However, participants also suggested that relationships between those providing palliative care and those providing medical assistance in dying became more sympathetic over time. „We`ve come a long way because people aren`t so angry or defensive.“ P31 In some cases, this was because medical assistance in dying teams had been trained outside palliative care teams and had learned to work together. In other cases, palliative care professionals felt more comfortable with MAID as an option, either inside or outside palliative care. Despite this apparent relaxation of the relationship between medical assistance in dying and palliative care providers, significant concerns remain about the inadequacy of palliative care systems in Canada and the impact that medical assistance in dying may have in light of this inadequacy. For example, one participant suggested that the workload caused by medical assistance in dying could be a significant barrier for palliative care professionals who are already working at full capacity. Another participant suggested that palliative care, which already had some degree of stigma because of its link to death, would be further stigmatized with the introduction of medical assistance in dying. Ultimately, this perception would result in even lower patient acceptance of palliative care. However, what has caused nurses the most concern is the lack of access to palliative care services for some patients in Canada. Under Bill C-14, clinicians are required to provide palliative care to clients contemplating death from medical assistance in dying. Participants reflected on the irony of the focus on supporting the accessibility of medical assistance in dying without paying due attention to the general accessibility of palliative care. „We use this rhetoric that it`s someone`s right to die, and I don`t want to discuss that part, but I think it`s also their right to have access to care from clinicians who know about palliative care.“ P23 This participant reflected on the lack of specialized palliative care, but also on the lack of knowledge about palliative care in primary care, where most palliative care takes place. The same participant went on to describe how providers` lack of knowledge about palliative care unintentionally contributed to patient suffering. This tension between a system that caused unnecessary suffering due to ignorance of good palliative care and a system that was supposed to alleviate that suffering through medical assistance in dying put this nurse in a state of intense tension: the obligation means that people are legally bound by a rule, so their behaviour is checked according to the general rules.
Procedures and speeches of law. Precision means that rules uniquely define the behavior they require, approve, allow, or prohibit. Delegation refers to the body empowered (by the public) to establish, implement, interpret and apply the rules. The three dimensions can vary in degree. Based on these characteristics, legalization can be difficult (with all three properties maximized), gentle (where some properties are maximized and others are minimized), and zero (where all three properties are minimized). [emphasis added] (5 p. 7) Bill C-14, An Act to amend the Criminal Code and other Acts (medical euthanasia), S.C. 2016, c 3. www.parl.ca/DocumentViewer/en/42-1/bill/C-14/royal-assent.
Retrieved 15 November 2019. The conceptualization of assisted dying as physician-driven action has resulted in a lack of attention to the roles and experiences of caregivers in the processes surrounding medical assistance in dying. In this article, we synthesize evidence from 6 articles on the experiences of 55 nurses from Canada, Belgium and the Netherlands, with relevant ethical and policy implications drawn from the literature. Nurses play a central role in negotiating requests for euthanasia and providing comprehensive care to patients, families and other health care providers. This role is important to nurses and requires considerable personal and professional moral work. Providing an open and transparent dialogue that presents both the benefits and challenges of a particular ethical issue helps the profession answer thorny questions about the day-to-day ethical challenges of nursing practice. The voice of nursing is crucial for patients; This is no less important for a society grappling with the morality of assisted suicide and euthanasia. Carers need to be part of the dialogue involving wider citizenship. Let`s not be afraid to tackle the difficult ethical issues we face as a profession – Ann Hamric and her colleagues have given us a unique opportunity to do so. CJS is a nurse and non-practitioner lawyer who teaches in the Bachelor of Science and Science programs at the University of Northern British Columbia. She has published articles on the impact of medical assistance in dying on nurses practising in rural and remote communities across Canada. The term used in Carter v.
The Canadian decision is „medical assistance in dying.“ Recognizing that this process affects the entire health care team, legislators changed the term in Bill C-14 to „medical euthanasia“ to more fully reflect actual practice. Now that Bill C-14 has become law, the revised wording of medical assistance in dying is in effect and reflects the involvement of the entire health care team in this process. Given the importance of the role of registered nurses and the new role of nurses in Canada, we conducted a study on the policies, practices and ethical implications of MAID for nursing. This was a two-phase study in which we first conducted systematic reviews of the literature [12,13,14] and then a qualitative review of Canadian nurses` experiences with MAID. As part of the literature review, we collected and analyzed nursing law documents created to guide nursing practice in MAID in Canada`s 10 provinces and 3 territories [13]. We found significant variability in that these regulatory bodies provide additional guidance for nurses beyond what was provided for in medical assistance in dying legislation.