Nursing Narratives of Assisted Dying Implementation in New Zealand
Background: New Zealand is a country with a health system built upon both Western and Māori world views and care is delivered to, and by people from culturally diverse backgrounds. In November 2020, the End-of-Life Choice Act was passed in New Zealand following a referendum, with assisted dying subsequently legalised in November 2021. Some form of assisted dying has been legalised in several countries and jurisdictions globally, wherein nurses play a significant role at different stages of the assisted dying process, thus impacting nursing practice and policy. However, nurses were not mentioned in the End-of-Life Choice Act in New Zealand. There is limited assisted dying literature from New Zealand, categorically nursing focused to comprehend the implications of this change for nurses, and nursing practice and policy. Aim: The aim of this research was to develop an understanding of how assisted dying legislation and subsequent implementation impacts upon practice and policy for nurses in New Zealand. Methods: This qualitative research was conducted through narrative inquiry and grounded within a social constructivist paradigm in the field of nursing research. Participants were ten nurses working in a range of end-of-life care settings across New Zealand. Interviews were conducted after the End-of-Life Choice Act was passed, but two to three months prior to the date where it was enacted. Thematic analysis was applied to make sense of the data and generate meaningful themes. Results: The overall finding from this research was that, the assisted dying implementation in New Zealand challenged the professional identity of nurses. The nurses’ narratives deepened the understanding that nursing is a human profession, and nurses’ roles include compassion, care, intuition, advanced clinical skill and intricate knowledge of their communities. Nurses were not recognised as stakeholders by local boards and policymakers, showing a lack of cognisance of the significance of this legislative and social change for nursing. Participants described being excluded during implementation processes, education and resource provision thus, lessening the meaningfulness, confidence, and understanding of what it meant to be a nurse who would support patients, families, and other health professionals through this new type of death. The nurses felt that this had the potential to compromise patient care, and safety. Consequently, resulting in assisted dying challenging the professional identity of nurses, as they were unprepared to understand and fulfil their roles in assisted dying practice and policy. Conclusion: The results suggested there is a need for change to assisted dying policy specific to nursing practice, and increased support, education, and resource allocation to better prepare nurses for assisted dying in practice. It is proposed that including the role of the nurse in the End-of-Life Choice Act, could place responsibility on policymakers and organisations, to better resource and support nurses with this legislative and social change. As nurses’ roles and responsibilities continue to grow to meet population requirements there is a growing need to clearly define nurses’ roles through the way the government shapes policy, recognising nurses as key stakeholders in any healthcare practice and policy change.