Evaluation of Nursing Ethics in Coordination with Physician Assisted Dying
Faith Russell
Communications Department, Lambton College
COM 2033 – Communications for Health
Murielle Michaud
November 15, 2021
Summary
The research report titled “Evaluation of Nursing Ethics in Coordination with Physician
Assisted Dying” examines the ethical values in association with Medical Assistance in Dying
(MAiD) and identifies how nurses can obey them in a scenario when a patient requests this plan
of action. The Code of Ethics was created by the College of Nurses (2021) in consideration of
how nurses can adhere to their duties by the elimination of biases in the health care field.
Reflection of biases include nurses becoming knowledgeable in their duties that include ethical
values. The first key ethic examined is respect for life. This is incorporated with MAiD by nurses
being aware that patients have the right to make their own decisions. In addition, the report
explains how ethical principles such as client choice and maintaining commitments to patients
have the ability to take place when a patient requests MAiD. This report explores a controversial
topic and forces readers to reflect and go beyond their current beliefs to evaluate the Code of
Ethics. The purpose of this report is to address the idea that Physician Assisted dying complies
with nursing ethics.
Evaluation of Nursing Ethics in Coordination with Physician Assisted Dying
The bill for Physician Assisted Dying passed in June of 2016. This has become a medical
opportunity for those challenged in multiple health care situations. It is used to relieve pain,
suffering and to respect patient autonomy. However, this topic has also become controversial.
Viewpoints on Medical Assistance in Dying (MAiD) differ for everyone involved in these
situations. In the nursing profession, nurses are faced with ethical dilemmas, these dilemmas
make nurses question their ability to do the right thing. MAiD can be viewed as an ethical
dilemma because of many biases and different circumstances that accompany the situation.
Biases include those of nurses, such as the factor that they may not be providing the best care by
allowing their patient to pass or watch families mourn. In the occurrence of conflict, the College
of Nurses “Standards and Guidelines: Ethics,” CNO (2021) was created to shift our focus to the
crucial factors a nurse must follow to provide competent care. However, the guidelines for
nursing ethics can continue to be viewed in different ways when it comes to MAiD. This is
caused because the guidelines create questions on how to properly pursue our ethical obligations.
By evaluating respect for life, healthcare workers perspectives and the nurse's role when a patient
request MAiD the reader will be able to understand the beneficial outcomes and how they relate
to ethics. The purpose of this report is to address the idea that Physician Assisted dying complies
with nursing ethics by assessment of key values and their directives.
Respect for Life
An important moral for all nurses to follow in the healthcare system is to respect a
patient’s life. Liz Stokes (2019) examines the appropriate response to a patient's request while
maintaining sympathy and professionalism. All nurses must comply with obligations that are
created by sources such as the College of Nurses. Stokes says biases are immediately considered
when nurses are dealing with the concern that letting a patient die is the right course of action
(2019). Nurses are taught to save lives and to do no harm, however, are nurses able to do that
with MAiD? The answer is yes. With evaluation of the behavioral directives towards ethics,
nurses have the ability to disagree upon a situation they do not believe in. However, they must
adhere to the patient’s rights and wishes. Respect for life is a multidimensional right that is not
limited to a single individual or factor such as age. By proper education on the seven values of
nursing and its relevance to MAiD, healthcare workers can provide efficient and competent care.
As a nursing student, I stand with the idea that acceptance of physician assisted dying is a
suitable and compassionate action to collaborate in. Compassion can be seen in this circumstance
because nurses are giving time, effort, and care to understand the patient’s wish. A requirement
upon graduation is to become educated on the steps to take when nurses are in an ethical
dilemma. Although initial thoughts can take over, nurses are obligated to maintain
professionalism and an appropriate nurse to client relationship. In the opinion of Liz Stokes
(2019), how nurses act upon dilemmas is important because it influences a patient’s perspective
of the health care system. If nurses do not provide adequate care this can increase the chance of
patient harm. Patient harm can involve lack of trust between healthcare workers and an
escalation of thoughts that the patient is most likely going through at the time of request. In
addition, most individuals look towards MAiD as an option when they are currently suffering.
Health care action may pressure the patient into thinking that they are not doing the right thing
for themselves. Liz Stokes (2019) declares “Nurses recognize that death is a part of the natural
continuum of life and respect that end-of-life decision making is multifactorial and deeply
personal” (p.16). Respect for life is one of the seven ethics that accompanies a patient's thoughts.
Nurses must consider how a patient is coping with their condition, the care plans that continue to
result negatively and their wishes. Overall, the Code of Ethics is critical to assisting a patient
with the decision of MAiD. Nurses must provide accurate health teaching and evaluation of
competency. By doing so, nurses can treat patients with respect and fitting considerations.
Healthcare Perspectives
In healthcare an important examination is to recognize how each worker's interpretation
of MAiD will affect the patient's care circle. Perception allows individuals to act and feel
differently in situations. This applies to nurses in association with MAiD because they may reject
the assignment or do the opposite and collaborate with the patients' wishes. A healthcare
worker’s perception towards MAiD may never be the exact same as another. Each person will
view this as any other medical decision, or some may interpret it as a dilemma. K.L Durant and
K.K Miller’s (2020) article explores experiences of health care members and patients that have
taken part in the decision making of MAiD. Client choice is a virtue that the College of Nurses
explores by understanding that a patient has the opportunity to decide how they see fit in their
own healthcare decision making. K.L Durant and K.K Miller (2020) explain that the directorial
to comply with MAiD created questions towards healthcare workers on how this would affect
their personal belief system. Revision of this, patients should be given the same freedom as any
worker would have the right to. However, they also say that at the end of the day health care
workers must serve the rights of their patients (Durant, Miller 2020). By allowing patients to
participate, it permits them to feel that they can continue to take charge of their own lives till the
end. However, the circumstance may be in question when reviewing a patient's competency to
make their own decision making. If a patient is cognitively incapable of making the right choice,
MAiD is usually off the table for client choice. However, if the circumstance is a lack of
understanding, K.L Durant and K.K Miller (2020) explore that physicians/nurses believe
continuous communication and health teaching is required. Patients must be given applicable
resources and measures which assist them in client choice. Therefore, physicians and nurses
believe that with provision and evaluation of the patient that MAiD incorporates one of the
virtues in the nursing code of ethics.
A Nurse’s Role
The nurse’s role is to provide the best clinical judgement. Additionally, nurses must aid
in making a patient their priority. MAiD relates to this because accompanying a patient is
important, considering they are a part of their care team. An ethical framework is required for
nurses because it guides nursing care. In the College of Nurses “Standards and Guidelines:
Ethics,” CNO (2021) incorporates the virtue to maintaining dedication to patients in the field.
This is a promise to always be a patient's number one source of protection. Along with that, a
nurse's job is to ensure that the patient is comfortable during their time of decision making. Anita
Hoid (2021) explains that patients discuss with members of the interprofessional team in a
variety of circumstances before deciding that the request is within good reason. This relates to
nursing ethics because the nurse maintains their commitments by advocating for their patient and
understanding the background of their beliefs, culture, and diagnosis to create an adequate plan.
As well as using the nursing plan of care such as interviewing and taking from conversations
subjective and objective data that reflects the decision. In relation, patients undergo a
qualification process. This additionally includes palliative care measures, like pain management.
By doing so the nurse is also able to determine and advocate for the patient because they are
incorporating actions beforehand that may create a change in thought.
Conclusion
Ethical dilemmas continue to be a concern in the healthcare field. Whilst there are
sources that nurses make promises towards when becoming a part of the team, it is understanding
that some may continue to question how these virtues are incorporated when it comes to MAiD.
Student nurses are educated in school that taking a step away from dilemmas and reviewing
nursing ethics can produce excellent outcomes. This relates to MAiD because graduates are
taught to review how ethics relates to this subject. By becoming knowledgeable about the
situation and how a nurse's decisions may affect the patient's outcome, it is believed that nurses
will be able to provide competent nursing care. Broderick, M. Horsley, T. Adams, W. Gallagher,
P. Zibricky, C. (2021) suggests that studying topics of ethical dilemmas nurses are facing can
highly benefit them when making choices, and lead them to make the moral and ethical choice.
Questioning as a nurse and reflection is a concept to continue to do daily. When a patient
requests MAiD, nurses need to ask themselves what knowledge they have about this situation
and how do the behavioral directives relating to nursing ethics comply. The situation of MAiD
projects the seven-nursing ethics in a variety of ways. It acts in accordance with patient wishes
by accepting that each patient at the end of the day is subject to making their own choices,
adheres to patient autonomy by prioritizing their own wishes as well the nurse must be
committed to providing efficient care. The process of MAiD acts in accordance with nursing
ethics and continues to help nurses meet set obligations.