Introduction
The practice and policy of Medical Assistance in Dying (MAiD) has undergone significant evolution in Canada since its legalization in 2016. The enactment of this legislation has considerably impacted the healthcare system, particularly the roles and responsibilities of nursing professionals. With Canada being the first country to authorize nurse practitioners as both assessors and providers of MAiD, nursing regulatory bodies have developed specific guidelines and documents to navigate this delicate area of healthcare. This article presents an in-depth review based on an analysis of regulatory documents produced by Canadian nursing regulatory bodies, aiming to clarify the roles and responsibilities of registered nurses (RNs) and nurse practitioners (NPs) within the context of MAiD, as outlined by Pesut et al. in the “Policy, Politics & Nursing Practice” journal.
Background
In a landmark judgement, Carter v. Canada paved the way for the introduction of MAiD in Canadian legislation, challenging the way death is managed within the healthcare system and calling for comprehensive guidelines for medical and nursing practice. Bill C-14, received as law on June 17, 2016, amended the Canadian Criminal Code to legalize MAiD and set forth criteria under which individuals could request and receive it.
Role of Nursing Professionals
RNs and NPs play a critical part in ensuring that end-of-life care is executed with compassion, dignity, and adherence to the law. These roles vary depending on the position of the nurse, with RNs often involved in assessing patient competency, providing information about MAiD, helping with coordination and preparation for the procedure, offering support to patients and their families, and engaging in post-death care. NPs, given their unique position in the Canadian context, hold not only the responsibilities shared with RNs but also those related to their authority to assess eligibility for MAiD and to administer it under legislation.
Regulatory Documents Analysis
A meticulous search across Canadian provincial and territorial websites retrieved 17 documents that offer regulatory guidance to RNs and NPs concerning MAiD. These documents serve as a compass for nursing professionals to safely and ethically navigate their roles. They articulate the varied responsibilities of RNs across all provinces and territories, emphasizing key safety concerns such as understanding boundaries related to counseling versus informing, administering versus aiding, meeting safeguards, obtaining informed consent, and meticulous documentation.
Key Safety and Ethical Considerations
Central to the regulatory guidance is the emphasis on safety and ethical practice. Nurses must understand their professional boundaries and the legal implications of their actions within the MAiD process. The documents urge nurses to ensure that all safeguards are met before proceeding with MAiD and that informed consent is adequately obtained and documented. Ethical complexities arise in the domain of counseling for MAiD, where it is paramount for nurses to recognize the distinction between providing information (permissible) and counseling patients (not permissible under certain regulations).
Conscientious Objection
Conscientious objection is a major theme in the regulatory documentation. Nurses are advised to acknowledge their moral or religious beliefs and to navigate the professional requirement to ensure that these do not obstruct patient access to legal medical services, including MAiD. Nurses may conscientiously object to participating in MAiD, but this objection should not prevent patients from receiving care by alternative means.
Implications for Education and Support
The transformation in healthcare approach that arises from the integration of MAiD in Canadian nursing requires comprehensive and ongoing education and support. Nurses need to be well-informed about the legalities, ethics, and practicalities of MAiD to provide quality care. Additionally, the polarizing presence of MAiD in healthcare emphasizes the need for robust support systems to aid nurses in their moral decision-making processes.
Keywords
1. Medical Assistance in Dying Canada
2. Nurse Practitioner MAiD
3. Nursing MAiD Guidelines
4. Conscientious Objection Healthcare
5. End-of-Life Care Ethics
Conclusion
The legalization of Medical Assistance in Dying has brought forth significant challenges and changes for nursing professionals in Canada. Rigorous analysis and implementation of regulatory documents are required to ensure that nurses can fulfill their roles effectively. There is a need for systemic support, education, and guiding frameworks to aid in the moral decision-making for nursing professionals as they provide care in instances of MAiD.
References
1. Pesut, B., Thorne, S., Stager, M. L., Schiller, C. J., Penney, C., Hoffman, C., … & Roussel, J. (2019). Medical Assistance in Dying: A Review of Canadian Nursing Regulatory Documents. Policy, Politics, & Nursing Practice, 20(3), 113-130. DOI: 10.1177/1527154419845407
2. Carter v. Canada (Attorney General), SCC 5, [2015] 1 SCR 331 (2015). Retrieved from [SCC Database]
3. Bill C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), SC 2016, c 3. Retrieved from [Parliament of Canada]
4. Canadian Nurses Association. (2017). National nursing framework on medical assistance in dying in Canada. Retrieved from [CNA Website]
5. Collins, A., & Leier, B. (2017). Can medical assistance in dying harm rural and remote palliative care in Canada? Canadian Family Physician, 63(3), 186–190. PMC5349713
6. Health Canada. (2018). Third interim report on medical assistance in dying in Canada. Retrieved from [Health Canada]