School of Nursing, University of British Columbia Okanagan, ARTS 3rd Floor, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
School of Nursing, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada.
BMC Palliat Care. 2021 Nov 11;20(1):174. doi: 10.1186/s12904-021-00869-1.
Intolerable suffering is a common eligibility requirement for persons requesting assisted death, and although suffering has received philosophic attention for millennia, only recently has it been the focus of empirical inquiry. Robust theoretical knowledge about suffering is critically important as modern healthcare provides persons with different options at end-of-life to relieve suffering. The purpose of this paper is to present findings specific to the understanding and application of suffering in the context of MAID from nurses' perspectives.
A longitudinal qualitative descriptive study using semi-structured telephone interviews. Inductive analysis was used to construct a thematic account. The study received ethical approval and all participants provided written consent.
Fifty nurses and nurse practitioners from across Canada were interviewed. Participants described the suffering of dying and provided insights into the difficulties of treating existential suffering and the iatrogenic suffering patients experienced from long contact with the healthcare system. They shared perceptions of the suffering that leads to a request for MAID that included the unknown of dying, a desire for predictability, and the loss of dignity. Eliciting the suffering story was an essential part of nursing practice. Knowledge of the story allowed participants to find the balance between believing that suffering is whatever the persons says it is, while making sure that the MAID procedure was for the right person, for the right reason, at the right time. Participants perceived that the MAID process itself caused suffering that resulted from the complexity of decision-making, the chances of being deemed ineligible, and the heighted work of the tasks of dying.
Healthcare providers involved in MAID must be critically reflective about the suffering histories they bring to the clinical encounter, particularly iatrogenic suffering. Further, eliciting the suffering stories of persons requesting MAID requires a high degree of skill; those involved in the assessment process must have the time and competency to do this important role well. The nature of suffering that patients and family encounter as they enter the contemplation, assessment, and provision of MAID requires further research to understand it better and develop best practices.
无法忍受的痛苦是请求协助死亡的人的常见资格要求，尽管痛苦已经受到了数千年的哲学关注，但直到最近才成为实证研究的焦点。关于痛苦的坚实理论知识至关重要，因为现代医疗保健为临终患者提供了不同的选择来减轻痛苦。本文的目的是从护士的角度介绍关于在 MAID 背景下理解和应用痛苦的研究结果。
这是一项使用半结构化电话访谈的纵向定性描述研究。采用归纳分析构建主题描述。该研究获得了伦理批准，所有参与者均提供了书面同意。
对来自加拿大各地的 50 名护士和护士从业者进行了采访。参与者描述了临终患者的痛苦，并深入了解了治疗存在性痛苦和患者因长期与医疗保健系统接触而遭受的医源性痛苦的困难。他们分享了导致请求 MAID 的痛苦看法，包括对死亡的未知、对可预测性的渴望以及尊严的丧失。了解痛苦故事是护理实践的重要组成部分。了解故事使参与者能够在相信痛苦是患者所说的任何痛苦之间找到平衡，同时确保 MAID 程序是为了正确的人、正确的原因、在正确的时间进行。参与者认为 MAID 过程本身会导致痛苦，这是由于决策的复杂性、被认为不合格的机会以及临终任务的工作量增加所致。
参与 MAID 的医疗保健提供者必须批判性地反思他们在临床遇到中带来的痛苦历史，特别是医源性痛苦。此外，引出请求 MAID 的患者的痛苦故事需要高度的技能；参与评估过程的人必须有时间和能力来做好这项重要的工作。患者和家属在考虑、评估和提供 MAID 时遇到的痛苦性质需要进一步研究，以更好地理解并制定最佳实践。
