A community hospital system located in Ontario within one of Canada’s most culturally-diverse regions opened a Medical Assistance in Dying (MAiD) room for outpatients in 2017. Shortly after opening the MAiD room, nursing and allied health staff on an adjacent unit reported ‘paranormal’ experiences. Their experiences included unexplained sounds, temperature and lighting changes, feeling a breeze, and feeling a sense of unease and dread when near the MAiD room.

Reports of paranormal experiences related to the MAiD room were brought to Ethics by the unit manager, likely because Ethics has been involved with the development and planning of MAiD services at the hospital. The unit manager was concerned that these experiences were affecting workflow, job satisfaction, and staff well-being. Some staff refused to enter the room, while others avoided walking near it or the nearby storage and meeting rooms, especially when alone or at night. Many staff requested that the room be moved. In addition, the Ethics team recognized that continued reports of paranormal activity could lead to difficulties maintaining the room as a space for outpatient MAiD assessments and procedures. Such difficulties could reduce outpatient access to MAiD.

Given that some of these issues raised by staff extend beyond the domain of Ethics, the departments of Spiritual Health Therapy, and Health Equity & Inclusion were invited to collaborate on this case. The three departments jointly created an Interdepartmental Team headed by Ethics.

The Interdepartmental Team was faced with the following questions: respect for diverse cultural and spiritual beliefs of patients is a core commitment of healthcare (1) – but should this commitment extend to beliefs held by staff? And if it ought to extend, how can an organization respond to experiences staff are having in a way that demonstrates such respect?

In order to demonstrate respect for staff’s beliefs and experiences while also knowing that it would be difficult or impossible to find other space, we were committed to engaging directly with staff and being transparent about our decision-making process. As we explain in this case study, our aim was not to discern the truth of staff reports, but to understand the problem and reduce staff discomfort by co-creating solutions with them. This approach was guided by health care Quality Improvement principles, which emphasize prevention and improvement strategies through consistent data collection (2). Achieving these aims required the interdisciplinary response of the Interdepartmental Team to address different aspects of the problem.

After discussions with the unit manager, the Interdepartmental Team (Ethics, Spiritual Health Therapy, and Health Equity & Inclusion) initiated and facilitated a series of weekly 10-30 minutes ‘huddles’ for a month with nursing and allied health staff on the unit adjacent to the MAiD room. The Interdepartmental Team started the huddles by explaining that their purpose was to provide a safe and respectful environment for staff to share their experiences, if they chose to do so. The aim was to learn about the nursing and allied health staff’s experiences, and to co-create solutions with them.

Spiritual Health Therapy offered spiritual support for staff’s experience of the paranormal and confirmed that similar experiences are reported in the literature (3-6). Health Equity & Inclusion reaffirmed the hospital’s commitment to the diverse religious and cultural belief systems that exist amongst staff. Ethics addressed staff questions related to the eligibility criteria, processes, and current context for MAiD in Canada.

The huddles provided opportunities to listen to staff, learn about their experiences, and understand how these affected their well-being and job satisfaction. Staff were also invited to recommend solutions that would address their concerns. In total, about 35 staff members, excluding the Interdepartmental Team, participated in the various huddles.

During the huddles, staff openly shared their experiences. Some staff reported auditory and sensory experiences inside or near the MAiD room, including feeling a breeze, hearing loud noises (including knocks and thuds that sounded like an individual falling out of their bed), hearing whispering, and feeling someone touch their arm. Others felt an unexplained “heavy energy.” One staff member expressed that although she did not believe in the paranormal, her arm had been moved involuntarily when she was in the room, while another reported that mechanical equipment started working on its own. Some staff were apprehensive or fearful to come near the room during night shifts.

Although the staff who participated in the huddles were not directly involved with the assessments or procedures in the out-patient MAiD room, some expressed strong feelings and values surrounding MAiD itself. Some said that they were “there to save lives” and “it does not seem natural to let people die.” Others described MAiD as inherently different from other kinds of deaths that happen all the time in the hospital, because such a death is intentional. Others shared that it was unnerving to see people walking and talking, going into the MAiD room, and then later coming out dead. This did not seem to meet their version of ‘normal’ because “God had not been calling them [MAiD patients] and they themselves chose to die.” Others expressed that although MAiD was not against their personal beliefs, it elicited a spiritual response such as saying a blessing or prayer for those who had elected to receive MAiD.

When asked for recommendations, staff requested that they be alerted whenever the room was to be used for an assessment or procedure, and that Spiritual Health Therapy regularly visit the unit. Many also asked that the room be moved away from the unit to another location in the hospital.

Co-designed interventions included Spiritual Health Therapy providing daily room blessings, reading scripture aloud in the room, performing blessings for staff members, and providing a night light for continuous lighting. Smudging and meditation were also provided. Spiritual Health Therapists supported staff by frequently visiting the unit and engaging in one-on-one conversations.

The unit staff will also receive pre-briefs and de-briefs from Ethics whenever the MAiD room is booked for a procedure, in order to review the legal and ethical aspects of MAiD, as well as to enable staff to discuss their feelings. Spiritual Health Therapists are present after MAiD procedures to support individual staff members as needed.

Ethics also affirmed for staff that the hospital is committed to facilitating the provision of MAiD for eligible patients, and is also committed to providing a safe workplace for staff.

The room was not moved as a different space was not available and the issues were likely to persist in a different location.

In this case, the collaborative interdisciplinary approach has encouraged staff engagement and resulted in positive feedback from staff. There have been several MAiD procedures in the room since the interdisciplinary response. Staff have reported feeling more at ease and less distressed and no new paranormal experiences have been reported. We found transparency, engagement, and interdisciplinary collaboration valuable in addressing staff concerns of paranormal experiences related to the MAiD room. The case study raises further questions to consider: Death occurs regularly in the hospital – was MAiD a catalyst for these experiences? Are there strategies, such as increased education or awareness that could prevent similar staff discomfort when MAiD provision occurs?