Ethical Reflections on Medical Assistance in Dying in Nova Scotia
We have presented the last workshop in our two-part conference, and the conversations we’ve had on the topic of medical assistance in dying (MAiD) have been rich and open. We would like to thank all those who watched the broadcast and who joined us for the workshops for their thoughtful engagement with the questions that we raised and for bringing their questions and concerns to the discussion.
Several themes emerged from this process. The focus on and concern about “inducement” clearly resonated with participants. Similarly, the identification of some strong social biases spoke to concerns that health care providers have about MAiD. Workshop participants clearly identified a need for further opportunities for discussion and education for health care providers, as well as a need to stimulate public discussion and engagement. Concerns about equitable access to MAiD as well as to supports arose and although similar concerns are raised about other health care services in Nova Scotia these seem to be especially pressing.
Another theme has been discussing the ways in which MAiD is comparable to established practice and the ways in which it is a departure from what we’ve done before, and how those facts will shape the experience of MAiD for health care providers and for patients and families.
Throughout the discussions it was clear that individual people – patients, their loved ones, and health care providers – and their stories are at the heart of considerations about MAiD. And it was also clear that there is an essential role for health care providers in supporting each other as they work through these issues, since there is an element of lived experience that is not accessible to those not involved in health care practice.
We need practice and feedback to facilitate providing the best possible care from everyone’s perspective. There is a need to develop new “scripts” and habits to help providers feel comfortable with their practice. There is certainly a worry on the part of health care providers that they might not be practicing within the scope of what is permitted by law, and uncertainty about when they can safely broach the subject of MAiD.
We continue to collaborate with NSHA and the nursing colleges to present further education sessions that respond to the needs and concerns of health care providers. One challenge is finding time to have discussions about MAiD given the workloads carried by health care providers. Another significant challenge is initiating conversations with those who are reluctant to engage with the questions raised.
The passing of the law does not settle all the ethical questions raised by MAiD, although in some cases it does shift the focus of the discussion. We might still debate whether health care providers should be able to conscientiously object, but we also must respond to a law that gives health care providers that right. Some of the concerns that arose when the debate was centred on whether we should have legalized medical assistance in dying still shape the ways that we craft policy and process.
Overall, there is strong interest in the topic and considerable willingness to engage with and reflect on various aspects. Anecdotal evidence seems to indicate that in many cases health care providers are successfully finding the balance between supporting patient choices, providing the best possible care, and practicing with integrity. We will continue to explore ways in which ethics can support health care providers and how best to provide that support.