Class of 2024: Nursing doctoral researcher examines impact of medical assistance in dying on hospice nurses

Since 2016, when legislation on medical assistance in dying (MAID) was introduced, Canadians have had the autonomy and control to make their own end-of-life decision.  A deeply personal and complex issue for the patient, definitely, but what about the experience of hospice palliative care nurses when their patients request, contemplate or complete MAID? 

PhD graduate and registered nurse Jennifer Dorman, BA’04, BN’07, PhD’24, wanted to explore the feelings of moral distress in caregivers in these end-of-life spaces to discover how hospice nurses were understanding and experiencing this monumental change in practice. 

“I’ve been a hospice palliative care nurse for 16 years — I worked with both adults and children at the end of life — as well as a hospice nurse educator in the lead-up to the legalization of MAID,” Dorman explains. 

She had heard from several colleagues apprehensive about MAID being provided in hospice. “It didn’t fit with their beliefs about what end-of-life care should look like and what we could provide as hospice nurses. Conversely, I also heard from colleagues who felt that [hospice] patients should be able to apply for MAID and it could be aligned with palliative and end-of-life care.” 

MAID is a process that allows someone, if found eligible, to receive assistance from a medical practitioner, including nurse practitioners, in ending their life. The federal Criminal Code of Canada permits this to take place only under very specific circumstances and rules: anyone requesting this service must meet specific eligibility criteria to receive medical assistance in dying.  

“Jennifer’s doctoral research is novel as we truly do not understand the impact that MAID may have on hospice nurses, in particular, who hold strong beliefs about end-of-life care,” says Dr. Shelley Raffin Bouchal, RN, PhD, UCalgary Nursing associate professor and Dorman’s PhD supervisor.  

“She had some interesting findings: the related distress that nurses face is the inability to work closely with patients and families in understanding their experience as they navigate the MAID process.”  

The results from Dorman’s research surprised her. “The majority of the nurses I spoke to felt they were not experiencing moral distress, but the way they spoke about their experiences with MAID suggested that there was the potential for it to develop in the future,” she says.

“I also had expected most distress to originate from being asked to end, or be involved with ending, a patient’s life. But what nurses were most distressed by was how hospice policy and procedure around MAID prevented them from being involved in these discussions/decisions in a meaningful way."

Nurses felt they could not support their patients or provide high quality end-of-life care while the patient was being assessed for — and potentially undergoing — MAID provision.

Working in palliative care for several years, Dorman really wanted to learn more about her area. “I decided to go back to school as I had reached the limits of what I could do with an undergraduate degree and was interested in becoming an advanced practice nurse.” 

Dorman admits that although graduate studies was definitely what she wanted to do, the personal “life stuff” proved to be a bit tough. Unlike many graduate students, Dorman did not have a lot of financial strain: she had built up her savings, received scholarships (including an Eyes High doctoral award) and worked as a teaching assistant. 

“My family was very supportive of me returning to nursing studies, and helped out around the house so I could focus on my studies. My struggles were more with aging parents, and my own health, than the actual school piece.” 

Dorman completed her thesis and defense in late 2023 and will convocate this month. Part of her research developed practice recommendations: she hopes to work with hospices to see what kind of impact those suggestions make on nursing practice. 

She has shared her findings at a national hospice palliative care conference, as well as with several of the hospices that participated in the study. “What struck me was how nurses across the country shared similar experiences to my participants and hospice management indicating what I presented resonated with what they had been observing in their own organizations,” she comments.  

“Nurses voice more about the process rather than their beliefs about MAID,” adds Raffin Bouchal.

“This research has potential for significant contributions for professional education, patient outcomes and health policy at the end of life.”

Dorman relocates to Newfoundland this summer to begin a new career as an assistant professor at Memorial University’s Faculty of Nursing. 

“I plan to continue research into hospice palliative care and MAID, but also examine end-of-life care for marginalized populations.”