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Dear nurses: On this day…

On the morning of a planned assisted death, Rosanne Beuthin acknowledges her colleagues and the complex emotions many will be experiencing

Nov 06, 2016, By: Rosanne Beuthin, RN, PhD

Our new reality is that capable adults now have the right to request medical assistance in dying to allow them to end their suffering with dignity and respect.

In late June, I took on a new and unique role in our health authority. I am responsible for facilitating access to information about this care option and coordinating various aspects of the care provided in an assisted death. I support our nurses and other staff in understanding the related practice standards and what their roles are.

When the first planned deaths were about to take place, I spoke with the nurse leaders and nurses who would be indirectly or directly involved. I heard uncertainty in their voices as they asked me about what to expect clinically for their patients, the boundaries within their scope of practice and their moral and ethical concerns. These interactions left me deeply moved. While I ensured they had access to key resources that emphasize legal, regulatory and ethical obligations, I also wanted to offer something more personal. To that end, I wrote a letter to a group of nurses on a particular care unit on the morning of an assisted death and handed a copy to each of them. Later, many thanked me and asked if they could share the letter with others.

During the past four months, we have had many such deaths in our health authority. While I continue to direct nurses to regulatory resources and our employee assistance program for additional guidance as needed, I also share the letter with them because I have been told that it resonates in a different way. I humbly offer this excerpt in the hope that it informs your reflections.

For today, on a professional level, do not judge the patient for making this choice. As a competent adult, it is her choice and her right. It is her life. Journey with this patient as best you can, with sensitivity and compassion. She has met the criteria for having a “grievous and irremediable” condition. She is facing death that is reasonably foreseeable. We do not know her suffering — the depth or experience of it. What we see on the outside is not always telling of what is happening on the inside. Her suffering may be physical or emotional or spiritual or…it is not for each of us to know. We can imagine and assume, or maybe we have spoken with her along the way and gained a glimpse of understanding into her experience.>

But it is such that this is her choice, here, today. Her final wish. To leave the pain and suffering, to say goodbye to this precious life. She did not choose to have the illness, but she can choose how and when it will end. We have the privilege of bearing witness to the illness journey of others. And it is not always easy. We are challenged, we are changed, and this is what we do — we care for all.

Thank you for your professionalism and your caring, today and every day.

PS: I expect that as each of you goes home at the end of the day, you will have your own reaction. You may seek quiet and a time of reflection. You may want to go for a run. There may be feelings of sadness or peace. Or you may be filled with amazement. Or you may not be sure how you feel yet at all. We are all individual. We are all learning together. And it is all okay.


Editor’s Note: The views expressed in this column are those of the author and do not necessarily represent the policies of CNA.

Rosanne Beuthin, RN, PhD, is a practice consultant, Island Health (Health Authority) and a nurse researcher with the school of nursing, University of Victoria.