Exploring Medical Assistance in Dying and Moral Distress in Western Canadian Hospice Palliative Care Nurses: An Interpretive Description Study
Date
2023-11-20
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Abstract
Background: The prohibition against medical assistance in dying (MAiD) was removed from the Criminal Code in specific circumstances in Canada in 2016. Several moral and ethical questions arose from this decision. Gaps in the literature unearthed by this monumental shift in healthcare practice included how moral distress and moral uncertainty were conceptualized in the context of MAiD; what the discourse around death and dying in Canada looked like given this change; and whether hospice palliative care (HPC) nurses were experiencing moral distress when their patients requested, contemplated, or completed MAiD in a hospice setting. Methodology and methods: A simultaneous concept analysis of moral distress and moral uncertainty in the context of MAiD was undertaken, followed by an integrative literature review to better understand the discourse of dying in Canada around MAiD, as well as the relationship amongst MAiD, HPC, and suffering. An interpretive description study was completed regarding HPC nurses, MAiD, and moral distress in the setting of hospice. Semi-structured interviews were completed with 10 hospice palliative care nurses in a single province in Western Canada prior to thematic analysis and development of practice recommendations. Results: Moral distress in the context of MAiD focuses on nurses perceiving they know the right course of action to take but being unable to act in concert with their moral intuitions. Moral uncertainty centers on an inability to decide on which course of action to take or knowing what outcome is preferable. Four main themes were identified in the literature: the relationship between MAiD and HPC; suffering in the context of MAiD; moral distress and moral uncertainty in providing or not providing MAiD; and future research recommendations. HPC nurses described how MAiD requests could cause moral distress, but that moral distress was most often centered on hospice policies and procedures that influenced their relationships with and nursing practice around patients seeking MAiD. Conclusions: Hospice nurses struggle to provide high-quality HPC and participate meaningfully in MAiD due to several factors, including hospice policies and procedures. The gap between the care they want to provide and are able to provide results in moral distress. Recommendations for practice to reduce moral distress include revisiting policies and procedures, improving communication between the hospice and MAiD Teams, and supporting debriefing and further education around MAiD are offered.
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Keywords
Canada, ethics, interpretive description, hospice, medical assistance in dying (MAiD), moral distress, nursing, palliative care, concept analysis, integrative literature review
Citation
Dorman, J. D. (2023). Exploring medical assistance in dying and moral distress in Western Canadian hospice palliative care nurses: an interpretive description study (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.