{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:32:37Z","timestamp":1793165557340,"version":"4.5.0"},"reference-count":39,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["150144"],"award-info":[{"award-number":["150144"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Since its inception over half a century ago, a defining attribute of palliative care philosophy has been an insistence that this approach intends to neither hasten death nor prolong life. A commitment to facilitate a \u2018natural\u2019 end-of-life trajectory is ubiquitous in palliative care discourse. However, as an increasing number of jurisdictions around the world legislate to allow assisted death, palliative care providers are having to re-evaluate the relevance of this commitment for the relational ethics of their practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Aims and Participants<\/jats:title>\n                    <jats:p>In this paper, we explore how a sample of Canadian specialist palliative care nurses reflected on this longstanding disciplinary ethic of never intending to hasten death amidst evolving professional and ethical responsibilities to support people who explore and choose medical assistance in dying (MAiD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Design<\/jats:title>\n                    <jats:p>A qualitative analysis of semi-structured interviews with Canadian speciality palliative care nurses, conducted shortly after Canada legalized MAiD. We present an interpretive description through a framework of moral reflection; moral reflection consists of moral intuition, relational ethics, and moral coherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical Considerations<\/jats:title>\n                    <jats:p>Approval was granted from the Research Ethics Board of the University of Ottawa. Informed consent was obtained in writing and confirmed verbally at the time of each interview. We removed identifiers such as participant roles and geographic locations from interview quotes to protect confidentiality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Across the different components of moral reflection, palliative care nurses negotiated their ethical positions amidst changes to end-of-life care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Moral reflection and striving for moral coherence are ongoing processes; the goal is an engagement with moral plurality. As new jurisdictions consider and legalize MAiD, revisiting the early moral reflections of palliative care nurses can help nurses currently wrestling with similar ethical questions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09697330261465860","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:24:11Z","timestamp":1785410651000},"page":"1983-1998","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Palliative care nursing and moral coherence: Early responses to MAiD as hastened death"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2672-5996","authenticated-orcid":false,"given":"Marianne","family":"Sofronas","sequence":"first","affiliation":[{"name":"University of Ottawa, Ottawa, ON, Canada"},{"name":"University of Ottawa, Ottawa, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5174-4024","authenticated-orcid":false,"given":"Dimitri","family":"L\u00e9tourneau","sequence":"additional","affiliation":[{"name":"University of Ottawa, Ottawa, ON, Canada"},{"name":"Universit\u00e9 de Montr\u00e9al, Montreal, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Chan","sequence":"additional","affiliation":[{"name":"University of Ottawa, Ottawa, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0581-827X","authenticated-orcid":false,"given":"Mary Ellen","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Dalhousie University, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8130-656X","authenticated-orcid":false,"given":"David Kenneth","family":"Wright","sequence":"additional","affiliation":[{"name":"University of Ottawa, Ottawa, ON, Canada"},{"name":"University of Ottawa, Ottawa, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"e_1_3_5_2_2","volume-title":"Palliative care","author":"WHO","year":"2023","unstructured":"WHO. Palliative care. World Health Organization, 2023. Available from: https:\/\/www.who.int\/europe\/news-room\/fact-sheets\/item\/palliative-care"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2009.0031"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2004.03148.x"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.12968\/ijpn.2009.15.10.44886"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1191\/0269216304pm961oa"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.21037\/apm-20-632"},{"key":"e_1_3_5_8_2","unstructured":"Health Canada. Medical Assistance in Dying: An Overview. 2025. Available from: https:\/\/www.canada.ca\/en\/health-canada\/services\/health-services-benefits\/medical-assistance-dying.html."},{"key":"e_1_3_5_9_2","unstructured":"Department of Justice Canada. Canada\u2019s medical assistance in dying (MAID) law. Ottawa (ON): Government of Canada; 2024. Available from: https:\/\/www.justice.gc.ca\/eng\/cj-jp\/ad-am\/bk-di.html."},{"key":"e_1_3_5_10_2","unstructured":"Act respecting end-of-life care CQLR c. S-32.0001. Quebec (QC): Government of Quebec; 2026. Available from: https:\/\/www.legisquebec.gouv.qc.ca\/fr\/document\/lc\/s-32.0001"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2021-003191"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12308"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733020976185"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-020-0404-5"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15427"},{"key":"e_1_3_5_16_2","volume-title":"Medical assistance in dying (MAiD): Canadian nurses\u2019 experiences. Nursing forum","author":"Beuthin R","year":"2018","unstructured":"Beuthin R, Bruce A, Scaia M (eds). Medical assistance in dying (MAiD): Canadian nurses\u2019 experiences. Nursing forum. Wiley Online Library, 2018. https:\/\/doi.org\/10.1111\/nuf.12280"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733016679468"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/jan.17025"},{"key":"e_1_3_5_19_2","unstructured":"Wright DK McPherson C Sofronas M et al. Canadian Palliative Care Nursing Association Position Statement on Medical Assistance in Dying and Nursing Care. 2023. Available from: https:\/\/www.cpcna.ca\/_files\/ugd\/67b8a1_7a6f4684300a4719b22d23fb4e6f03a6.pdf."},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2016.0290"},{"key":"e_1_3_5_21_2","unstructured":"Canadian Hospice Palliative Care Association. Position Statement on Hospice Palliative Care and Medical Assistance in Dying 2023. Available from: https:\/\/www.chpca.ca\/wp-content\/uploads\/2024\/07\/CHPCAs-Position-Statement-on-MAiD-%E2%80%93-2023-Update.pdf."},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/nup.12438"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2021.114366"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/09697330251397446"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733020921493"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1037\/0033-295X.108.4.814"},{"key":"e_1_3_5_27_2","volume-title":"The righteous mind: why good people are divided by politics and religion","author":"Haidt J","year":"2012","unstructured":"Haidt J. The righteous mind: why good people are divided by politics and religion. Vintage, 2012."},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1067\/mno.2000.100944"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.1998.00700.x"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.4324\/9781315426259"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733019876312"},{"key":"e_1_3_5_32_2","volume-title":"Affidavit 2. (Carter v. Canada)","author":"Taylor G","year":"2011","unstructured":"Taylor G. Affidavit 2. (Carter v. Canada). Supreme Court of British Columbia, 2011. https:\/\/bccla.org\/wp-content\/uploads\/2012\/06\/20110825-Affidavit-Gloria-Taylor-Affidavit.pdf"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1188\/08.ONF.241-247"},{"key":"e_1_3_5_34_2","volume-title":"Interpreting Canada\u2019s medical assistance in dying legislation","author":"Downie J","year":"2018","unstructured":"Downie J, Chandler JA. Interpreting Canada\u2019s medical assistance in dying legislation. Montreal: Institute for Research on Public Policy, 2018. https:\/\/digitalcommons.schulichlaw.dal.ca\/reports\/28\/."},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-021-00869-1"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1002\/hast.626"},{"key":"e_1_3_5_37_2","first-page":"1","article-title":"The evolving complexities of MAID care in Canada from a nursing perspective","volume":"11","author":"Pesut B","year":"2024","unstructured":"Pesut B, Thorne S, Chambaere K, et al. The evolving complexities of MAID care in Canada from a nursing perspective. Glob Qual Nurs Res 2024; 11: 1\u201315. https:\/\/doi.org\/10.1177\/23333936241228233","journal-title":"Glob Qual Nurs Res"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951523001311"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/09697330211012049"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2019-105758"}],"container-title":["Nursing Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261465860","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09697330261465860","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261465860","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T04:44:57Z","timestamp":1793162697000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09697330261465860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":39,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1177\/09697330261465860"],"URL":"https:\/\/doi.org\/10.1177\/09697330261465860","relation":{},"ISSN":["0969-7330","1477-0989"],"issn-type":[{"value":"0969-7330","type":"print"},{"value":"1477-0989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}