Introduction
Delivering care to patients entails facing complex ethical dilemmas and resolving them. Nurses must make decisions about care delivery and meet the client’s demands to fulfill all their needs. Unfortunately, in many cases, health workers interact with patients who have fatal diseases and do not have chances for recovery.
It gave rise to the problem of euthanasia, which is often viewed as the way to cease suffering and provide patients with a good death. Although the problem is not new, it has always been a disputable issue. Medical assistance in dying (MAiD) triggered debates about its legalization because of the various philosophies of death and dying, views on how to deliver care, and whether euthanasia is morally acceptable following the existing code of ethics.
Background, Historical Events, Moral Complexity of Legalizing MAiD
Medical assistance for dying is the old idea that emerged at the dawn of civilization. The tools for suicide and euthanasia were available to terminally ill patients who had severe suffering (Brenna, 2021). The evolution of human society led to the development of the humanistic approach and a reconsideration of the value of human life. For this reason, MAiD was considered a crime (Brenna, 2021). However, during the 20th century, public support for euthanasia grew, and in 1972, suicide was decriminalized in Canada (Brenna, 2021).
In the 1990s, in Canada, Sue Rodriguez wanted a physician to end her life because of the disease (Brenna, 2021). The Supreme Court appealed to the moral complexity and ruled against her, resulting in a conflict with the Charter of Rights and Freedoms (Brenna, 2021). In 2015, MAiD was legalized in Quebec, and overall awareness of the problem grew (Brenna, 2021). Furthermore, in 2016, Bill C-14 legalized the procedure in the whole state (Brenna, 2021). However, there are still some complexities associated with the issue.
Thus, MAiD might be shocking for nurses and other health workers. In cases where the patient does not appear to be dying, caregivers may cry afterward or experience complex feelings (Koksvik, 2020). Moreover, organizing the process requires considerable time and effort, raising legal issues about whether to defy the intervention and how to conduct it (Koksvik, 2020). The moral complexity of agreeing with the patient to end their life influences nurses who have feelings of guilt and helplessness (Koksvik, 2020). In this way, although there is a legal framework for performing MAiD, it remains a challenging issue that requires further investigation.
Personal Position on MAiD
My personal position on MAiD is linked to the assumption that every person has the right to manage their own life. It means that if the patient has an incurable disease and wants to die to avoid suffering, the health workers must help them.r/ It might be difficult for a nurse; however, MAiD is supported by fundamental ethical principles, such as autonomy and fidelity. The patient has the right to make care decisions, and the specialist should be prepared to accept them. I also value the idea of a good death, meaning that every person has the right to pass away with dignity.
At the same time, I recognize the validity of another position, which views MAiD as an unacceptable procedure. This view rests on the extreme value of every individual’s life and the workers’ inability to end it. It also implies that there is always hope, and a nurse should focus on providing care in ways that might support a client or alleviate pain and suffering. The idea might also rest on religious beliefs about the sacred nature of life and the impossibility of its termination by human beings. Both positions have specific moral reasoning, meaning they are personal choices for every specialist working in the healthcare sector.
Nursing Practice Challenges
Although MAiD is legal in Canada, there are specific challenges and barriers a nurse may encounter. First, the legalization of the procedure led to the development of specific policies to guide the practice. However, they vary across the country, which can confuse a health worker about the current approach used in the hospital. Second, there is a problem of mental and emotional health and burnout.
Although MAiD might be an appropriate option for patients who have pain and no chance of recovery, for nurses, it is a morally difficult procedure. That is why there is a need for time to recover and focus on performing daily duties. Finally, the absence of a clear, understandable procedure for interacting with the patient and their family if MAiD is selected can affect caregivers. Overcoming these challenges is critical for future work and meeting the patients’ needs.
Causes of the Challenges
The challenges associated with MAiD and its use in healthcare settings may have specific causes. First of all, there is excessive complexity in the policies regulating the procedure. The research shows that the guides should be written in terms of differing scopes of practice for registered nurses and nurse practitioners (Pesut et al., 2020). Moreover, their further involvement is regulated by health regions where policies can be more restrictive (Pesut et al., 2020). As a result, the divergences in legal frameworks within the state are the essential factor affecting MAiD.
Furthermore, there is institutional resistance to euthanasia in Canada, which might serve as the cause of numerous challenges. For instance, ethical uncertainties specific to certain healthcare establishments in the sector can lead to access problems, policy gaps, and poor interactions with patients and their families (Knox & Wagg, 2023). As a result, the nurse might face barriers that limit their ability to provide MAiD and affect the quality of interactions with the patient.
Strategies to Address Challenges
In such a way, there is a need for effective strategies to overcome the challenges mentioned above. The first possible approach might imply introducing MAiD as part of advanced care planning (Pesut et al., 2024). It would resolve the problem of inappropriate communication between the family and the patient, especially when the patient is most vulnerable and may make wrong decisions (Pesut et al., 2024). Additionally, it will support the concept of good practice and provide clients with information about all options available to them (Pesut et al., 2024). Otherwise, the lack of information about the procedure’s availability can influence clients’ decisions, depriving them of the chance to make informed choices.
Another possible strategy for addressing the problem implies changes at the organizational level. It focuses on improving institutional support for the procedure and revising the current policies that govern it (Oczkowski et al., 2021). Currently, there is significant confusion about the methods and regulations existing within the given framework and their acceptability (Oczkowski et al., 2021).
Descriptions of MAiD and training for nurses would make it easier for them to work with this patient cohort. At the same time, the development of standardized care pathways and inter-professional collaboration would establish the framework necessary to make the practice accessible (Oczkowski et al., 2021). Implementing these strategies can help to address the challenges mentioned above and assist nurses.
Conclusion
Altogether, regardless of the establishment of the legal framework, MAiD remains a disputable issue within the healthcare sector. It is associated with the moral dilemma and the complexity of making choices about the patient’s health and life. For many nurses, it remains a challenging procedure that is followed by distress, emotional pain, and crying. At the same time, there are barriers to delivering MAiD, such as a lack of clear policies and difficulties interacting with patients and their families.
As for me, I am sure that MAiD is a critical part of care. It rests on the idea of cessation of suffering, respecting patients and their right to manage their bodies. For this reason, it is vital to eliminate barriers that affect the procedure by integrating it into advanced care planning and providing institutional support. I also view MAiD as an essential part of the future nursing practice. Trustful relationships with patients require close cooperation and a readiness to assist with questions that are important to them. That is why nurses should be ready to accept clients’ decisions and select the best possible ways to assist them.
References
Brenna, C. (2021). Regulating death: A brief history of medical assistance in dying. Indian Journal of Palliative Care, 27(3), 448–451.
Knox, M., & Wagg, A. (2023). Institutional resistance to medical assistance in dying in Canada: Arguments and realities emerging in the public domain. Healthcare, 11(16).
Koksvik, G. (2020). Practical and ethical complexities of MAiD: Examples from Quebec. Wellcome Open Research, 5, 227.
Oczkowski, S. J. W., Crawshaw, D., Austin, P., Versluis, D., Kalles-Chan, G., Kekewich, M., Curran, D., Miller, P. Q., Kelly, M., Wiebe, E., Dees, M., & Frolic, A. (2021). How we can improve the quality of care for patients requesting medical assistance in dying: A qualitative study of health care providers. Journal of Pain and Symptom Management, 61(3).
Pesut, B., Thorne, S., Schiller, C., Greig, M., Roussel, J., & Tishelman, C. (2020). Constructing good nursing practice for medical assistance in dying in Canada: An interpretive descriptive study. Global Qualitative Nursing Research, 7.
Pesut, B., Thorne, S., Chambaere, K., Hall, M., & Schiller, C. J. (2024). The evolving complexities of MAID care in Canada from a nursing perspective. Global Qualitative Nursing Research, 11.