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Wong LS, Scahill SL, Barton E, Van der Werf B, Boey J, Ram SS. Pharmacists' Attitudes towards Medically Assisted Dying. PHARMACY 2024; 12:40. [PMID: 38391008 PMCID: PMC10885061 DOI: 10.3390/pharmacy12020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
AIMS We aimed to explore pharmacists' attitudes and support toward medically assisted dying (MaiD) through the End of Life Choice Act 2019 (EOLC), their willingness to provide services in this area of practice, and the influences on their decisions. METHODS The study was conducted via an anonymous, online QualtricsTM survey of pharmacists. Registered New Zealand pharmacists who agreed to receive surveys from the two Schools of Pharmacy as part of their Annual Practicing Certificate renewal were invited to participate through an email with a Qualtrics URL link. The survey contained questions regarding demographics, awareness, knowledge, support for, and attitudes and willingness to participate. RESULTS Of the 335 responses received, 289 were valid and included in the analysis. Most participants supported legally assisted medical dying (58%), almost a third of participants did not support it (29%), and 13% of respondents were unsure. The five primary considerations that participants perceived to be beneficial included support from legislation, respect for patient autonomy, discussions around morality, ending suffering, and preserving dignity. The main concerns were legal, personal bias, palliation, stigmatisation, and vulnerability. CONCLUSIONS The influences on the decision by pharmacists to support and willingness to participate in the provision of services consistent with the EOLC are complex and multifactorial. Diverse factors may influence attitudes, of which religion is the most significant factor in not supporting the Act or willingness to participate. Clarity and standardised guidance to ensure that assisted dying queries are appropriately managed in practice would help to address any potential access issues.
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Affiliation(s)
- Lun Shen Wong
- School of Pharmacy, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Shane L Scahill
- School of Pharmacy, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Emma Barton
- School of Pharmacy, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Bert Van der Werf
- School of Epidemiology and Biostatistics, The University of Auckland, 28 Park Ave., Grafton, Auckland 1023, New Zealand
| | - Jessica Boey
- School of Pharmacy, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Sanyogita Sanya Ram
- School of Pharmacy, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
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Bustin H, Jamieson I, Seay C, Reid K. A meta-synthesis exploring nurses' experiences of assisted dying and participation decision-making. J Clin Nurs 2024; 33:710-723. [PMID: 38054527 DOI: 10.1111/jocn.16949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
AIMS AND OBJECTIVES To explore nurses' experiences of assisted dying and understand how their perspectives inform their participation decision-making. BACKGROUND Assisted dying is a complex and contentious issue with the potential to create moral unrest for nurses. The nursing role in assisted dying varies between jurisdictions. DESIGN Systematic review. A meta-synthesis using thematic analysis. METHODS Three electronic databases were searched for primary qualitative studies published in English, from New Zealand, Australia or Canada, up to October 2022. Seven articles were included; themes were analysed and key themes were established. Reporting adhered to PRISMA. RESULTS The findings highlight the complexity of nurses' decision-making about participation or non-participation in assisted dying and the moral, philosophical and social influences that impact on their decision-making. This is presented as a spectrum of influence which persuades or dissuades nurses to participate in assisted dying. The 12 themes have been categorised into four key themes: personal persuaders, personal dissuaders, professional persuaders and professional dissuaders. CONCLUSIONS The findings suggest that nurses should be involved in policy and procedure guideline development and be offered education and training programmes to ensure safe, confident and informed practice. The need for mentorship programmes was also prevalent in the research. RELEVANCE TO CLINICAL PRACTICE It is crucial that nurses be offered education and training in assisted dying. Clear policy and procedure guidelines are essential, and nurses should be involved in the development of these.
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Affiliation(s)
- Heather Bustin
- Ara Institute of Canterbury, Te Pūkenga, Manawa Campus, Christchurch, New Zealand
- University of Canterbury, Christchurch, New Zealand
| | - Isabel Jamieson
- Ara Institute of Canterbury, Te Pūkenga, Manawa Campus, Christchurch, New Zealand
- University of Canterbury, Christchurch, New Zealand
| | | | - Kate Reid
- University of Canterbury, Christchurch, New Zealand
- University of Otago, Christchurch, New Zealand
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McDougall R, Pratt B, Sellars M. Ethical Diversity and Practical Uncertainty: A Qualitative Interview Study of Clinicians' Experiences in the Implementation Period Prior to Voluntary Assisted Dying Becoming Available in their Hospital in Victoria, Australia. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:71-88. [PMID: 36800132 PMCID: PMC10126061 DOI: 10.1007/s11673-022-10224-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/01/2022] [Indexed: 05/04/2023]
Abstract
In the Australian state of Victoria, legislation allowing voluntary assisted dying (VAD) passed through parliament in November 2017. There was then an eighteen-month period before the start date for patient access to VAD, referred to as the "implementation period." The implementation period was intended to allow time for the relevant government department and affected organizations to develop processes before the Act came into effect in June 2019. This qualitative interview study investigates the perspectives of a multidisciplinary sample of twelve clinicians from a single metropolitan hospital during this implementation period. Maximum variation sampling was utilized to ensure breadth across discipline (medical, nursing, allied health), speciality, and stated level of support for the VAD legislation. Four key themes were identified from the interview data: preparing for the unknown, ethical diversity within the organization, building a respectful culture, and concerns about the inability of the legislated approach to capture clinical nuances. Overall, these clinicians' workplace experiences during the implementation period were shaped by the ethical diversity within their organization and a sense of uncertainty about how the VAD legislation would integrate with the practical realities of their clinical setting. The concept of "ethical diversity" could be a useful one for supporting staff in an organization during a VAD implementation period.
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Affiliation(s)
- Rosalind McDougall
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria 3010 Australia
| | - Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University, Brisbane, Queensland 4000 Australia
| | - Marcus Sellars
- Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, Australia, Canberra, Australian Capital Territory 2600 Australia
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Richardson S. An international expansion in voluntary euthanasia/assisted dying: The implications for nursing. Int Nurs Rev 2023; 70:117-126. [PMID: 36271824 DOI: 10.1111/inr.12807] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
AIM To provide an update on the international position of assisted dying legislation and its implications for nursing policy. BACKGROUND Assisted dying legislation has been introduced in health systems in Europe, North America and Australasia (Australia and New Zealand). Despite contributions in research literature, this remains focussed on medical practitioners, with limited acknowledgement of the need for policy development in nursing. DISCUSSION There is a need for critical evaluation of this contemporary issue and the significance for nursing practice of the lack of unified nursing perspective and robust policy guidance is identified. An overview of the existing role of voluntary euthanasia/assisted dying with recent developments is provided and the resulting concerns for nurses regarding the scope of practice, role confusion and conflicting professional values is considered. CONCLUSION Despite a long history of assisted dying and the continued expansion of these practices, limited and highly variable nursing policy highlights the lack of clear guidance available to nurses. The growing inclusion of nurse practitioners and recognition of registered nurse involvement in the care of individuals on an assisted dying pathway merits clearer support from regulatory authorities and professional organisations. IMPLICATIONS FOR NURSING PRACTICE Nurses are the most likely health professionals to be approached with questions regarding assisted dying; they are intimately involved in patient experiences and need to understand what is possible, expected and legal in terms of their scope of practice regarding assisted dying. IMPLICATIONS FOR NURSING POLICY Nursing regulators and professional representatives need to provide clear policy statements and guidance identifying the nursing role and recognising where protections and support are necessary.
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Affiliation(s)
- Sandra Richardson
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
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Hol H, Vatne S, Strømskag KE, Orøy A, Rokstad AMM. Norwegian nurses' perceptions of assisted dying requests from terminally ill patients-A qualitative interview study. Nurs Inq 2023; 30:e12517. [PMID: 35975335 PMCID: PMC10078436 DOI: 10.1111/nin.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 01/25/2023]
Abstract
This study explores the perceptions of Norwegian nurses who have received assisted dying requests from terminally ill patients. Assisted dying is illegal in Norway, while in some countries, it is an option. Nurses caring for terminally ill patients may experience ethical challenges by receiving requests for euthanasia and assisted suicide. We applied a qualitative research design with a phenomenological hermeneutic approach using open individual interviews. A total of 15 registered nurses employed in pulmonary and oncology wards of three university hospitals and home care in one municipality were recruited. Four themes emerged from the analysis: (1) unprepared for the request; (2) meeting direct, indirect, and nonverbal requests; (3) working in a gray zone, and (4) feeling alone and powerless. The study found that nurses were unsure how to handle such requests due to professional uncertainty about assisted dying. Working in an environment where the topic is taboo made nurses morally uncertain, and some perceived this as moral distress. The hospital chaplain played a significant role in providing support to these nurses.
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Affiliation(s)
- Hege Hol
- Faculty of Health Science and Social Care, Molde University College, Molde, Norway
| | - Solfrid Vatne
- Faculty of Health Science and Social Care, Molde University College, Molde, Norway
| | | | - Aud Orøy
- Faculty of Health Science and Social Care, Molde University College, Molde, Norway
| | - Anne Marie Mork Rokstad
- Faculty of Health Science and Social Care, Molde University College, Molde, Norway.,Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Hewitt J, Grealish L, Bonner A. Voluntary assisted dying in Australia and New Zealand: Exploring the potential for nurse practitioners to assess eligibility. Collegian 2022. [DOI: 10.1016/j.colegn.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bernier L, Bernatchez S, Sweeney Beaudry A. L’avortement tardif et l’aide médicale à mourir au-delà de l’autonomie individuelle : comment réguler les pratiques pour assurer le vivre ensemble ? CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1089781ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Fuscaldo G, Gwini SM, Larsen R, Venkataramani A. Do Health Service staff support the implementation of Voluntary Assisted Dying at their workplace? Intern Med J 2021; 51:1636-1644. [PMID: 33710752 DOI: 10.1111/imj.15285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND On 29 November 2017, the Victorian Parliament passed the Voluntary Assisted Dying (VAD) Act 2017, which came into effect from 19 June 2019. AIM To investigate whether staff from a large regional health service support the legalisation of Voluntary Assisted Dying (VAD) and the implementation of VAD at their workplace. METHODS Staff were invited to complete an anonymous online survey comprising both closed and open-ended questions. RESULTS 38% of the workforce (n = 1624) responded to the survey. Most participants supported the legalisation of VAD (88%), the provision of eligibility assessment and/or the administration of VAD within the health service (80%). There were negligible differences in support for VAD by role, however, specialist doctors were significantly less supportive (65%). Approximately half of the respondents expressed concern about monitoring (49%) or implementation (53%) of VAD. Concerns were also raised about assessment of eligibility, support for staff involved in VAD and pressure on both patients and staff to participate. Nearly three quarters (71%) of participants agreed that if the health service offers VAD services, a special unit or facility should be available. CONCLUSION This study found that health workers have concerns about the implementation of VAD at their workplace but are generally supportive. This paper provides information for health services considering the implementation of VAD, about staff concerns and issues that need to be addressed for the successful introduction of VAD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- G Fuscaldo
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia, 3128
| | - S M Gwini
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220.,iMPACT, Faculty of Health, Deakin University, Geelong, Australia, 3220
| | - R Larsen
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220
| | - A Venkataramani
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220
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Pentaris P, Jacobs L. UK Public's Views and Perceptions About the Legalisation of Assisted Dying and Assisted Suicide. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:203-217. [PMID: 32746764 DOI: 10.1177/0030222820947254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Current debates about assisted dying and assisted suicide cover a series of medical, legal, moral, ethical and religious aspects. Yet, public views on the subject remain underexplored and, therefore, not always accounted for in the formation of public policy. This paper reports on empirical data from a cross-sectional study in the UK in 2019, which examines public views about the legalisation of assisted dying and assisted suicide, by means of a self-administered Qualtrics-based survey (self-devised vignettes). A combination of simple random and convenience sampling was used. Participants (n = 297) state their preference that both assisted dying and assisted suicide should be legalised in the UK (n = 70%), while doctors should be legally allowed to support such wishes of patients with an incurable and painful illness from which they will die (n = 62.22%). The paper concludes that public opinion needs to be further accounted for in policymaking and discourses regarding patient autonomy and dignity of care.
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Affiliation(s)
- Panagiotis Pentaris
- School of Human Sciences & Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Lucy Jacobs
- Social Work Alumni, School of Human Sciences, University of Greenwich, London, UK
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Velan B, Ziv A, Kaplan G, Rubin C, Connelly Y, Karni T, Tal O. Truth-telling and doctor-assisted death as perceived by Israeli physicians. BMC Med Ethics 2019; 20:13. [PMID: 30777058 PMCID: PMC6380017 DOI: 10.1186/s12910-019-0350-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/31/2019] [Indexed: 11/22/2022] Open
Abstract
Background Medicine has undergone substantial changes in the way medical dilemmas are being dealt with. Here we explore the attitude of Israeli physicians to two debatable dilemmas: disclosing the full truth to patients about a poor medical prognosis, and assisting terminally ill patients in ending their lives. Methods Attitudes towards medico-ethical dilemmas were examined through a nationwide online survey conducted among members of the Israeli Medical Association, yielding 2926 responses. Results Close to 60% of the respondents supported doctor-assisted death, while one third rejected it. Half of the respondents opposed disclosure of the full truth about a poor medical prognosis, and the others supported it. Support for truth-telling was higher among younger physicians, and support for doctor-assisted death was higher among females and among physicians practicing in hospitals. One quarter of respondents supported both truth-telling and assisted death, thereby exhibiting respect for patients’ autonomy. This approach characterizes younger doctors and is less frequent among general practitioners. Another quarter of the respondents rejected truth-telling, yet supported assisted death, thereby manifesting compassionate pragmatism. This was associated with medical education, being more frequent among doctors educated in Israel, than those educated abroad. All this suggests that both personal attributes and professional experience affect attitudes of physicians to ethical questions. Conclusions Examination of attitudes to two debatable medical dilemmas allowed portrayal of the multi-faceted medico-ethical scene in Israel. Moreover, this study, demonstrates that one can probe the ethical atmosphere of a given medical community, at various time points by using a few carefully selected questions. Electronic supplementary material The online version of this article (10.1186/s12910-019-0350-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Baruch Velan
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel. .,Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.
| | - Arnona Ziv
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Giora Kaplan
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.,Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Carmit Rubin
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Yaron Connelly
- Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Tami Karni
- Comprehensive Breast Care Institute, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Orna Tal
- Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
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