An exploration of how specialist palliative care nurses respond to patient-initiated conversations about assisted dying : A qualitative study utilising Reflexive Thematic Analysis.

Ali, Victoria and Preston, Nancy and Machin, Laura (2026) An exploration of how specialist palliative care nurses respond to patient-initiated conversations about assisted dying : A qualitative study utilising Reflexive Thematic Analysis. PhD thesis, Lancaster University.

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Abstract

Background Assisted dying is illegal in the UK, although some individuals with a desire to die may consider hastening their death with the support of others, including travelling abroad to a jurisdiction where assisted dying is permitted. When patients choose to discuss assisted dying, nurses are often the first healthcare professionals they approach to explore this topic with. However, little is known about the decision-making processes that nurses engage in when determining their response to patients expressing these wishes. Aim The aim of the study is to explore how nurses, who work in specialist palliative care, respond to patients who wish to discuss hastening their death through assisted dying. Methods A qualitative evidence synthesis was undertaken utilising Thematic Synthesis exploring the experience of nurses involved with care they may perceived as death hastening. These findings informed the empirical study, which utilised Reflexive Thematic Analysis methodology. Fifteen nurses were interviewed using a clinical vignette to explore the case. Findings Within the empirical study, an overarching theme providing patients with solutions to remove the desire to die was developed. To do this, the nurses engaged with three themes relating to their own understanding of the legal status of assisted dying, the influence of the care setting to build relationships with the patient and the teams they work within, and protecting professional and public perceptions of palliative care. Conclusion A patient’s wish to seek an assisted death disrupts the pervasive forces that exist within palliative care services. Perceptions of palliative care, both from patients and the profession itself, have an impact on how nurses engage with patient-led discourse relating to assisted dying. Nurses are struggling to find their voice within these discussions, both within their teams and with wider society. Physical and emotional space needs to be created to enable nurses to be able to fully realise their impact on discussions relating to assisted dying.