Palliative care nursing and moral coherence: Early responses to MAiD as hastened death

BackgroundSince its inception over half a century ago, a defining attribute of palliative care philosophy has been an insistence that this approach intends to neither hasten death nor prolong life. A commitment to facilitate a 'natural' end-of-life trajectory is ubiquitous in palliative care discourse. However, as an increasing number of jurisdictions around the world legislate to allow assisted death, palliative care providers are having to re-evaluate the relevance of this commitment for the relational ethics of their practice.Research Aims and ParticipantsIn this paper, we explore how a sample of Canadian specialist palliative care nurses reflected on this longstanding disciplinary ethic of never intending to hasten death amidst evolving professional and ethical responsibilities to support people who explore and choose medical assistance in dying (MAiD).Research DesignA qualitative analysis of semi-structured interviews with Canadian speciality palliative care nurses, conducted shortly after Canada legalized MAiD. We present an interpretive description through a framework of moral reflection; moral reflection consists of moral intuition, relational ethics, and moral coherence.Ethical ConsiderationsApproval was granted from the Research Ethics Board of the University of Ottawa. Informed consent was obtained in writing and confirmed verbally at the time of each interview. We removed identifiers such as participant roles and geographic locations from interview quotes to protect confidentiality.FindingsAcross the different components of moral reflection, palliative care nurses negotiated their ethical positions amidst changes to end-of-life care.ConclusionsMoral reflection and striving for moral coherence are ongoing processes; the goal is an engagement with moral plurality. As new jurisdictions consider and legalize MAiD, revisiting the early moral reflections of palliative care nurses can help nurses currently wrestling with similar ethical questions.