https://www.infirmiere-canadienne.com/blogs/ic-contenu/2024/05/27/infirmiere-aide-medicale-mourir-nord
Embraces ability to ‘mitigate suffering through human connection and empathy’
By Traci Tripp
May 27, 2024
Courtesy of Traci Tripp
“Providing good palliative care is not only about the quality of living, but also the quality of dying. For some, the quality of their death is influenced by the amount of control they have over it,” Traci Tripp says.
I have found that accepting the inevitability of death — not fearing it — enables me to truly start living.
Courtesy of Traci Tripp
Getting outdoors is one of the best ways to enjoy the North, Traci Tripp says. “Northerners do not just survive the cold, they thrive.”
I truly started living in 2010 when I became a nurse on the tertiary palliative care unit at the Grey Nuns Community Hospital in Edmonton, while providing specialty care to those experiencing life-limiting illness.
An interdisciplinary team
As an interdisciplinary team at the unit, we sought to mitigate suffering through holistic care. It was while working on this unit that I first became acquainted with medical assistance in dying (MAID) as a treatment option upon its legalization in 2016.
There has been a lot written about MAID, from a variety of frames of reference. Despite this, there still seems to be a lot of confusion about who can access MAID, the eligibility requirements, and who can have discussions related to this care option. Indeed, this confusion became my reality in January of 2023, as I accepted a position as the first MAID nurse navigator for the Northwest Territories.
Living in the North
The Northwest Territories are a vast land mass inhabited by some of the warmest people I have ever met. Northerners do not just survive the cold, they thrive.
In true northern fashion, I donned fur, wool, and mukluks to survive my winter treks to work. As the seasons changed to endless sunlight, so did my dress — and as winter faded from a howl to a whisper, I began to find my stride as the MAID nurse navigator for the North.
Prior to arriving in Yellowknife, I had received my specialty certification in Hospice Palliative Care Nursing (CHPCN) through the Canadian Nurses Association. Certification demonstrates expertise in this field of practice and a dedication to providing the best possible care to people experiencing life-limiting illness.
Quality of living and dying
As I can attest, providing good palliative care is not only about the quality of living, but also the quality of dying. For some, the quality of their death is influenced by the amount of control they have over it. As disease robs them of control over their body and its functions, it is in choosing a peaceful death that they can regain control.
Unequivocally, the request for MAID is rooted in suffering or in the anticipation of suffering. Some feel that this expression of suffering is the result of limited access to quality palliative care. However, I can say without hesitation that in the North, I worked with many dedicated physicians and nurse practitioners who juggled multiple care responsibilities, to provide quality palliative care while also upholding someone’s right to seek care options of their choosing.
Eligibility and assessment
People wishing to be assessed for MAID must meet several eligibility requirements as outlined by federal legislation (Canadian Association of MAiD Assessors and Providers, 2022a). Under these requirements a person must meet the following criteria:
- Be eligible for government-funded health insurance in Canada
- Be 18 years of age or older
- Have a grievous and irremediable condition
- Have made a voluntary request for MAID that was not a result of external pressure
- Have decision-making capacity
- Give informed consent to receive MAID after having received all information needed to make this decision, including a medical diagnosis, available forms of treatment, and options to relieve suffering (including palliative care) (CAMAP, 2022a).
A person is evaluated by a minimum of two independent health-care professionals (either a physician or nurse practitioner) to confirm eligibility and verify that procedural safeguards have been met (CAMAP, 2022a).
Living while dying
During my time as a nurse navigator, I would work with clinicians, clients, and family members to provide referrals, education, and support to confirm that those seeking control of their final moments could also live while they were dying.
This role is complex and requires nurses to connect with their clients on an emotionally intimate level, without reserve. Hearing about the nature of someone’s suffering, their regrets, hopes, and wishes is by far some of the most privileged information you can be trusted with as a nurse, or even as a person. You cannot be untouched by these moments — nor would you want to be.
These conversations are the sum of a person’s life and show true courage — the courage to reflect on a life lived and a willingness to accept death as the person they are, not as the person that disease has left them. It also shows courage on behalf of the listener: a willingness to mitigate suffering through human connection and empathy.
A professional obligation
Often, MAID teams are not the first point of contact for those wishing for a medically assisted death. There is no provision in the law that bans nurses from responding to questions about MAID from patients or loved ones. In fact, health-care professionals have a professional obligation to respond factually and without bias to questions about MAID (CAMAP, 2022b).
As a registered nurse, asking the right questions, at the right time, can go a long way to supporting a patient and their family and in developing a therapeutic relationship. Questions such as, “Do you want to talk about your end-of-life care options?” or “What does a good death look like to you?” can start the conversation and establish advance care planning, which is key in achieving a person’s end-of-life goals (British Columbia Ministry of Health, 2021).
Prior to MAID being legislated as a treatment option, many nursing programs did not provide instruction on how to respond to a person’s request to die. Now, learning institutions such as Aurora College in Yellowknife, host representatives from the Northwest Territories MAID care team to prepare nursing students for these eventualities.
An appropriate response: validation and assessment
Preparation includes being ready to respond to statements such as, “I just wish this was over” or “I want to die” or “Can you give me something, so I don’t wake up again?” Having an appropriate response can validate a person’s suffering and clarifies what a patient means or is asking for (BCMH, 2021).
In these moments, it can be challenging to know what to say. Having some prepared responses can help you assess a patient’s care needs, wants, and desires. These responses can take the form of questions, such as “Would you like to tell me more about what you are feeling?” or “It sounds like you are suffering; how can I help?” and more directly, “Sometimes when people say these things, they are asking for information on assisted dying. Is that what you are asking about?” (BCMH, 2021).
If it is determined that a client is asking for information on or for MAID, documenting the conversation and ensuring a referral to the MAID program or someone who can speak to them about MAID as a treatment option, as soon as possible, is a professional requirement (BCMH, 2021). Moreover, unless the person who receives the request is completing a formal assessment, they cannot determine a person’s eligibility. Decisions about capacity or qualification can be established only through a formal assessment as done by a MAID assessor (BCMH, 2021).
A pivotal time
Without a doubt, early 2024 had promised to be a pivotal time for MAID programs across Canada. Legislative changes were in place to permit eligibility for MAID programs for people where a mental disorder was their sole underlying medical condition (known as MD-SUMC).
Discussions about this expansion have been heated and have referenced concerns over the availability of resources and treatments for clients with mental illness across Canada. On whichever side of the debate Canadians sit, having an informed opinion is vital, and should include familiarity with the eligibility criteria, assessment requirements, and safeguards.
As care providers and patients, our stories are sacred. We all play an important role in creating a healthy and sustainable health-care system. While there are many designations and titles working within a health-care system, it takes only one of us to make a profound difference in someone’s life.
Having worked as a MAID nurse navigator, I have been privileged to witness and, I believe, to be a part of that difference. And I have learned, in the process, to be grateful for and more alive in my own life.
References
British Columbia Ministry of Health. (2021). Introduction to medical assistance in dying (MAiD). Available from https://learninghub.phsa.ca/Learner/Home
Canadian Association of MAiD Assessors and Providers. (2022a). Eligibility. Retrieved from https://camapcanada.ca/for-the-public/eligibility/
Canadian Association of MAiD Assessors and Providers. (2022b). Bringing up medical assistance in dying (MAiD) as a clinical care option. Retrieved from https://camapcanada.ca/wp-content/uploads/2022/02/Bringing-up-MAiD.pdf
Traci Tripp, RN, BN, CHPCN(c), recently joined Vancouver Coastal Health as a palliative care resource nurse, where she continues to provide treatment options for those with life-limiting illness.
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