The Role of Nursing in MAID

In the last five years, the Canadian approach to end-of-life treatment decisions has changed significantly. These changes, including the legalization of medical assistance in dying have bestowed major role in the nursing practitioners in the country. According to the Canadian Nurses Association (2017) nurses have a vital role in providing quality end-of-life patient care to all persons. For patients seeking MAID, nurses have a major role in identifying and alleviating the factors that may prompt such decision. The nurses have the role of establishing whether the requests are from the pain, fear or anxiety experienced by the patient or step from unmet needs that could be addressed by adequate care alleviate suffering (Canadian Nurses Association, 2017). The nurses also have the role of providing competent and safe ethical care to the patient and the family. This includes the provision of information on alternative end-of-life treatments including palliative care.

 

In the event that the patient makes a decision to receive MAID services, the nursing plays a role in determining the eligibility of the patient for the service. The nurses have the responsibility of ensuring that only eligible patients based on the Canadian law on MAID, are offered the service (Canadian Nurses Association, 2017).  For the patients who have requested MAID and are legible for the service, the nursing practitioners have a role of administering or prescribing medication that will cause death. It is the responsibility of the nurses to provide all the needed documentation required by law, the healthcare facility and territorial policies on the care provided before and during MAID (Canadian Nurses Association, 2017). Also, the nurses have the role of maintaining and preserving documents stated in the criminal code provision of MAID such as the written and signed request for MAID, and documented opinions from independent practitioners on the eligibility of the patient, to ensure the MAID process is successfully completed.

Ethical Actions

A major issue warranting an ethical action is the need to safeguard vulnerable patients from opting for MAID. Not all persons who express the wish to die have reached the end of life stage where they are not able to regain any quality life. It is reported that some decisions can be as a result of pain and suffering that have failed to be effectively managed, or just due to some form of distress. As much as patient autonomy should be protected, it is important that the nurses identify, understand and alleviate the underlying reasons for the requests to ensure they do not arise from any form of unmet needs or pain. The nurses need to address the unmet needs if any and offer maximum care to the patients to lower their unnecessary sufferings.

Conclusion

There are significant limitations of autonomy as an ethical concern in MAID. The principle of autonomy dictates that patients have the right to make decisions regarding their health without being influenced by any external parties. In MAID such, rights may not be upheld owing to various limitations including eligibility of the patients, and the nature of the reasons prompting such decision. From the utilitarianism perspective autonomy is supported only when the decision has significant benefits to all the engaged persons, presenting further dilemmas. Regardless of the limitations presented, it is important that health care practitioners protect the autonomy of the patient while exploring the possible limitations to avoid harming the patient. Safeguarding vulnerable individuals from MAID by identifying and evaluating the reasons that prompt decision for MAID, is an ethical action that should be adopted by healthcare practitioners, to ensure vulnerable patients, whose suffering could be alleviated with alternative treatments, do not opt for MAID.

 

References

Beuthin, R., Bruce, A., & Scaia, M. (2018, October). Medical assistance in dying (MAiD): Canadian nurses’ experiences. In Nursing forum (Vol. 53, No. 4, pp. 511-520).

Nuhn, A., Holmes, S., Kelly, M., Just, A., Shaw, J., & Wiebe, E. (2018). Experiences and perspectives of people who pursued medical assistance in dying: Qualitative study in Vancouver, BC. Canadian Family Physician64(9), e380-e386.

Karnik, S., & Kanekar, A. (2016). Ethical issues surrounding end-of-life care: a narrative review. In Healthcare (Vol. 4, No. 2, p. 24). Multidisciplinary Digital Publishing Institute.

Jordan, M. (2017). The Ethical Considerations of Physician-assisted Suicide. Dialogue & Nexus4(1), 12.

Martin, S. (2018). A right-to-die plan that offers autonomy to patients, The Globe and Mail, Retrieved from https://www.theglobeandmail.com/opinion/a-right-to-die-plan-that-offers-autonomy-to-patients/article28920923/

Canadian Nurses Association (2017). National Nursing Framework on Medical Assistance in Dying in Canada, Retrieved from https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/cna-national-nursing-framework-on-maid.pdf

Beuthin, R., Bruce, A., & Scaia, M. (2018). Medical assistance in dying (MAiD): Canadian nurses’ experiences. In Nursing forum (Vol. 53, No. 4, pp. 511-520).

Spence, R. A., Blanke, C. D., Keating, T. J., & Taylor, L. P. (2017). Responding to patient requests for hastened death: Physician aid in dying and the clinical oncologist. Journal of oncology practice13(10), 693-699.

Li, M., Watt, S., Escaf, M., Gardam, M., Heesters, A., O’Leary, G., & Rodin, G. (2017). Medical assistance in dying—implementing a hospital-based program in Canada. N Engl J Med376(21), 2082-8.