Liz Stokes, PhD, JD, RN, director of the Center for Ethics and Human Rights, discusses the nurse’s role in medical aid in dying and common misconceptions.
Nurses living in states where medical aid in dying (MAiD) is legal feel they need clearer guidelines on what their role in this process looks like, according to the results from 2 new comprehensive studies shared by the American Nurses Association’s Center for Ethics and Human Rights.1
Specifically, the survey found that 86% of nurses would care for a patient contemplating MAiD, 67% of nurses would care for a patient in the final act of MAiD, and 57% of nurses support MAiD in the context of their professional role as a nurse.
Furthermore, while 49% of respondents personally support MAiD, nurses said they were more likely to support the concept of MAiD if they felt more knowledgeable about what it entails. Notably, nurses who identified as spiritual were more likely to support MAiD than those who identified as religious.
To gain better clarity on these findings, Oncology Nursing News® spoke with Liz Stokes, PhD, JD, RN, director of the Center for Ethics and Human Rights, about common misconceptions surrounding MAiD, and the oncology nurse’s role in supporting a patient with a terminal illness.
Oncology Nursing News®: The survey found that nurses were more likely to support the concept of MAiD if they felt knowledgeable about it. What are some misconceptions or things that nurses may not understand about MAiD that makes it more difficult for them to support it?
Stokes: Many do not realize that the patient is self-ingesting [the medication]; the misconception is that a health care provider is administering the medication to the patient.
MAiD means helping someone to end their life [on their own terms]. The requirement is that the patient must be able to self-ingest the medication. The patient is the only one who can administer the medication. That is probably the largest misconception related to MAiD.
Another misconception is related to the nurse’s role in MAiD; oftentimes nurses feel that they have to participate. They may feel that if MAiD is legal in their state, then they are obligated to participate, when, of course, that is not the case.
If there is a situation where a nurse feels that supporting MAiD would be against his or her personal values, then they certainly do not have to participate. That is important to remember as well: Nurses do have the ability to [step away] from participation.
Similarly, about 50% of the nurses reported that they personally support MAiD. Can you talk about why it might be difficult for some nurses to personally support MAiD?
We found that there was a correlation with nurses’ personal values as well as their religious and spiritual values. We know that there are certain religions—Catholicism is one of them—that have a very strong position against MAiD. We recognize that nurses who identify as Catholic, [for example], may be opposed to MAiD.
Beyond that, we also know that there are nurses who, because of their personal values, feel adamantly against MAiD because they feel they would be assisting a patient with suicide.
To pivot to the patient perspective, could you discuss the ethical value of MAiD and why it may be important to a patient and their family?
MAiD is another End-of-Life Options act. Within the context of a larger discussion about end-of-life options, [there are] of course hospice and palliative care options, but in those states where it is legal, MAiD is also an End-of-Life Option: it gives the patient the decision-making ability to say, “I want to utilize this option to control the manner of [my] death.”
That is what we hear from most patients who are considering MAiD: they want to be in control of their death. We are in control of every single aspect of our lives—from how we live to how we walk and who we choose to be around. It is not surprising that in this final moment, patients want to have some control over how it occurs.
Most of the time, patients are fearful that they will lose their ability to function; that they will lose their ability to walk, or they will lose their ability to talk or to interact with loved ones and family members. They [may] want to have the autonomy to utilize MAiD before they physically decline so that they can have what they consider [to be] a peaceful death.
Nurse respondents reported a need and desire for more guidance on the expectations of their role to provide competent and quality care where MAiD is legalized. Could you discuss these data and the broader implications?
This was a surprising finding for me. I was surprised by the lack of education and lack of knowledge that nurses had. Nurses were somewhat aware of MAiD, especially in states where it was legal. However, many nurses were not clear on what MAiD actually meant.
Many [believed] that a physician is going to administer medication through an intravenous (IV) formulation—there is still a lot of confusion about the type of medication. Many people believe there will be an IV medication when, in fact, they are oral pills that the patient must self-ingest. There's a lot of confusion around that and then there is confusion around the process.
[Nurses should] understand that it takes several steps for a patient to utilize MAiD. They cannot just say “Hey, I want to do this” and then the next day it is done. There is a very long process with several safeguards in place to make sure that patients are not coerced to do this, or are under any pressure to use this option, but that they are exercising their decision-making autonomy and their judgment to make a safe decision and appropriate decision for themselves.
Our audience is primarily oncology nurses. What is the oncology nurse’s role in supporting a patient who is considering MAiD in a state where it is legal?
Oncology nurses have a unique space because they are often dealing with patients who have been diagnosed with a terminal illness and, in those situations, it is important that patients understand their entire options for end-of-life care. If a nurse is working in a state where MAiD is legal, [they must] to talk with their patient about all the available options, including hospice, but also recognize that MAiD is also an end-of-life option that patients can take.
Again, oncology nurses are not going to be directly involved with the clinical aspects of medical aid in dying. They are not going to be prescribing the medications for medical aid in dying. They are not going to be administering the medications; they may be there during the end-of-life moment when the patient is self-ingesting that medication just as if they were present for a patient in the dying process on hospice. The nurse can still be present for MAiD as well. It is good for oncology nurses to really understand the holistic aspect of end of life. Again, it includes many different options. In those states where medical aid and dying is legal. It would also include that end-of-life option as well.
New survey findings describe nurses’ values and perspectives on medical aid in dying. American Nurses Association. News release. April 12, 2022. Accessed May 11, 2022. https://bit.ly/3Fz6cZc