Not long ago, it was standard practice when someone was near death to do everything possible to try to save them. Today, our efforts are usually aimed at helping people nearing the end of life achieve a good death. But there can be disagreements over what a “good death” is and how we as nurses can help make that happen. It does not matter if this is a patient in the hospital, a nursing home resident, an inmate, or someone wanting to die at home—all benefit from nurses who care about them.
Since 2016, nurses in Canada have needed to adapt to the legal right of terminally-ill adults to request and receive MAiD—Medical Assistance in Dying. MAiD became a publicly funded healthcare service in Canada, provided to people age 18 or older who fill out a form and are assessed as having met the criteria. When approved, nurse practitioners or physicians write a lethal drug prescription, or more often, inject a fatal dose of medication. The MAiD annual reports show it is most often done at home.
There is a history of major developments leading to the legalization of MAiD in Canada, but all nurses in Canada quickly needed to become informed about MAiD after the law was passed in 2015 and procedures for it were developed over the next year. You can imagine how upsetting this new health service can be for some nurses. There are nurses who believe that death should be prevented no matter what the cost. Others believe palliative care alone is needed for a good death to occur. But regardless, the reality is that MAiD became a legal option for dying people in Canada, which all nurses must recognize.
There are only 10,000 MAiD deaths each year out of a total of 300,000, so few Canadian nurses are directly involved in any MAiD case. But all nurses may be asked about MAiD at work and outside of work. Nurses are known as honest and clear communicators, who can be trusted to provide unbiased information sensitively and carefully. Nurses often need to be educators. They must ensure dying people in Canada understand MAiD is an option, and that it will not be forced on them or expected of them. Nurses also provide or supervise the care that dying people need. This care is often challenging, as good deaths are not always easy to achieve. In Canada, the reality is that MAiD is a legal care option, and nurses must be open to the autonomous right of people to choose MAiD.
When I started nursing, MAiD was unimaginable! Mercy killings did happen, like a family member ending the life of a person who was seen as suffering. They were jailed for doing that criminal act. I always felt sad over those cases. I wondered what I would do if it was my family member who was suffering. In general, I found it hard to look after dying people and their grieving families. At that time, there were only a few drugs and care options that could help reduce pain and suffering. Thankfully, I had good friends to talk to about tough cases at work. Finding support and taking time for myself helped prepare me for another day at work.
Later, when I started to do research on death and dying before MAiD was legalized, people told me they had put their beloved pet down when it was suffering. However, their family member who was dying of incurable cancer did not have that option, and they did not think that was right. I came to realize that the public’s views on death and dying were changing.
Recently, I talked with a daughter who attended a party for her mother the night before MAiD was done. Her mother loved parties and she enjoyed this one. All of the visitors told stories and they laughed and cried together. Knowing she would die the next day, each of them got to say goodbye, and they got to hear from her how much she appreciated them coming to her final party. Her daughter stayed through the procedure, and though MAiD did not lessen her grief, it did end her mother’s suffering.
I have also talked with nurse practitioners who never dreamed that they would perform MAiD. Yet, they took the required course to learn how to correctly perform it. Most have gone on to assess people who have applied for MAiD, and some have actually performed MAiD. This work is not easily or quickly done, but all of them feel that MAiD aligns with nursing’s care and compassion for others.
I have come to realize that I could not do that work. I suppose though, if I were suffering at the end of life, I would be comforted to know that MAiD is available to me. How things have changed!
Canadian nurses are not alone. Canada is 1 of 10 countries where death hastening is legally done now, and the conversation continues in others. I think it is very likely that many more countries will legalize it, and I hope nurses and their voices of compassion and care are heard in all those discussions. I also hope nurses in countries that legalize MAiD will take a leadership role in ensuring that it is carefully, properly, and compassionately done.
In my long career as a nurse, I have consistently seen exceptional acts of care and compassion by nurses. This is especially true when someone is dying, with or without MAiD.
Donna Wilson, PhD, RN, is a Professor Emeritus at the University of Alberta, Edmonton in Edmonton, Canada. She is a member of Sigma’s Mu Sigma Chapter.