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Ethical Concerns: Many nurses have ethical reservations due to conflicting values or beliefs. Some nurses may believe that participating in assisting patients ending their lives contradicts the fundamental principles of nursing. (preserving life/alleviating suffering)

Legal Uncertainty: Despite the legality of medical aid in dying in certain jurisdictions,there may be legal ambiguity surrounding the nursing role in this process. Nurses may fear legal repercussions if their involvement is perceived as ethically/legally questionable.

Organizational Policies: Healthcare institutions may have policies that restrict/prohibit nurses from participating in medical aid in dying.

Social/Emotional: This topic is highly controversial and can have profound emotional consequences for nurses. They may have feelings of moral distress, guilt, and sorrow. They may also face judgement from outside parties if they choose to participate in these practices. The fear of professional isolation may deter nurses from engaging with this issue.

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Nurses play crucial roles in end-of-life care. However pertaining to medical aid in dying, their roles vary based on factors such as personal beliefs, institutional policies, legal considerations, and available support. MAID is not yet being practiced in many of the states, but many are fighting for this to become a right for patients to decide for themselves. Advocates of MAID in many of the 50 states are fighting to get legislation passed to support this bill. Nurses in states where it is legalized, feel a morale obligation to share their stories and spread awareness to others. In the next box, there is an example of how nurses are improving and exacerbating this issue. Many nurses are taking an active part in politics and joining boards to express their support of this act.

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The issue at hand is the concept of "death with dignity", or medical aid in dying. (MAID). This involves terminally ill patients voluntarily choosing to end their lives with assistance of medical professionals. This practice is considered when patients are facing unbearable suffering due to their illness and have a prognosis of a limited life expectancy.

The issue is that there are very conflicting views on this subject matter. Some believe that it is a very humane way to end one's life. This practice has always been used in pets/animals, it preserves a patients autonomy and dignity, and avoids prolonged suffering. As long as the patient is mentally cognitive and able to make decisions about their healthcare, they should have an option of a peaceful death versus unimaginable suffering. Others argue from ethical and religious perspectives. They say this is morally wrong, and that there is great potential for coercion, abuse, and pressure on vulnerable individuals. Debates surrounding this issue involve heavy discussion about morality, autonomy, compassion, and the role of medicine in end of life care.

The issue directly affects terminally ill patients who may consider medical aid in dying as an option to alleviate their suffering, and retain control over their end-of-life decisions. It impacts their families, healthcare providers, policymakers, and more.

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TedTalk: Dying with Dignity (NURSE POV):

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TedTalk: Dying with Dignity (NURSE POV):

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Dying With Dignity:The Importance of Choice at End of Life | Helen O'Shaughnessey | TEDxDunLaoghaire

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The involvement of nurses is vital to help patients through the MAID process. Nurses are the most present healthcare professional at the beside through a patients stay in the hospital. Nurses help the patient both physically as well as mentally. Choosing MAID is not an easy decision to be make with many factors involved, and the nurse will have many responsibilities to help the patient through this. With the support of committed and empathetic nurses, going through this transition will be made a lot more comfortable for both the patient and the support systems.

They will help facilitate informed decision making.

They will advocate for patient rights.

They provide constant emotional support and compassion to both the patient as well as to the family.

They provide consistent and ethical care to the patient, even after the time of passing.

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According to a quantitative study published in the Journal of Hospice and Palliative Nursing, 86% of nurses said they would care for a patient contemplating MAID. 67% of nurses would physically care for a patient in the final acts of MAID. Many nurses said they would likely support the concept of MAID if they were given more information about it. (Moore, 2022).

There are many people who confuse the terms medical aid in dying with euthanasia, and learning the key differences between the two could help understanding. "Laws that allow medical aid in dying permit an adult patient with a terminal illness and the capacity for medical decision-making to self-administer medication when certain criteria are met. Euthanasia, which is not legal in the United States, occurs when someone other than the patient administers medication in any form with the intention of hastening the patient’s death. Euthanasia is inconsistent with the core commitments of the nursing profession and profoundly violates public trust." (ANA, 2019).

Today, only 10 of the 50 states in America have medical aid in dying legalized. Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, New Jersey, Maine, and New Mexico. There are 19 states pending legislation, but this takes years to process to potentially get approved. (Choices, 2022).

There is a very large concern of MAID being used against vulnerable populations, and a way to abuse this system. To avoid this, there are very strict eligibility criteria and protective requirements. "For instance, patients are eligible only if they are terminally ill with six months or less to live, more than one physician must be involved, and requests must be witnessed (by individuals unrelated to the patient who will not profit from the patient’s estate." (Beer, 2023).

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What happens during a doctor-assisted death

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Sufleta, A. (2022, June 6). Nurses and medical aid in dying. American Nurse. https://www.myamericannurse.com/nurses-and-medical-aid-in-dying-maid/

ANA Center for Ethics and Human Rights. (2019). The nurse’s role when a patient requests medical aid in dying. American Nurses Association. https://www.nursingworld.org/~49e869/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/social-causes-and-health-care/the-nurses-role-when-a-patient-requests-medical-aid-in-dying-web-format.pdf

States Where Medical Aid in Dying is Authorized. (2022). Compassion & Choices. https://www.compassionandchoices.org/resource/states-or-territories-where-medical-aid-in-dying-is-authorized

Hoffman, D. C., & de, S. (2023). Have Arguments For and Against Medical Aid in Dying Stood the Test of Time? Voices in Bioethics, 9. https://doi.org/10.52214/vib.v9i.12079

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1. Education and Training: Providing education/training programs for nurses about MAID and end of life care, can empower nurses with necessary knowledge and skills. This is something very new that has a lot of questions surrounding it, so nurses need a safe place for learning to occur.

2. Establishing Policies: By supporting specific policies pertaining to nurses and their role in MAID, this sets the path. These policies need to align with legal regulations as well as professional standards. This would include things such as responsibilities, rights, as well as ethical obligations.

3. Interdisciplinary Collaboration: This re-establishes the very common use of practice, collaboration. It is very important in end of life care, and more specifically in the use of MAID, to continue to work with all of the healthcare staff. This includes physicians, social workers, chaplains, etc. There should be open communication and shared decision making processes to help prioritize our patient's preferences.

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1. Ethical Decision Making: Throughout my time at SCHOS, we have continuously learned the importance of ethical decision making in patient care. We learn principles such as beneficence, non-maleficence, autonomy, and justice. These all greatly affect end of life care decisions. When facing a challenge like MAID, I feel equipped to analyze the ethical considerations, potential benefits and harms, and also to make informed decisions based off of this.

2. Advocacy for Patient Autonomy: This is also a very largely covered topic throughout nursing school. Our job, as nurses, is to be the patients biggest advocate. This includes advocating for their autonomy and their right to make informed decisions about their healthcare. By advocating for these very basic patient rights, I can help ensure their voices are heard and respected throughout the care process.