Authorities within the field of palliative care frequently espouse that assisted death is – and must remain – separate from palliative care. This fault line, between palliative care and assisted death, has important implications for how we enact end-of-life care, particularly in jurisdictions where assisted death is legal. And yet little is known about how direct-care clinicians providing palliative care navigate this demarcation in everyday practice. This qualitative study reports on semi-structured interviews with 22 palliative care nurses from across Canada, where assisted death was legalized in 2016. Although a minority of participants did express categorical opinions around the (non) legitimacy of assisted death as an ethical end-of-life care option, most engaged in an ongoing and sometimes painful process of questioning and self-examination. Their ethical reflections were more nuanced than simply dismissing MAiD as incompatible with palliative care philosophy; yet this idea of incompatibility weighed heavily as they reasoned through their experiences and questioned their own perspectives. Nurses described grappling with the finality of assisted death, which contradicts their belief in the telos of palliative care; when adequately resourced, palliative care should be available to support people to live well before death. At the same time, commitment to important palliative care values such as the non-abandonment of dying people and respecting peoples’ individual end-of-life choices reveal the possibility of overlap between the ethos of assisted death and that of palliative care nursing. Drawing on scholarship in feminist ethics, our study sheds light on the moral identity work that assisted dying catalyzes amongst palliative care nurses. We highlight what is at stake for them as they navigate a delicate tension in responding ethically to patients whose suffering motivates an interest in assisted death, from within a wider professional collective that upholds a master narrative about the incompatibility of assisted death and palliative care.

姑息治疗领域的权威经常支持辅助死亡与姑息治疗分开——而且必须保持分离。姑息治疗和辅助死亡之间的这条断层线对我们如何制定临终关怀具有重要意义，特别是在辅助死亡合法的司法管辖区。然而，人们对提供姑息治疗的直接护理临床医生如何在日常实践中驾驭这一界限知之甚少。这项定性研究报告了对来自加拿大各地的 22 名姑息治疗护士的半结构化访谈，其中辅助死亡于 2016 年合法化。尽管少数参与者确实对辅助死亡作为道德终结的（非）合法性表达了明确的意见- 生活护理选项，大多数人都在进行持续的、有时是痛苦的质疑和自我检查过程。他们的伦理反思比简单地将 MAiD 视为与姑息治疗哲学不相容更微妙。然而，当他们通过自己的经历进行推理并质疑自己的观点时，这种不兼容的想法很重要。护士们描述了如何应对辅助死亡的终结，这与他们对姑息治疗的目的相矛盾；如果资源充足，应提供姑息治疗，以支持人们在死前过上好日子。同时，对重要的姑息治疗价值观的承诺，例如不放弃临终者和尊重人们的个人临终选择，揭示了辅助死亡与姑息治疗精神之间可能存在重叠。借鉴女权主义伦理学，我们的研究阐明了在姑息治疗护士中协助临终催化的道德认同工作。我们强调了他们面临的利害关系，因为他们在一个更广泛的专业集体内部，在道德上应对患者的道德反应时出现微妙的紧张关系，该集体支持关于辅助死亡和姑息治疗不相容的主要叙述。