Medical Assistance in Dying: The Role of the Nursing Profession

24 March 2016

by Tieghan Killackey, Elizabeth Peter, and Anne Simmonds

On March 17, 2016, an Ontario Superior Court Justice granted permission for Ontario’s first physician-assisted death. The patient, identified only by his initials “A.B.”, was able to petition the court for permission for a medically-assisted death after the Supreme Court of Canada ruled that those wanting such assistance could ask courts for an exemption to the ban on physician-assisted suicide while the government develops legislation. One day later, on March 18, A.B.’s family released a statement saying he had “passed away in peace and dignity with the assistance of his caring physicians.”

Requests for assisted deaths will only rise, with the federal government required to pass legislation on Medical Assistance in Dying (MAID) by June 6. Provincial and territorial governments and regulatory bodies will then have the opportunity to respond to this legislation, but in the interim, requests will continue to be assessed on a case-by-case basis by a superior court in the individual’s jurisdiction. A number of reports have been released which provide guidelines and recommendations for how this service may be implemented for Canadians in various settings across the country.

How could MAID impact nurses? For nurses, the most significant reports are the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying report and the Parliamentary Report of the Special Joint Committee on Physician-Assisted Dying, which outline a number of recommendations for the implementation of this service. Suggestions that nurse practitioners (NPs) provide MAID, or that registered nurses provide MAID under the direction of a physician or NP hold serious ethical and legal implications for nurses across Canada.

The fact that the Supreme Court of Canada has exempted physicians (but not nurses or other health care professionals) from criminal code charges related to the provision of MAID is particularly concerning. In fact, the Canadian Nurses Protective Society has advised nurses to refrain from “raising the issue of physician-assisted death with patients,” and to respond to inquiries by “directing patients to their doctor or to health institution personnel in a position to respond to questions about services available at the institution”.

On June 10, Bloomberg Nursing’s Centre for Professional Development will be hosting a one-day course, “Assisted Dying In Canada – Is Nursing Ready?”, designed to prepare nurses to take part in this dialogue. This course will address the history, language, and core concepts related to medically assisted dying, as well as the current realities and professional implications for nursing with an emphasis on ethical conflict, required competencies, and nursing leadership.

The nursing profession needs to engage in an in-depth exploration of the impact of the legalization of MAID on the role of nurses. An examination of the expectations that will be placed on nurses by the institutions and organizations within which they work, what protections may be offered until the Criminal Code is amended, and what rights nurses may have to choose not to participate in this type of care is also necessary to ensure nurses are informed and prepared when they encounter MAID in their practice.

Learn more about “Assisted Dying – Are Nurses Ready?”

Photo: Marjan Lazarevski/flickr under CC BY-NC 2.0