CONCEPT ANALYSIS MEDICAL ASSISTANCE IN DYING (MAID) PREPARED

Abstract

Medical Assistance in Dying (MAiD) is a complex, ethically sensitive and challenging approach in modern nursing. This paper discusses the concept of MAiD through the lens of structured concept analysis as developed by Walker and Avant (2011) in their eight-step method in a nursing ethical approach. The five key characteristics of MAiD are described using thematic synthesis which are as follows: (1) voluntariness and autonomous patient request where decisional capacity and lack of coercion is a non-negotiable precondition; (2) intolerable and irremediable suffering involving the patient’s perception of physical and psychological suffering; (3) documented clinical protocol and legal sanction, where decisional authority over MAiD can be delegated, and MAiD is established as a legally regulated professional activity within its jurisdiction; (4) moral and professional relationality, where MAiD involves a higher degree of relationality than any other form of palliative intervention, encompassing patients, families and nursing staff; and (5) intentionality of finality, where the finality of MAiD is a distinguishing characteristic; with life put to an end as the explicit, documented, and primary clinical objective. The attributes refer to the four principles of bioethics – autonomy, beneficence, non-maleficence and justice – making clear that these principles are not simply background for MAiD, but play a significant role throughout each stage of patients’ care. The consequences of MAiD are recognized within three spheres: for the patient, it is a planned death and a finality that comes in advance of the patient; for the family caregiver, it is a complex and qualitatively different grief process; for nursing staff, it is a continuum of psychological and moral reactions, anxiety and compassion fatigue, moral distress, moral growth, and strengthened professional identity. The analysis includes implications for nursing, concluding that the structured institutional support of nurses who perform MAiD is needed; that there are critical gaps in nursing curricula regarding ethical and legal concerns related to MAiD; and that clear protections against consentious objection,nursing-specific procedures about MAiD and funding are necessary to prevent vulnerable populations from being disproportionately pressured as eligibility for MAiD expands.