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“Reflection and soul searching”: Negotiating nursing identity at the fault lines of palliative care and medical assistance in dying

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  • Wright, David Kenneth
  • Chan, Lisa S.
  • Fishman, Jennifer R.
  • Macdonald, Mary Ellen

Abstract

Authorities within the field of palliative care frequently espouse that assisted death is – and must remain – separate from palliative care. This fault line, between palliative care and assisted death, has important implications for how we enact end-of-life care, particularly in jurisdictions where assisted death is legal. And yet little is known about how direct-care clinicians providing palliative care navigate this demarcation in everyday practice. This qualitative study reports on semi-structured interviews with 22 palliative care nurses from across Canada, where assisted death was legalized in 2016. Although a minority of participants did express categorical opinions around the (non) legitimacy of assisted death as an ethical end-of-life care option, most engaged in an ongoing and sometimes painful process of questioning and self-examination. Their ethical reflections were more nuanced than simply dismissing MAiD as incompatible with palliative care philosophy; yet this idea of incompatibility weighed heavily as they reasoned through their experiences and questioned their own perspectives. Nurses described grappling with the finality of assisted death, which contradicts their belief in the telos of palliative care; when adequately resourced, palliative care should be available to support people to live well before death. At the same time, commitment to important palliative care values such as the non-abandonment of dying people and respecting peoples’ individual end-of-life choices reveal the possibility of overlap between the ethos of assisted death and that of palliative care nursing. Drawing on scholarship in feminist ethics, our study sheds light on the moral identity work that assisted dying catalyzes amongst palliative care nurses. We highlight what is at stake for them as they navigate a delicate tension in responding ethically to patients whose suffering motivates an interest in assisted death, from within a wider professional collective that upholds a master narrative about the incompatibility of assisted death and palliative care.

Suggested Citation

  • Wright, David Kenneth & Chan, Lisa S. & Fishman, Jennifer R. & Macdonald, Mary Ellen, 2021. "“Reflection and soul searching”: Negotiating nursing identity at the fault lines of palliative care and medical assistance in dying," Social Science & Medicine, Elsevier, vol. 289(C).
    • Handle: RePEc:eee:socmed:v:289:y:2021:i:c:s0277953621006985
    DOI: 10.1016/j.socscimed.2021.114366
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    1. Paul T E Cusack, 2020. "On Pain," Biomedical Journal of Scientific & Technical Research, Biomedical Research Network+, LLC, vol. 31(3), pages 24253-24254, October.
    2. Atanu Sengupta & Sanjoy De, 2020. "Review of Literature," India Studies in Business and Economics, in: Assessing Performance of Banks in India Fifty Years After Nationalization, chapter 0, pages 15-30, Springer.
    3. Karsoho, Hadi & Fishman, Jennifer R. & Wright, David Kenneth & Macdonald, Mary Ellen, 2016. "Suffering and medicalization at the end of life: The case of physician-assisted dying," Social Science & Medicine, Elsevier, vol. 170(C), pages 188-196.
    4. Barbara Pesut & Sally Thorne & Janet Storch & Kenneth Chambaere & Madeleine Greig & Michael Burgess, 2020. "Riding an elephant: A qualitative study of nurses' moral journeys in the context of Medical Assistance in Dying (MAiD)," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(19-20), pages 3870-3881, October.
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    1. Sellars, Marcus & White, Ben P. & Yates, Patsy & Willmott, Lindy, 2022. "Medical practitioners’ views and experiences of being involved in assisted dying in Victoria, Australia: A qualitative interview study among participating doctors," Social Science & Medicine, Elsevier, vol. 292(C).

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