Introduction
Patients who want to avoid suffering may request to end their lives through assisted dying. Assisted death is controversial and illegal in several nations globally. Interestingly, the Canadian government allowed assisted suicide in 2016 through a program known as Medical Assistance in Dying (MAiD). MAiD has been in effect for less than a decade and people cite several reasons for requesting the program. When people lose the ability to participate in meaningful activities in life. Some persons will consider MAiD an option if they cannot perform daily living activities (Beuthin et al., 2018). The history, eligibility criteria, statistics, the role of nurses and the ethical and moral challenges on patients, nurses and their families can inform future changes in MAiD.
The purpose of the paper is to provide a comprehensive description and analysis of MAiD and the role of nurses in carrying out the program. In addition, the current research will explore the ethical and moral challenges faced by nurses, patients, and their families. The topic of assisted dying in Canada is important to nursing and health for two reasons. First, nurses are affected in their daily lives because they deal with issues of ethics and morality while making decisions on whether to participate in MAiD. Dealing with such issues regularly may cause stress for nurses who partake in the program. Second, MAiD helps individuals to die peacefully and with dignity, avoiding suffering (Banner et al., 2019). Specifically, the paper will review the history, statistics, and eligibility criteria of MAiD in Canada, the role nurses play in MAiD implementation. Finally, the ethical and moral challenges that nurses, patients, and their family face will be explored.
History, Eligibility Criteria, and Statistics in Canada
To understand MAiD, it is critical to review its history from its adoption process to today’s changes. MAiD was adopted in June 2016, twelve months after Carter v Canada ruled that the provisions of the Criminal Code of Canada that criminalized assisted suicide violated a person’s rights according to the Canadian Charter of Rights and Freedoms. Bill C-14 resulted from the ruling and attempted to find a balance between eligible patients’ autonomy rights and protecting vulnerable people who may be coerced to end their lives (Pesut et al., 2020a). The origins of MAiD can be attributed to Canada’s Supreme Court case by Sue Rodriguez. Rodriguez argued that criminalizing consent to assisted suicide and assistance in euthanasia violated the right to security, liberty, and life of a person (Pesut et al., 2021). Rodriguez lost narrowly and the Criminal Code sections that banned MAiD remained unchallenged until a joint case by Gloria Taylor and Lee Carter was filed in 2015.
Taylor and Carter argued that MAiD should be legally accessible by drawing on various elements of Rodriguez’s case. However, the section 7 infringement failed to meet the Oakes test rendering the ban on MAiD unconstitutional. As a result, MAiD was legalized but remained unregulated. Finally, Bill C-14 was made into law in 2016 (Pesut et al., 2020b). Six years have passed since the MAiD practice was implemented in Canada. The federal Criminal Code contains the eligibility criteria to be met for a patient to receive MAiD (Schiller et al., 2019). The territories and provinces of Canada are responsible for delivering healthcare services, including implementing MAiD and enforcing relevant regulations.
The eligibility criteria continue to be a topic of debate among different scholars and stakeholders. Five specific criteria should be fulfilled before MAiD is received by Canadian residents. First, patients must be eligible to receive health services that are funded by the Canadian government. The requirement is also applicable to persons who have completed the minimum residence period needed for accessing government-funded health services in Canada. Second, for a person to receive MAiD, they must be aged no less than eighteen years and able to make health-related decisions. Third, successful MAiD candidates should have an irremediable and grievous medical condition that has failed to be treated. Fourth, MAiD eligible persons must make voluntary requests for MAiD and their decision should not have been made due to external pressure. Finally, for individuals to be eligible for MAiD, they must provide informed consent to receive MAiD after knowing all the available means that can reduce their suffering (Pesut et al., 2020). However, three essential groups are considered ineligible for MAiD, including mature minors, mentally ill patients, and sick persons who want to access MAiD due to a medical directive.
The statistics of MAiD provide a platform to understand its adoption and use by Canada’s general public. The number of MAiD deaths has continued to increase since the program’s adoption. Approximately, 7,595 MAiD deaths were reported in Canada in 2020, which accounted for nearly 2.5 percent of all Canadian losses of life, reflecting a 34.2 percent increase compared to 2019 (Government of Canada, 2021). The profile of people who receive MAiD is vital in understanding assisted suicide. More men received MAiD services compared to women in 2020 and 2019. The average age for persons receiving MAiD was 75.3 years in 2020 (Government of Canada, 2021). Finally, cancer was the most cited underlying disease that MAiD recipients had in 2020 and 2019. Other underlying conditions affecting MAiD recipients were neurological conditions, chronic respiratory problems, and cardiovascular conditions.
Primary care physicians are the main MAiD providers; however, MAiD administration has shifted its focus to patients’ homes. In 2020, about 68 percent of MAiD cases were conducted by family physicians, showing the shift to home-based service with private residences accounted for more than 47 percent of primary settings (Government of Canada, 2021). Although most requests for MAiD were accepted, about 21 percent were rejected for various reasons (Government of Canada, 2021). Some reasons for rejection include patient death before MAiD administration, ineligibility, and request withdrawal. Most patients withdrew their application due to a change of mind or palliative measures being sufficient (Nuhn et al., 2018). The data provided in this section can help inform future decisions on MAiD provision.
Role of Nurses
The role nurses play in the delivery of MAiD cannot be understated. Nurses are the most essential part of the system that coordinates MAiD administration (Fujioka et al., 2020). For instance, they are responsible for providing education and information on MAiD. Patients may ask questions regarding MAiD-specific services. For example, a patient may ask questions about a choice between palliative care and assisted suicide. A nurse can then offer a professional opinion on the topic but the final decision is done by a patient. Furthermore, nurses help to provide MAiD as they can help insert an intravenous tube utilized by nurse practitioners or physicians to administer MAiD medication specifically (Thangarasa et al., 2022). Ultimately, nurses must understand the standards and laws relating to MAiD administration as well as employer policies.
Professionally, nurses’ roles in MAiD administration are offering holistic care with no judgments, supporting patients’ choices, and guaranteeing a comfortable death. Nurses often believe that there is an expression of holistic care in MAiD. Additionally, their main role in providing holistic care is supporting the choices patients make since it is a personal and the best decision for patients. Although they may have differing opinions on whether MAiD is the right choice, nurses support patients’ wishes without judging those making certain decisions (Thangarasa et al., 2022). The role of nurses in advocacy is to promote the right of patients to choose among multiple end-of-life options.
An essential role that nurses can play during MAiD is presence. Patients may require that a nurse be physically present when they ingest the MAiD medication. Presence should be consistent with ethical values and may include several options. For instance, nurses are expected to be sensitive to the vulnerability of the patient. Furthermore, they are required to demonstrate compassion and care for MAiD recipients. Nurses should also promote comfort to sustain trust in the nurse-patient connection. They decide to be present in the MAiD procedure by considering organizational policy and personal values. If they are present during MAiD, nurses promote patient dignity and provide emotional support, comfort, and symptom relief to patients and their families (Simpson‑Tirone et al., 2022). In addition, through their presence, nurses keep patient privacy and confidentiality in the MAiD process.
Moral and Ethical Challenges to Nurses, Patients, and Family
Even when a patient fulfills the legal criteria to access MAiD, ethical tensions and disagreements may arise between families, patients, and nurses. A moral challenge that nurses face during MAiD is guilty when they refuse to take part in a MAiD case (Schiller et al., 2019). On one hand, refusing to complete a patient’s request to participate in a MAiD case may align with the nurse’s moral values. Their moral values may not be comfortable with ‘killing’ a person since they consider assisting in MAiD cases equivalent to planning someone’s death (Frolic & Oliphant, 2022). As a result, they may feel guilty when they remember the incident. In such a case, it may be good for their mental health to refuse to take part in MAiD (Brown et al., 2020). On the other hand, rejecting a patient’s request regarding MAiD may deny care to the sick person which does not align with respecting the patient’s choices. In addition, a nurse’s right to choose whether to partake in MAiD is a recurring ethical issue since as moral agents, caregivers are justified to exercise autonomy while providing services. Dealing with such a case may require referrals to another MAiD provider.
An ethical issue that both nurses and patients may experience is the duty to patient care and confidentiality. If a patient is diagnosed with a terminal illness, they may opt for MAiD. However, an ethical issue may arise if the patient does not want their family to know they are undergoing the MAiD process. Such a case forces nurses to uphold the confidentiality of the patient, MAiD providers and assessors (Simpson‑Tirone et al., 2022). However, moral distress may be experienced by nurses who have conflicting feelings while hiding the patient’s decision from their family.
The nature of death and suffering may differ for the patient and their family. Suffering is a profound personal experience which may result in physical and psychological pain for patients and their families. Unbearable suffering for a patient may not be accepted by their family, which causes a disagreement on the provision of MAiD. Although patients have autonomy over MAiD decisions, their choices may be affected by the will of their families (Nielsen, 2021). Patients who choose to die through MAiD may do so to avoid causing more pain to their families.
Conclusion
In conclusion, reviewing the history, eligibility criteria, and statistics of MAiD in Canada as well as the role of nurses and ethical challenges can inform future policies on MAiD. The paper started by exploring the history, eligibility criteria and MAiD statistics. The history of MAiD dates back to 2016 when the legislation was adopted. Following a Supreme Court case by Taylor and Carter, MAiD was legalized. More than six years have passed since the legalization of MAiD. However, MAiD has faced difficult challenges in its implementation. The statistics on MAiD in Canada show that more men use MAiD compared to women. In addition, the number of MAiD deaths keeps increasing each new year. Finally, the number of MAiD deaths carried out in private residences has been steadily increasing. The data suggest that MAiD is gaining more followers, indicating widespread adoption.
Nurses’ role in the provision of MAiD is undeniably fundamental to the program’s success. Nurses are tasked with educating and providing information to patients who enquire about MAiD. They may also support patients and their families emotionally. The most fundamental role of nurses is to support patients’ choices with no judgment. The presence of a nurse during MAiD offers support to the patients and helps in achieving a good death.
Unfortunately, nurses, patients, and families face ethical and moral issues during the MAiD process. For instance, the issue of confidentiality can lead to moral distress on the nurses’ part. When patients require caregivers to keep their MAiD involvement a secret, the decisions may have complex ethical challenges. However, the fundamental part of handling moral questions regarding MAiD is balancing the issues that arise by respecting patients’ choices and autonomy. In addition, caregivers should not forget their duty to patient care.
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