Medical assistance in dying and the meaning of care: Perspectives of nurses, pharmacists, and social workers.

Rachel Wortzman,Sally Bean,Kristin Bright,Anneliese Mills,Debbie Selby

doi:10.1177/1363459321996774

Abstract

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. While it has generated significant academic interest, the experiences of healthcare workers other than physicians remain understudied. This paper reports on a qualitative study of interprofessional Healthcare Providers (HCPs) involved in the provision of MAiD in order to: (1) characterize providers' views about the care they offer in general; (2) examine whether or not they consider MAiD a form of care; and (3) explore their reasons for viewing or not viewing MAiD as care. Semi-structured qualitative interviews were conducted with ten nurses, eight social workers, and three pharmacists with firsthand experience delivering MAiD at an academic hospital in Toronto, Canada. The study was approved by the hospital's REB. Written informed consent was obtained prior to participation. Codebook thematic analysis and template analysis generated four themes: (1) care as advocacy, (2) care as easing suffering, (3) care as psychosocial, and (4) care as relational. Every participant viewed MAiD as a form of care and drew on these four themes to authenticate MAiD as care. Participants consider MAiD a form of care for patients, families, other healthcare workers, and even themselves. In alternating and composite fashion, they describe MAiD in terms of autonomy, easing suffering, and a kind death for the dying (and those entrusted with their care)-a complex choreography of social discourses and moral logics that refuse to settle into a simple dichotomy of "choice versus care." Participants depict MAiD in many of the same terms and imagery they use to describe the care they offer in general. In light of ongoing social controversies surrounding MAiD, HCPs utilize a range of logics strategically to repel negative attention and enable their participation in what they see as a caring end for their patients.

Highlights

Physician assistance with dying, variably termed voluntary euthanasia, assisted suicide, or Medical Assistance in Dying (MAiD), has become increasingly available in multiple countries (Dyer, 2008; Orentlicher, 2016; Watson, 2009)
Medical Assistance in Dying came about as a result of a Charter Challenge—the Supreme Court of Canada ruled that the criminal prohibition on physician-assisted suicide violated the rights of Canadians with severe and life-limiting illnesses
Interviewer: . . . What is your role in offering care? As you see it

Summary

Introduction

Variably termed voluntary euthanasia, assisted suicide, or Medical Assistance in Dying (MAiD), has become increasingly available in multiple countries (Dyer, 2008; Orentlicher, 2016; Watson, 2009) Canada legalized such assistance through the passage of Bill C-14 in 2016, which amended the federal Criminal Code allowing physicians and nurse practitioners to provide MAiD to patients meeting specific criteria This is indicative of a broader trend in social scientific studies where qualitative researchers tend to focus on the patientphysician dyad rather than the interprofessional healthcare team These criteria paint a picture akin to Mol’s (2008) “logic of choice,” a system in which patients are treated as autonomous consumers or citizens capable of making their own decisions if they are provided with impartial information. These studies locate choice and agency within the patientdoctor relationship and, obscure the role of interprofessional HCPs

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Conclusion