Background: Medical Assistance in Dying, also known as euthanasia or assisted suicide, is expanding internationally. Canada is the first country to permit Nurse Practitioners to provide euthanasia. These developments highlight the need for nurses to reflect upon the moral and ethical issues that euthanasia presents for nursing practice. Purpose: The purpose of this article is to provide a narrative review of the ethical arguments surrounding euthanasia in relationship to nursing practice. Methods: Systematic search and narrative review. Nine electronic databases were (...) searched using vocabulary developed from a stage 1 search of Medline and CINAHL. Articles that analysed a focused ethical question related to euthanasia in the context of nursing practice were included. Articles were synthesized to provide an overview of the literature of nursing ethics and euthanasia. Ethical Considerations: This review was conducted as per established scientific guidelines. We have tried to be fair and respectful to the authors discussed. Findings: Forty-three articles were identified and arranged inductively into four themes: arguments from the nature of nursing; arguments from ethical principles, concepts and theories; arguments for moral consistency; and arguments from the nature of the social good. Key considerations included nursing’s moral ontology, the nurse–patient relationship, potential impact on the profession, ethical principles and theories, moral culpability for acts versus omissions, the role of intention and the nature of the society in which euthanasia would be enacted. In many cases, the same assumptions, values, principles and theories were used to argue both for and against euthanasia. Discussion: The review identified a relative paucity of literature in light of the expansion of euthanasia internationally. However, the literature provided a fulsome range of positions for nurses to consider as they reflect on their own participation in euthanasia. Many of the arguments reviewed were not nursing-specific, but rather are relevant across healthcare disciplines. Arguments explicitly grounded within the nature of nursing and nurse–patient relationships warrant further exploration. (shrink)

With the advent of legalized medical assistance in dying [MAiD] in Canada in 2016, nursing is facing intriguing new ethical and theoretical challenges. Among them is the concept of conscientious objection, which was built into the legislation as a safeguard to protect the rights of healthcare workers who feel they cannot participate in something that feels morally or ethically wrong. In this paper, we consider the ethical complexity that characterizes nurses' participation in MAiD and propose strategies to support nurses' moral (...) reflection and imagination as they seek to make sense of their decision to participate or not. Deconstructing the multiple and sometimes conflicting ethical and professional obligations inherent in nursing in such a context, we consider ways in which nurses can sustain their role as critically reflective moral agents within a context of a relational practice, serving the diverse needs of patients, families, and communities, as Canadian society continues to evolve within this new way of engaging with matters of living and dying. (shrink)

We recognize a paradox of power and promise in the context of legislative and organizational changes in nurse regulation which poses constraints on nursing's capacity to bring voice and influence to pressing matters of healthcare and public policy. The profession is at an important crossroads wherein leaders must be well informed in political, economic and legislative trends to harness the profession's power while also navigating forces that may put at risk its central mission to serve society. We present a critical (...) policy analysis of the impact of recent regulatory trends on what the International Council of Nurses considers nursing's three ‘pillars’ – the profession of nursing, socioeconomic welfare of nurses and nurse regulation. Themes surfacing from this analysis include regulatory discontinuity, a tightening of regulatory control, and an increasingly managerial governance culture. These themes illuminate insights and strategies required to renew and revitalize the social mandate of our profession amidst a climate of urgency in the questioning of nurse scholars with respect to the future of the profession. At this historic juncture, nurses must clearly understand the implications of legislative and organizational regulatory changes to ensure the profession contributes to full capacity in achieving health and health equity globally. (shrink)

In 1978, Barbara Carper named personal knowing as a fundamental way of knowing in our discipline. By that, she meant the discovery of self‐and‐other, arrived at through reflection, synthesis of perceptions and connecting with what is known. Along with empirics, aesthetics and ethics, personal knowing was understood as an essential attribute of nursing knowledge evolution, setting the context for the nurse to become receptively attentive to and engaged within the interpersonal processes of practice. Although much has been done over the (...) 40 years since Carper described these ways of knowing, and we have seen enormous advances in empirics and ethics, and I would argue even in aesthetics (understanding the subtle craft of nursing in action), personal knowing may not have attracted its fair share of critical unpacking. Further, we see increasing evidence of a distortion on how forms of personal knowledge, including beliefs and attitudes, are being taken up within segments of the profession; these include legitimizing idiosyncratic positionings and, most worrisome, challenges to the idea that there are and ought to be fundamental truths within nursing that stand as central to disciplinary knowledge. In this paper, the author reflects on the confusion that a continued uncritical deference to personal knowing may be creating and the evolving interests it seems to serve. (shrink)

Recent ideological positioning on the world stage has born a startling resemblance to a form of positioning within nursing theory – that of taking complex ideas, reducing them to a simplistic binary form, and uncritically adopting one half of that form. In some cases, this adoption of a binary position has led to a passionately held form of ‘othering’ that prohibits a healthy and critical engagement with ideas. As alluring as settling for the binary form may be – we argue (...) for holding binaries in tension as a catalyst for stimulating dialogue – reasoning and exploration of new ways of wrestling with the social and moral complexity of nursing. (shrink)

Canadian nursing practice has been profoundly influenced by the legalization of medical assistance in dying in 2016, requiring that nurses navigate new and sometimes highly challenging experiences. Findings from our longitudinal studies of nurses' experiences suggest that these include deep emotional responses to medical assistance in dying, an urgency in orchestrating the perfect death, and a high degree of relational impact, both professionally and personally. Here we propose a theoretical explanation for these experiences based upon a relational ontology. Drawing upon (...) the work of Wildman, we understand a relational ontology to be one in which relationships are more fundamentally central than the conceptual entities that provide the context to practice. It is in a relationship that conceptual entities, and their affiliated values, are created and recreated. Seen as causal, relationships have ontological status, with important implications for how we consider the concepts of death, suffering, and time in this context. From a conceptual perspective, suffering is primarily self‐defined based upon personal histories, time reflects the potential remaining until death, and death is primarily biological and amoral, although social discourses of a good and bad death surround the death trajectory. However, within a relational ontology of medical assistance in dying, these understandings shift. Death becomes primarily social rather than biological, suffering is shared, and time until death is now clearly delimited. Accordingly, nurses assume a profound responsibility for influencing outcomes that are authentically person‐centered. These understandings provide important insights into nurses' experiences, enabling us to recognize the causal effects, both intended and unintended, of nurses' relational practices amidst the complexities of assisted death. Drawing on such a perspective, we find implications for how we provide spaces for nurses to reflect on, and have conversations about, their experiences with some of the greatest mysteries of life—death, suffering, and time. (shrink)

This manuscript represents one segment of a philosophical conversation held in a virtual webinar in February 2021 to consider some of the current debates in nursing theory, education and practice, and their relationship to philosophy. The webinar was sponsored by the International Philosophy of Nursing Society and the Centre for Nursing Philosophy at University of California, Irvine as an opportunity provide a venue for important philosophical and theoretical thinking to a wide audience of nurse educators and practitioners around the world.

Diverse beliefs about the nature and essence of scientific truth are pervasive in the nursing literature. Most recently, rejection of a more traditional and objective truth has resulted in a shift toward an emphasis on the acceptance of multiple and subjective truths. Some nursing scholars have discarded the idea that objective truth exists at all, but instead have argued that subjective truth is the only knowable truth and therefore the one that ought to govern nursing's disciplinary inquiry. Yet, there has (...) been relatively little critical debate or dialogue about the implications of adopting subjective and multiple truths as a maxim to govern the discipline. In this paper we examine what it might mean to adopt subjective forms of truth as the only knowable truths for nursing, and to accept the possibility of multiple co-existing realities. We understand the implications of such a philosophical stance for the epistemological basis of a practice science to be considerable, therefore we consider what it might mean for a practice-based discipline such as nursing to remain ambiguous on the question of truth, and examine the implications of failing to achieve consensus on what constitutes a truth claim. On the basis of this examination, we urge a cautious approach to the extremes of either position and argue for a more thoughtful and rigorous dialogue about ‘truth’ and knowledge in nursing practice, education, and research. (shrink)

In this paper, we reflect on factors that seem to have influenced the accessibility of medical assistance in dying (MAID) in the Canadian context. Since legalization in 2016, the uptake of MAID has increased rapidly to equal or exceed rates in other countries. In that MAID implementation involves numerous ethical/moral complexities, we consider four factors that appear to have influenced this growth. First, we reflect on the vague language contained within the legislation that has been interpreted by a community of (...) practice in which making MAID accessible is an important priority. Second, we consider policies of effective referral and self-referral that have been strategies for enhancing accessibility in relation to a wider context that contains conscientious objection. Third, we examine the apparent impact of centralized clinical teams and coordination services that have enhanced accessibility for persons residing in rural and remote areas. Fourth, we reflect on ways in which public awareness of MAID has been enhanced through policies that enable healthcare providers to introduce the topic of MAID as an option within advance care planning. We conclude with a consideration of how these intersecting factors may be shaping the moral complexity inherent in the idea of making MAID accessible. (shrink)