title: Nurses' moral experiences of assisted death: A meta-synthesis of qualitative research.
abstract: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses' experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses' experiences of caring for people who request this option.
  To synthesize what has been learned about nurses' experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who undertake this type of care.
  Qualitative meta-synthesis.
  Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis.
  The moral experience of the nurse is (1) defined by a profound sense of responsibility, (2) shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and (3) sustained by intra-team moral and emotional support.
  The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses' moral agency that operate in everyday end-of-life care.
  Research ethics board approval was not required for this synthesis of previously published literature.
  In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded.
authors.affiliation: St. Mary's Research Centre, Canada; McGill University, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Elmore
authors.affiliation: University of Ottawa, Canada; St. Mary's Research Centre, Canada.
authors.forename: David Kenneth
authors.initials: DK
authors.lastname: Wright
authors.affiliation: McGill University, Canada.
authors.forename: Maude
authors.initials: M
authors.lastname: Paradis
mesh_terms: D006801:Humans; D009014:Morals; D009726:Nurses / Q000523:psychology*; D036301:Qualitative Research; D017236:Suicide, Assisted / Q000941:ethics* / Q000523:psychology*
keywords: Assisted death; assisted suicide; empirical approaches; end-of-life issues; ethics of care/care ethics; euthanasia; literature review; meta-synthesis; nurses; palliative care; qualitative research; theory/philosophical perspectives; topic areas