Cedar McMechan

Helping someone end their life may seem like a compassionate act, but it’s fraught with legal and ethical complications, as well as emotional and faith-based arguments that have challenged society from the beginning of time.

Now Canadian law permits physicians and nurse practitioners to provide medical assistance in dying (MAiD). RNs can play a valuable supportive role in this regard, however, Cedar McMechan, 29, wanted to know more about that role and the frontline experiences of her fellow RNs.

Rather than ask difficult questions, she prepared a research paper analyzing her fellow students’ experiences with, and perceptions of, MAiD including what they thought a nurse should know to prepare for the bedside reality of a medically-assisted death.

McMechan shared her findings which broke new ground in Canadian nurse education. Not only did she win a 2018 JCURA award in her fourth and final year with UVic’s School of Nursing, she went on to publish a paper in Quality Advancement in Nursing Education (April 2019) which caught the attention of policymakers and media alike (CBC News, Feb. 20, 2020).

"Students really struggled to know what their role was," said McMechan, who now works as an RN in her hometown of Nelson, BC. She described how nurses are impacted personally and professionally by MAiD and identified gaps within the current curriculum. Her focus was centred on the experience of nine fourth year nursing students in Island Health.

McMechan found students were dedicated to supporting patients' autonomy, but were confused about their responsibilities and feared saying the wrong thing. Opportunities to enhance learning included having clear instructions on the process, using clinical simulation to role-play speaking with patients about MAID, and hearing from nurses who could share their first-hand experiences.

Nursing students want to know what medications patients will be receiving, McMechan explained. Once administered, they wondered how the patient reacted and how fast the drugs took hold. They asked what it felt like for a nurse to witness a patient’s death and how a nurse should take care to manage emotions and spiritual beliefs.

“It is such a complicated experience," she said.

McMechan posed recommendations in her paper, including access to peer networks as a form of support. Counselling and guidance should be made available, too. “Talking with the physician present is valuable,” she said, “especially in the case of a complicated death.”

When asked what drew her towards this work, she talks about growing up with Peter, a man who had cerebral palsy whom her father cared for.

“My dad was a personal caregiver. Peter would come live with us two weeks on and two weeks off. He was like another brother. He had a calming effect on me when I was little and so he was a major force in my early years. Along with my dad, who modeled such caring behaviours, they both inspired me to become a nurse.”

Peter was the first person in McMechan’s young life to die.

“I used to feel fear around death but I’ve since learned that it can also be an incredible experience. Coming into the world of nursing education, I felt it was a natural part of living and important to learn about.”

That fear has dissipated, she says, through exposure to end-of-life care.

“I became competent in the management of the dying patient and in supporting the family. I help them come to terms with what to expect and how we care for patients at the end of their lives.”

“Yes, this work can be emotionally wearing,” she admits, pointing to a kind of subconscious toll which caught her off guard in her early career.

Learning about end of life care is one thing, she says, while working in a professional setting is quite another. Even with her experiences and polished skills, it took time for her to realize she was taking on people’s pain. “It crippled me,” she says and she had to find a way to better protect her emotional and spiritual self to carry on.

“I have since learned how to remain strong and supportive, to store my emotions away for processing at a later time. Fitness is a huge piece, too. I’m a runner and I love being outside. Running, hiking, skiing; these are things I prioritize now.”

“Death is a powerful teacher,” she adds.

Today, McMechan is fully engaged in her work, serving as an RN with Trail Regional Hospital and Kootenay Lake Hospital in Nelson. She works in the community, too, with home health care services and with a non-profit sexual health clinic. She also speaks to nursing students within her community about the logistics of MAID and encourages students to ask the difficult questions.

Training to be a critical care nurse, McMechan plans on returning to academia to become a nurse practitioner.

“My big passion is to become a palliative care practitioner.”