting Canada’s medical assistance in dying legislation. Retrieved from http://irpp.org/research-studies/interpreting-canadas-medical-assistance-in-dying-maid-legislation/

26.

Frank

(2010). Letting stories breathe: A socio-narratology. Chicago, IL: University of Chicago Press.

27.

Government of Canada. (2017, October 6). Second interim report on medical assistance in dying in Canada. Retrieved from https://www.canada.ca/en/health-canada/services/publications/health-system-services/medical-assistance-dying-interim-report-sep-2017.html

28.

Graham

I. W.

Andrewes

Clark

(2005). Mutual suffering: A nurse’s story of caring for the living as they are dying. International Journal of Nursing Practice, 11(6), 277–285. doi:10.1111/j.1440-172X.2005.00535.x

29.

Grulke

Larbig

Kachele

Bailer

(2009). Distress in patients undergoing allogeneic haematopoietic stem cell transplantation is correlated with distress in nurses. European Journal of Oncology Nursing, 13(5), 361–367.

30.

Hold

(2017). A good death: Narratives of experiential nursing ethics. Nursing Ethics, 24(1), 9–19.

31.

Joinson

(1992). Coping with compassion fatigue. Nursing, 22, 118–121.

32.

Josselson

(2011). Bet you think this song is about you: Whose narrative is it in narrative research? Narrative Works: Issues, Investigations, & Interventions, 1(1), 33–51.

33.

Kirk

Mahon

(2010). National Hospice and Palliative care Organization (NHPCO) position statement and commentary on the use of palliative sedation in imminently dying terminally ill patients. Journal of Pain and Symptom Management, 39, 914–923.

34.

LeBaron

Beck

S. L.

Black

Palat

(2014). Moral distress and cancer pain management: An ethnography of oncology nurses in India. Cancer Nursing, 37(5), 331–344.

35.

Lombardo

, & Eyre, (2011). Compassion fatigue: A nurse’s primer. Online Journal of Issues in Nursing, 16 (1), 1–6.

36.

Martin

(2016). A good death: Making the most of our final choices. Toronto, Canada: Harper Collins.

37.

Monteverde

(2017). Nursing and assisted dying: Understanding the sounds of silence. Nursing Ethics, 24(1), 3–8.

38.

Morse

(2018). Theoretical coalescence: A method to develop qualitative theory. The example of enduring. Nursing Research, 67(2), 177–187.

39.

O’Donohue

(1999). Eternal Echoes: Exploring our yearning to belong. New York, NY: Harper Collins.

40.

Oliphant

(2017). “If not me, then who?” The narratives of Medical Aid in Dying (MAiD) providers and supporters around their professional identity and role in MAiD. A thesis submitted to the School of Graduate Studies in partial fulfillment of the requirements for the Degree Master of Arts, McMaster University, Canada (Doctoral dissertation). Retrieved from https://macsphere.mcmaster.ca/handle/11375/22146

41.

Pesut

(2017). Profits and prophets: Derrida on linguistic bereavement and (im)possibility in nursing. Nursing Philosophy, 19(1). doi:10.1111/nup.12186

42.

Riessman

(2008). Narrative methods for the human sciences. Thousand Oaks, CA: SAGE.

43.

Sawatzky

Porterfield

Roberts

Lee

Liang

Reimer-Kirkham

, . . . Baumbusch

(2017). Embedding a palliative approach in nursing care delivery: An integrated knowledge synthesis. Advances in Nursing Science, 40, 263.

44.

Schiller

(2017). Medical assistance in dying in Canada: Focus on rural communities. The Journal for Nurse Practitioners, 13(9), 626–634.

45.

Schwarz

J. K.

(2003). Understanding and responding to patients’ requests for assistance in dying. Journal of Nursing Scholarship, 35, 377–384.

46.

Stamm

B. H.

(2010). The Concise ProQOL Manual (2nd ed.). Pocatello, ID: ProQOL.org. Retrieved from www.proqol.org/uploads/ProQOL_Concise_2ndEd_12-2010.pdf

47.

Taylor

B. R.

McCann

R. M.

(2005). Controlled sedation for physical and existential suffering? Journal of Palliative Medicine, 8(1), 144–147. doi:10.1089/jpm.2005.8.144

48.

Thorne

(2008). Interpretive description. Walnut Creek, CA: Left Coast Press.

49.

Varcoe

Pauly

Storch

Newton

Kara Makaroff

(2012). Nurses’ perceptions of and responses to morally distressing situations. Nursing Ethics, 19(4), 488–500.