The Discourse of Medical Assistance in Dying and Its Relationship With Hospice Palliative Care in Canada: An Integrative Literature Review.
Jennifer D Dorman, D Shelley Raffin Bouchal, Eric Wasylenko and 1 others
PMID 40372001WHAT IT FOUND
Legalising medical assistance in dying blurred the line with hospice palliative care in Canada.
Nurses reported moral distress and uncertainty, feeling pressured to define their participation. The literature lacked clear distinctions between the two practices, leaving providers to navigate complex ethical ground without adequate guidance.
Key findings
01The legalisation of medical assistance in dying (MAiD) created conceptual confusion with hospice palliative care (HPC), as both are often perceived by the public and providers as end-of-life interventions aimed at relieving suffering, despite differing philosophies.
02Healthcare providers, particularly nurses, experienced moral distress and uncertainty regarding MAiD participation, driven by unclear policies, lack of education, and conflicting professional values.
03Conscientious objection was viewed as a spectrum rather than a binary choice, and while it buffered against moral distress, it did not protect against moral uncertainty or isolation from colleagues.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The search was limited to two databases and English-language sources, potentially missing relevant literature. The included articles were heavily skewed towards healthcare provider perspectives, with fewer studies on patient, family, or caregiver experiences. Papers focusing exclusively on Quebec were excluded due to its distinct regulatory framework, which may limit the generalisability of findings to all Canadian contexts. The review included articles regardless of methodological rigour to capture a diverse range of discourse, which may affect the weight of some findings.
Declared interests
The authors declare no conflicts of interest. Funding was provided by the Alberta Registered Nurses Education Trust and the Calgary Health Trust: Florence and Lloyd Scholarship for Nursing Leadership.
The easy way to misread this
Do not assume that MAiD and hospice palliative care are interchangeable or that one replaces the other. The review shows significant conceptual confusion and ethical tension. Nurses should not interpret a patient's request for MAiD as a failure of palliative care, nor should they assume that providing palliative care obligates them to participate in MAiD. Clear communication about roles and boundaries is essential.