Work

Nurses’ experience of moral distress in the context of medical assistance in dying (MAiD): a systematic review

Year: 2025

Type: review

Abstract: Purpose Moral distress poses a significant challenge in nursing, often arising in ethically complex situations and leading to negative outcomes such as mental and physical strain, burnout, staff turnover, and diminished care quality. As medical assistance in dying (MAiD) is an ethically contentious practice, it could be a major source of moral distress for nurses. This systematic review synthesizes international evidence on nurses’ experiences of moral distress in the context of MAiD and considers its relevance for the German healthcare system. The central question guiding this review is: What evidence exists on nurses’ experiences of moral distress related to MAiD? Methods The review was pre-registered on PROSPERO and conducted in accordance with PRISMA guidelines. Peer-reviewed empirical studies in English were included, spanning all care settings. Databases searched were CINAHL, MEDLINE, and PsycINFO, supplemented by manual searches. Studies were screened using predefined criteria and assessed with Joanna Briggs Institute tools. A narrative synthesis resulted in a conceptual model outlining contributing factors to moral distress in MAiD. Results From 3079 records, 25 studies (22 qualitative, 2 quantitative, 1 mixed-methods) from nine countries were included. Six interconnected themes were identified: (1) complex emotional reactions, (2) moral reasoning, (3) intrinsic factors, (4) situational factors, (5) relational factors, and (6) extrinsic factors. Conclusion The findings underscore the complexity of moral distress in the MAiD context. Addressing this requires policy and educational strategies as well as the promotion of ethical dialogue and interdisciplinary support structures.

Source: Ethik in der Medizin

DOI: 10.1007/s00481-025-00887-0

Authors: Karen Klotz, Thomas Heidenreich, Pia Madeleine Haug, Stephanie Feinauer, Annette Riedel

Institution: Esslingen University of Applied Sciences

Language: English

Topic: Ethics in medical practice

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Peace, justice, and strong institutions

Open Access status: hybrid

Estimated APC paid: $2,290