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Running Head: MEDICAL ASSISTANCE IN DYING

N438 Assignment
Marking Record for Discussion Paper
Instructor: Lisa Barrett
Mark: 58/ 100
Marking Criteria Instructor Comments
Content 36/70 Some marking criteria were addressed in
sufficient detail. Please see comments below
and at the end. Please also download and
open your attached assignment to read
further comments and feedback.
Introduction 5/10
Briefly highlight the most salient points Succinct discussion of main points of topic
of your topic achieved to beginning level.

State your main thesis on the topic for Clear thesis on the topic achieved to a
discussion [your view on the issue or an beginning level.
assertion about your topic, something
you claim to be true]

Background 6/10 Background information provided and clear

Provide background information from definitions given to a beginning level.
the literature on your general topic area
Definition and Scope Definitions and scope of issue attained to a
Provide a definition of your topic Outline beginning level.
the scope of the topic-does this affect all
of Canada, or just your province or your Discussion of how nurses or health care
health care region? Explain. system factor into the topic attained to a
How do nurses or the health care system satisfactory level.
factor into the topic?

Benefits and Challenges 9/15

Describe the benefits to nurses or the Discussion on the benefits to nurses or
health care system healthcare system achieved to a beginning
level.

Challenges identified to a satisfactory level.

Describe the challenges that nurses [or
other health care providers] face in this
Discussion of benefits and challenges
topic
supported with current scholarly literature
What does the literature say about the achieved to a beginning level.
benefits and challenges?

Impact and Implications 8/15

What is the impact on nurses or the Discussion on impact on nurses (or
health care system? healthcare system), human resource
How will this affect human resource management and potential implications
management? (supported in the literature) achieved to
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Running Head: MEDICAL ASSISTANCE IN DYING

What other implications do you foresee; satisfactory level.

what does the literature say about
implications?
Recommendations 5/10 Next steps clearly articulated and included
What do you think needs to be done who should be involved achieved to a
next? beginning level.
Who do you think should be involved?
What are the recommendations from the Recommendations from the literature
literature?  identified and included personal opinion in
Would you agree or disagree with the support/disagreement with the literature
literature and why?
achieved to a beginning level.

Conclusion 3/10 Thesis restated and succinct summary of

Restate your thesis recommendations included achieved to a
Provide a summary of your poor level.
recommendations
Some details regarding the main ideas were
summarized in the Conclusion
Scholarly Format of Paper 22/30 Some

Discussion is logical in presentation of The subtopics were presented logically and

ideas; evidences clear, organized, and sequentially in some of the assignment.
concise writing style
There were a lot of errors in grammar,
Paper is free of typographical, spelling, punctuation, sentence structure,
grammatical and spelling errors. and tone in the assignment
Analysis, synthesis, and critical
thinking skills are demonstrated Evidence beyond course material was
integrated into some- minimal aspects of the
The paper integrates material beyond assignment.
course textbooks incorporating other
scholarly sources There were many errors in APA format.
Within 10 pages (excluding title/reference
Format follows APA (6th ed.) scholarly pages); correct font and margins applied
format of no more than 10 typed pages some of the paper.
(excluding title and reference pages).
Times New Roman, font size 12 with all the references are not correctly integrated
margins set at one inch [2.54 cm] throughout text

References are correctly integrated and

cited throughout text

Reference list is correct according to

current APA edition

Total Score 58/100

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Running Head: MEDICAL ASSISTANCE IN DYING

Pushpinderjit Bedi

Athabasca University

Discussion Paper

Trends and Issues in Nursing – 438

Professor: Lisa Barrett

Friday, January 8, 2021

Medical Assistance in Dying

In 2016 under criminal law C 14 Medical assistance in dying was legalized. It was a massive

change that took place after a lot of discussion and surveys of public opinion. Different physicians

together with their own will started giving aid in dying to patients coping with irremediable diseases.

There have been cases in the past where people had to leave Canada to opt for Medical assistance in

dying (MAiD). Legalization of MAiD came with a specific criterion for patients, and for physicians,

not everyone can request MAiD. Who so ever wanted MAiD has to get an approval from the court. It

impacted nurses in terms of their role and duties in this new procedure. Rural area's consideration
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Running Head: MEDICAL ASSISTANCE IN DYING

raised many questions in terms of care and limited health care resources. It impacted the cancer

patient's life in dealing with end of life situations. There are specific criteria for patients to meet their

request for MAiD. Patients suffering from their irremediable conditions, end-of-life care should have

the choice to end their suffering. Legalizing MAiD means recognizing their suffering and respecting

their choice, but this should be an alternative to palliative care. Nurse's ethical dilemma is to choose

between their duty and their religious beliefs. Patients should have their full right to decide on their

health.

MAID was a considerable change in the law under bill C 14 released in 2016. There was a large

discussion initially about legalization of MAiD. Authors (Beuthin, R., Bruce, A., & Scaia, M.,2018,

para. 3) state MAiD had first legalized in Switzerland in 1942. There was polling data, and 79% of the

general public agreed and favored MAID, but only 45 % of physicians agreed with this decision. There

were many surveys, 60 % of nurses agreed to work alongside physicians for MAiD. Quebec was the

first province where MAID first legalized under act end of life care in 2015. As it had legalized, all

facilities offering it had to make sure new policies and guidelines had been in place for health care

professionals.

MAiD had affected health care workers and the general public as it involved patients and their

families as well. People suffering through end of life stage gives them that one option to make their

choice to end their suffering. It impacts everyone, and legalization should be available everywhere to

everyone for easy access. It is not possible to make it accessible to one region as everybody should

have equal right. It was a challenge for rural areas because there are already limited health care

facilities available in those areas. There are specific criteria for this procedure stated in (Health Canada.

(2020). Patient should be legal age over 18 and mentally competent for consent, irremediable disease

that impacts their lives or causing them to suffer, volunteer decisions without any pressure, and consent

to perform the MAiD procedure. Criteria for physicians, patients have to be assessed by two health care
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professionals regarding their diagnosis that it is irremediable, and both have to agree for MAiD. They

have to make sure they get a consent signed and, before administering medication, need to get verbal

consent from the client right before procedure to make sure they have not changed their mind. In this

whole process, nurses had their moral and ethical dilemmas. There are particular criteria for patients to

meet who choose MAiD. Author (Collins, A., & Leier, B.,2017, p.1) states that the palliative care

community is limited to meet the need of a large population. Scarcity of resources to meet the needs of

palliative care community legalization of MAiD was one step to fill that gap. There were many

questions raised by palliate care physicians, as there is little palliative care available, but MAiD was not

an alternative to that option.

The only benefit to the health care system is that it decreases the burden to meet palliative needs

by just directly offering MAiD. As mentioned earlier, that MAiD fills in that gap, and the patients can

have an alternative option available. Nurse practitioners (NP) responsibility is higher as they were

eligible to carry out this procedure. They although face the dilemma but built up their courage to

provide end life care to suffering patients. Rural areas have limited physicians, and, in some facilities,

only nurse practitioners are available as the only source. According to MAiD criteria, there have to be

many health care professionals involved in providing support to the physician providing MAiD

assessment. Registered nurses did not have any specific education sessions regarding new changes, but

NP had mandatory education sessions as they were primary to carry out the procedure. It was a

reasonably new law, so initially, there were many challenges for nurses and the health care system.

Physicians and nurses were not clear about guidelines for separate roles. Nurses' challenges

were that there are no clear guidelines or policies for their expectations in this role. (Pesut, B., Thorne,

S., Greig, M., Fulton, A., Janke, R., & Vis-Dunbar, M. (2019). Talks about the workplace aspect of this

issue. Nurses were left in a blur as physicians had their guidelines, but nursing did not have specific

policies to follow. It was not clear that their role in this procedure was to be prepared and decide if they
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wanted to participate in their procedure. The moral dilemma was a massive concern as many catholic

nurses refused to participate in this because of their religious beliefs. Nurses now have the

responsibility to advocate for patients’ rights for MAiD. Author (Pesut, B., et al., (2019) talks about

different responsibilities of nurses. It includes assessing the patient, teaching, and providing

information about MAiD to the patient and family. Supporting patients and family during this time and

documentation is a huge part of this procedure. MAiD is not a standard process, and it does require

proper training and ongoing education support for nurses.

A group of nurses interviewed on MAiD to get their opinion on this process. Author (Beuthin,

R., et al., (2018). Talks about the nurse's opinion in this article. The interview process divides into three

aspects of the nursing profession: nursing, personal impact, and nursing practice. The professional

approach had to be nonjudgmental, respecting patient choice, and advocating for their rights under the

professional code of conduct. It was moral values for some, for it was like expanding their experience

in their field. For some, it was emotionally distressing because it was morally wrong, in their opinion.

Personal impact were there for some nurses were supporting MAiD as it is their right to choose, some

of them were in between they felt it was right but still not wholly agreed and some completely opposed

the whole process. Nursing practice was still involved in the process as there was the clinical approach

for insertions, basic care palliative approach, and emotional support to the family. A nurse can legally

say no if they do not morally support the process, but they have to conduct their duties until a

replacement is available as a professional. There should be new protocols and education sessions to get

nurses to have more knowledge about this topic.

It impacts not only the patient but its family and relatives also. MAiD is been legalized so

anyone can have access to it with their own will. It was a challenge for rural areas because there are

already limited health care facilities available in those areas. Rural areas have limited physicians, and,

in some facilities, only nurse practitioners are available as the only source. According to MAiD criteria,
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Running Head: MEDICAL ASSISTANCE IN DYING

there have to be two health care professionals involved to carry out the MAiD assessment. There was

nothing specific in criteria or the law about telehealth and its usage in this process. Telehealth uses a

second person assessment by a health care professional. It was beneficial and worked out well for the

rural area because of the limited resources available for health care. It was also suitable because the

patient who requested MAiD would not travel long distances to different facilities where physicians

were available.

Advancing cancer symptoms can be challenging for patients; sometimes, the pain they live with

is not tolerable. Patients with active cancer or end-stage can submit up request for MAiD, then two

physicians or nurse practitioners would be involved for maid assessment criteria. (Wu, J. S. Y., Pinilla,

J., Watson, M., Verma, S., & Olivotto, I. A. (2018). Author explains in study five phases of this

process, which is as follows: 1) pre-contemplation in which the patient will go over all their end of life

options. 2) Contemplation is to go over the delated explanation of the end of life options, including

MAID. 3) Determination in this step government of Alberta form will be signed then two physicians, or

nurse practitioner. 4) action in this phase they will go over the specific of MAiD to talk about the

location route of medication. 5) Aftercare in this step, they will be transferring body and grieving

support for the family.

There should be an education session on MAiD, so everybody gets familiar with the process.

Nursing education should include detailed palliative care, in which MAiD should become part of the

education system. Employees should provide extra resources for nurses to refer back to educational

purposes and mandatory education sessions. Nurses should have someone available to talk to so they

can talk about their ethical dilemma. Collins & Leier (2017) explains that rural area has limited access

to palliative assistance due to this reason MAiD should not become the first choice. The health care

system investing in physicians training for MAiD should invest more in providing palliative assistance

in rural areas. Resources and funding should be available for local people that can train in nursing.
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Educating patients on palliative care so they know how much of symptom management palliative care

can benefit them. (McCarthy, R.I. N. G., & Seal, M. (2019) explain that there have been many requests

for this procedure, but a lot of them do not meet the criteria. It indicates a lack of knowledge among

patients for MAiD eligibility. Patients were not having enough knowledge about their condition and

treatment options.

It should be the responsibility of health organizations to make sure NP and physicians get

compensated. The family physician needs training for MAiD, so it is not just the responsibility of

specific physicians. It will also help in decreasing the burden on the health care system. Ministry of

health and local health integration system (LIHN) should work together to help plan better ways. So,

there is no unnecessary request due to a lack of knowledge. As literature shows, we need to improvise

on a system that should help educate patients on MAiD. If everybody is educated and aware of their

options, patients will make a clear decision.

In this paper I have discussed how the legalization of MAiD has impacted everybody. Patients

who were suffering due to their prognosis required this freedom to have options available for them.

Nurses have a legal obligation to advocate for patients' rights. Scarcity of resources in rural areas has

been an issue, but authorizing nurse practitioners to perform MAiD is very beneficial. It indeed ends

much suffering in patients dealing with irremediable diseases and living life in such pain. Quality of

life matters because surviving daily and dealing with pain or other conditions is not life. Legalizing

MAiD means recognizing their suffering and respecting their choice, but this does not mean we should

not offer an alternative to improve their quality of life. MAiD is the patient choice, but palliative

assistance should always be their priority option given to patients. Educating patients on palliative care

and their prognosis can help the patient in making the right decision. Legalizing MAiD was freedom

for patients and end to their suffering. It was also a considerable responsibility of physicians and NP to
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make sure patients had alternative options. Ministry of health should encourage health organisations to

provide education to palliative patients.

References

Beuthin, R., Bruce, A., & Scaia, M. (2018). Medical assistance in dying (MAiD): Canadian nurses’

experiences. Nursing Forum, 53(4), 511–520. https://doi.org/10.1111/nuf.12280

Collins, A., & Leier, B. (2017). Can medical assistance in dying harm rural and remote palliative care

in Canada?. Canadian family physician Medecin de famille canadien, 63(3), 186–190.

Health Canada. (2020). Medical assistance in dying - Canada.ca. Government of Canada.

https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html#shr-pg0

McCarthy, R. N. G., & Seal, M. (2019). Medical Assistance in Dying (MAiD): the opinions of medical

trainees in Newfoundland and Labrador. A cross-sectional study. Canadian Medical Education

Journal, 10(4), e13–e20. https://doi.org/10.36834/cmej.52984

McDonald, C., & McIntyre, M. (2017). Realities of Canadian nursing: Professional, practice, and

power issues. Lippincott Williams & Wilkins.

Pesut, B., Thorne, S., Greig, M., Fulton, A., Janke, R., & Vis-Dunbar, M. (2019). Ethical, Policy, and

Practice Implications of Nursesʼ Experiences With Assisted Death. Advances in Nursing

Science, 42(3), 216–230. https://doi.org/10.1097/ans.0000000000000276

Pesut, B., Thorne, S., Stager, M. L., Schiller, C. J., Penney, C., Hoffman, C., Greig, M., & Roussel, J.

(2019). Medical Assistance in Dying: A Review of Canadian Nursing Regulatory Documents.

Policy, Politics, & Nursing Practice, 20(3), 113–130.

https://doi.org/10.1177/1527154419845407

Schiller, C. J. (2017). Feature Article: Medical Assistance in Dying in Canada:

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Focus on Rural Communities. The Journal for Nurse Practitioners, 13, 628–634. https://0-doi-

org.aupac.lib.athabascau.ca/10.1016/j.nurpra.2017.07.017

Wu, J. S. Y., Pinilla, J., Watson, M., Verma, S., & Olivotto, I. A. (2018). Medical assistance

in dying for cancer patients one year after legalization: a collaborative approach at a

comprehensive cancer centre. Current Oncology, 25(5), e486–e489. https://0-doi-

org.aupac.lib.athabascau.ca/10.3747/co.25.4118