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Bloomer MJ, O'Neill K, Hewitt J, Wheaton A, O'Connor M, Bonner A. "How to navigate this new area": Intensive care clinicians' perceptions of voluntary assisted dying in the intensive care unit: A multisite exploratory study. Aust Crit Care 2024:S1036-7314(24)00094-8. [PMID: 38880708 DOI: 10.1016/j.aucc.2024.05.007] [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: 02/08/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND There is growing momentum worldwide for assisted dying. In Australia, voluntary assisted dying may occur in any setting, including an intensive care unit (ICU). As the subject of much debate worldwide, exploring ICU clinicians' perceptions of assisted dying is essential. AIM The aim of this study was to explore clinicians' perceptions of and preparedness for voluntary assisted dying in the ICU. METHOD An exploratory qualitative descriptive design using individual interviews was used. Medical, nursing, and allied health clinicians from three ICUs were recruited. Interviews were conducted between Nov 2022 and Jan 2023, with a hypothetical scenario about voluntary assisted dying used to prompt discussion. Interviews were recorded, professionally transcribed, and analysed using inductive content analysis. FINDINGS ICU registered nurses (n = 20), physicians (n = 2), and allied health clinicians (n = 4) participated with interviews lasting 18-45 min (mean: 28 min). Analysis revealed four themes: (i) purpose of ICU reflected that ICU care was not all about saving lives, yet recognising dying and changing priorities was challenging; (ii) dying in the ICU is complex due to difficulties in talking about dying, accepting death as the outcome and evaluating care efficacy; (iii) voluntary assisted dying is a lot of grey because of perceived clinical and ethicolegal challenges; and finally, (iv) respecting choice was about respecting patients' values, beliefs, and autonomy, as well as clinicians' beliefs and right to exercise autonomy through conscientious objection. CONCLUSION Dying and death are inevitable, and views and perspectives about assisted dying will continue to evolve. Respecting patient choice is at the core of assisted dying, but respecting clinicians' perspectives and choice is equally important. With voluntary assisted dying now legal in all Australian states, ensuring ICU team and individual clinician preparedness through access to education, resources, and specialist support services is key to raising awareness and easing uncertainty about deaths through voluntary assisted dying.
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Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Intensive Care Unit, Princess Alexandra Hospital, Metro South Health and Hospital Service, Woolloongabba, QLD, Australia.
| | - Kylie O'Neill
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health and Hospital Service, Woolloongabba, QLD, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Queen Elizabeth II Hospital, Metro South Health and Hospital Service, Coopers Plains, QLD, Australia; Law Futures Centre, Griffith University, Nathan, QLD, Australia
| | - Andrew Wheaton
- Princess Alexandra Hospital, Metro South Health and Hospital Service, Woolloongabba, QLD, Australia
| | - Margaret O'Connor
- School of Nursing and Midwifery, Monash University, Peninsula Campus, Frankston, VIC, Australia; Voluntary Assisted Dying Review Board, Melbourne, VIC, Australia
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Kidney Health Service, Metro North Hospital and Health Service, Herston, QLD, Australia
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Michael N, Jones D, Kernick L, Kissane D. Does voluntary assisted dying impact quality palliative care? A retrospective mixed-method study. BMJ Support Palliat Care 2024:spcare-2024-004946. [PMID: 38871403 DOI: 10.1136/spcare-2024-004946] [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: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES We aimed to explore the relationship between the pursuit of voluntary assisted dying (VAD) and the delivery of quality palliative care in an Australian state where VAD was newly available METHODS: We adopted a retrospective convergent mixed-methods design to gather and interpret data from records of 141 patients who expressed an interest in and did or did not pursue VAD over 2 years. Findings were correlated against quality domains. RESULTS The mean patient age was 72.4 years, with the majority male, married/partnered, with a cancer diagnosis and identifying with no religion. One-third had depression, anxiety or such symptoms, half were in the deteriorating phase, two-thirds required help with self-care and 83.7% reported moderate/severe symptoms. Patients sought VAD because of a desire for autonomy (68.1%), actual suffering (57.4%), fear of future suffering (51.1%) and social concerns (22.0%). VAD enquiries impacted multiple quality domains, both enhancing or impeding whole person care, family caregiving and the palliative care team. Open communication promoted adherence to therapeutic options and whole person care and allowed for timely access to palliative care. Patients sought VAD over palliative care as a solution to suffering, with the withholding of information impacting relationships. SIGNIFICANCE OF RESULTS As legislation is expanded across jurisdictions, palliative care is challenged to accompany patients on their chosen path. Studies are necessary to explore how to ensure the quality of palliative care remains enhanced in those who pursue VAD and support continues for caregivers and staff in their accompaniment of patients.
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Affiliation(s)
- Natasha Michael
- Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, VIC, Australia
- Faculty of Medicine, University of Notre Dame, Australia, Sydney, NSW, Australia
| | - David Jones
- Anscombe Bioethics Centre, Oxford, UK
- St Mary's University Twickenham, London, UK
| | - Lucy Kernick
- Faculty of Medicine, University of Notre Dame, Australia, Sydney, NSW, Australia
| | - David Kissane
- Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, VIC, Australia
- Faculty of Medicine, University of Notre Dame, Australia, Sydney, NSW, Australia
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Light E, Kerridge I, Skowronski G, Venkatesha V, Krishnamurthy A, Kuper S, Noonan K, Hoyle P, Arnold M, Manley S, Stedman W, Sheahan L. Clinician perspectives on voluntary assisted dying and willingness to be involved: a multisite, cross-sectional survey during implementation in New South Wales, Australia. Intern Med J 2024; 54:724-734. [PMID: 38093686 DOI: 10.1111/imj.16305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/15/2023] [Indexed: 05/18/2024]
Abstract
BACKGROUND In the context of nationwide law reform, New South Wales (NSW) became the last state in Australia to legalise voluntary assisted dying (VAD) - commencing 28 November 2023. Clinicians have divergent views regarding VAD, with varying levels of understanding, support, and willingness to be involved, and these may have a significant impact on the successful implementation. AIMS To understand levels of support, understanding and willingness to be involved in VAD among clinical staff across NSW during implementation of VAD. METHODS A multisite, cross-sectional online survey of clinicians across four local health districts, assessing relevant demographics, awareness of and support for VAD legislation and willingness to be involved in different levels of VAD-related clinical activities. RESULTS A total of 3010 clinical staff completed the survey. A majority of participants were aware of VAD legislation in NSW (86.35%) and supportive of it (76%), with nursing and allied health clinicians significantly more likely than medical specialists to express support. Among medical specialists, support was statistically more likely in those who did not care for patients at the end of life and those with limited knowledge of the legislation. Willingness of medical specialists to perform key roles was significantly lower, with 41.49% willing to act in coordinating or consulting roles, and only 23.21% as administering practitioners. CONCLUSIONS The majority of clinical staff surveyed across NSW supported VAD legislation. While many eligible clinicians were reluctant to be actively involved, sufficient numbers appear willing to provide VAD services, indicating that successful implementation should be possible.
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Affiliation(s)
- Edwina Light
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ian Kerridge
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Haematologist and BMT Physician, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
| | - George Skowronski
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- St George Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Aravind Krishnamurthy
- Clinical Governance Unit, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Suzanne Kuper
- Northern NSW Local Health District, Ballina, New South Wales, Australia
| | - Kerrie Noonan
- Western NSW Local Health District, Dubbo, New South Wales, Australia
- Public Health Palliative Care Unit, La Trobe University, Melbourne, Victoria, Australia
- School of Social Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Philip Hoyle
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mark Arnold
- Western NSW Local Health District, Dubbo, New South Wales, Australia
- School of Rural Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Manley
- Cancer Services and Innovation, Northern NSW Local Health District, Ballina, New South Wales, Australia
| | - Wade Stedman
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
- VAD Implementation, NSW Health, Sydney, New South Wales, Australia
| | - Linda Sheahan
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
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Treleaven L, Komesaroff P, La Brooy C, Olver I, Kerridge I, Philip J. A review of the utility of prognostic tools in predicting 6-month mortality in cancer patients, conducted in the context of voluntary assisted dying. Intern Med J 2023; 53:2180-2197. [PMID: 37029711 DOI: 10.1111/imj.16081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/07/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Eligibility to access the Victorian voluntary assisted dying (VAD) legislation requires that people have a prognosis of 6 months or less (or 12 months or less in the setting of a neurodegenerative diagnosis). Yet prognostic determination is frequently inaccurate and prompts clinician discomfort. Based on functional capacity and clinical and biochemical markers, prognostic tools have been developed to increase the accuracy of life expectancy predictions. AIMS This review of prognostic tools explores their accuracy to determine 6-month mortality in adults when treated under palliative care with a primary diagnosis of cancer (the diagnosis of a large proportion of people who are requesting VAD). METHODS A systematic search of the literature was performed on electronic databases Medline, Embase and Cinahl. RESULTS Limitations of prognostication identified include the following: (i) prognostic tools still provide uncertain prognoses; (ii) prognostic tools have greater accuracy predicting shorter prognoses, such as weeks to months, rather than 6 months; and (iii) functionality was often weighted significantly when calculating prognoses. Challenges of prognostication identified include the following: (i) the area under the curve (a value that represents how well a model can distinguish between two outcomes) cannot be directly interpreted clinically and (ii) difficulties exist related to determining appropriate thresholds of accuracy in this context. CONCLUSIONS Prognostication is a significant aspect of VAD, and the utility of the currently available prognostic tools appears limited but may prompt discussions about prognosis and alternative means (other than prognostic estimates) to identify those eligible for VAD.
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Affiliation(s)
- Lydia Treleaven
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Komesaroff
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Camille La Brooy
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ian Kerridge
- Department of Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Sydney Health Ethics, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jennifer Philip
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia
- Palliative Care Service, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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5
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Young J, Snelling J, Beaumont S, Diesfeld K, White B, Willmott L, Robinson J, Ahuriri-Driscoll A, Cheung G, Dehkhoda A, Egan R, Jap J, Karaka-Clarke TH, Manson L, McLaren C, Winters J. What do health care professionals want to know about assisted dying? Setting the research agenda in New Zealand. BMC Palliat Care 2023; 22:40. [PMID: 37038170 PMCID: PMC10084592 DOI: 10.1186/s12904-023-01159-8] [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: 10/25/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND New Zealand recently introduced law permitting terminally ill people to request and receive assisted dying (AD) in specified circumstances. Given the nature and complexity of this new health service, research is vital to determine how AD is operating in practice. OBJECTIVE To identify research priorities regarding the implementation and delivery of AD in New Zealand. METHODS Using an adapted research prioritisation methodology, the researchers identified 15 potential AD research topics. A mixed-methods survey of health professionals was undertaken where respondents were asked to rate the 15 topics according to the relative importance for research to be conducted on each issue. Respondents could also suggest additional research areas, and were invited to participate in a follow-up interview. RESULTS One hundred and nineteen respondents completed the survey. 31% had some experience with AD. The highest rated research topic was the 'effectiveness of safeguards in the Act to protect people'; the lowest rated topic was research into the 'experiences of non-provider (e.g., administrative, cleaning) staff where assisted dying is being provided'. Respondents suggested 49 other research topics. Twenty-six interviews were conducted. Thematic analysis of interview data and open-ended survey questions was undertaken. Six research themes were identified: general factors related to the wider health system; the experiences of health care providers at the bedside; medico-legal issues; the impact of AD; experiences on the day of dying; and the overall effectiveness of the AD system. Key issues for stakeholders included safety of the AD service; ensuring access to AD; achieving equity for 'structurally disadvantaged' groups; and ensuring the well-being of patients, families/whānau, providers and non-providers. CONCLUSIONS Based on early experiences of the implementation of the AD service, health professionals provide important insights into what research should be prioritised post-legalisation of AD. These findings can be used to shape the research agenda so that research may inform law, policy and best practice.
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Affiliation(s)
- Jessica Young
- Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand.
| | | | - Sophie Beaumont
- Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Kate Diesfeld
- Auckland University of Technology, Auckland, New Zealand
| | - Ben White
- Queensland University of Technology, Brisbane, Australia
| | - Lindy Willmott
- Queensland University of Technology, Brisbane, Australia
| | | | | | - Gary Cheung
- University of Auckland, Auckland, New Zealand
| | | | | | - James Jap
- Tōtara Hospice, Auckland, 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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7
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Lizzio-Wilson M, Thomas EF, Louis WR, Crane MF, Kho M, Molenberghs P, Wibisono S, Minto K, Amiot CE, Decety J, Breen LJ, Noonan K, Forbat L, Allen F. Using Latent Profile Analysis to Understand Health Practitioners' Attitudes Toward Voluntary Assisted Dying. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228221149453. [PMID: 36826344 DOI: 10.1177/00302228221149453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Prior work has documented considerable diversity among health practitioners regarding their support for voluntary assisted dying (VAD). We examined whether their attitudes are characterised by different combinations of personal support, normative support by other health practitioners, and whether they are predisposed to vicariously experience others' emotions (i.e., empathy). We also examined whether these profiles experienced different mental health outcomes (i.e., burnout and posttraumatic stress) in relation to VAD. To test this, 104 Australian health practitioners were surveyed after VAD was legalised in Victoria, Australia in 2019. Results indicated that practitioners' attitudes were characterised by three profiles: 1) strong personal and normative support (strong VAD supporters), 2) moderate personal and normative support (moderate VAD supporters), and 3) lower personal and normative support (apprehensive practitioners). However, each profile reported similar mental health outcomes. Findings suggest that the normative environments in which health practitioners operate may explain their diverse attitudes on VAD.
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Affiliation(s)
- Morgana Lizzio-Wilson
- Department of Psychology, The University of Exeter, Exeter, UK
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Emma F Thomas
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Winnifred R Louis
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Monique F Crane
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Madison Kho
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | | | - Susilo Wibisono
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Kiara Minto
- School of Historical and Philosophical Inquiry, University of Queensland, Brisbane, QLD, Australia
| | - Catherine E Amiot
- Département de Psychologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Jean Decety
- Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - Lauren J Breen
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Kerrie Noonan
- Death Literacy Institute, University of Western Sydney, Penrith South, NSW, Australia
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
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8
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McDougall RJ, White BP, Ko D, Keogh L, Willmott L. Junior doctors and conscientious objection to voluntary assisted dying: ethical complexity in practice. JOURNAL OF MEDICAL ETHICS 2022; 48:517-521. [PMID: 34127526 PMCID: PMC9340035 DOI: 10.1136/medethics-2020-107125] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 05/09/2023]
Abstract
In jurisdictions where voluntary assisted dying (VAD) is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors' involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor's subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture.
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Affiliation(s)
- Rosalind J McDougall
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danielle Ko
- Department of Palliative Care, Austin Health, Heidelberg, Victoria, Australia
- Department of Quality and Patient Safety, Austin Health, Heidelberg, Victoria, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
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Snir JT, Ko DN, Pratt B, McDougall R. Anticipated impacts of voluntary assisted dying legislation on nursing practice. Nurs Ethics 2022; 29:1386-1400. [PMID: 35620841 PMCID: PMC9527354 DOI: 10.1177/09697330211022409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The Voluntary Assisted Dying Act 2017 passed into law in Victoria, Australia,
on the 29 November 2017. Internationally, nurses have been shown to be
intimately involved in patient care throughout the voluntary assisted dying
process. However, there is a paucity of research exploring Australian
nurses’ perspectives on voluntary assisted dying and, in particular, how
Victorian nurses anticipate the implementation of this ethically
controversial legislation will impact their professional lives. Objectives: To explore Victorian nurses’ expectations of the ethical and practical
impacts the voluntary assisted dying legislation will have on their
professional lives. Research design: This qualitative study analysed nurses’ free text responses collected as part
of a larger mixed methods online survey investigating staff views on the
Voluntary Assisted Dying Act. Data were collected during the period between
the passing of the voluntary assisted dying legislation and the start date
and were analysed using inductive content analysis. Participants and research context: Free text survey responses were analysed from 1873 nurses employed across
seven Victorian health services located in both metropolitan and regional
areas of the state. Ethical considerations: The study obtained research ethics approval and all participants were
informed of the voluntary and anonymous nature of their participation. Findings: This study identified three broad areas of Victorian nurses’ professional
lives that they expected to be impacted by the implementation of voluntary
assisted dying: professional identity, career development and workplace
relationships. Conclusion: Participants anticipate diverse and nursing-specific impacts of the
implementation of voluntary assisted dying in Victoria. Their insights can
inform health services in jurisdictions considering or already implementing
voluntary assisted dying, to develop policies, procedures and staff training
programmes that safeguard the well-being and legal rights of their nursing
staff.
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10
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Cassidy H, Sims A, Every-Palmer S. Psychiatrists' views on the New Zealand End of Life Choice Act. Australas Psychiatry 2022; 30:254-261. [PMID: 35245990 DOI: 10.1177/10398562221077889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This cross-sectional survey aimed to establish the views and intentions of New Zealand (NZ) psychiatrists regarding their role as competence assessors in the NZ End of Life Choice Act ('Act'). Some questions were replicated from a pre-existing Ministry of Health workforce survey regarding the Act, for comparative analysis between psychiatrists and other health professionals. METHODS The survey was disseminated via email to all NZ psychiatrists registered with the Royal Australia and NZ College of Psychiatry and promoted by snowballing methods to reach non-members. RESULTS There were similar (moderate) levels of understanding of the Act, compared to other health professionals. Psychiatrists show similar levels of support for assisted dying as other health professionals (55% and 47%, respectively), however psychiatrists are significantly less likely to be willing to provide assisted dying services than other health professionals. Concerns were raised regarding the challenges faced by psychiatrists and need for more clarity around the psychiatrist's role. CONCLUSIONS Few NZ psychiatrists were willing to be involved with the Act. There was a perceived lack of information around a psychiatrist's role, responsibilities and legal protections. Further guidance is needed regarding the concept of capacity in assisted dying and the factors that challenge these assessments.
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Affiliation(s)
- Helen Cassidy
- Department of Psychological Medicine, 8494University of Otago, Wellington, New Zealand
| | - Adam Sims
- Department of Psychological Medicine, 8494University of Otago, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, 8494University of Otago, Wellington, New Zealand
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11
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Auret K, Pikora T, Gersbach K. Being a safe place: a qualitative study exploring perceptions as to how a rural community hospice could respond to enactment of voluntary assisted dying legislation. BMC Palliat Care 2022; 21:2. [PMID: 34980093 PMCID: PMC8725330 DOI: 10.1186/s12904-021-00891-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background There is a lack of research to guide the implementation of voluntary assisted dying legislation within a hospice setting. Furthermore, there is limited published information related to the expectations of the community and staff to assist decision making regarding voluntary assisted dying in a community hospice. The aim of this study was to explore the expectations of staff, volunteers and members of the community as how a rural Australian community hospice could respond in relation to imminent enactment of Voluntary Assisted Dying legislation. Methods A total of 63 Hospice staff and volunteers and community members participated in 11 workshops. This qualitative study used the interpretive description method to analyse the workshop transcripts. Results While there was not a consensus view on community expectation, there was agreement among the participants for respect for a patient’s individuality and choices. Furthermore, care offered in hospice needs to remain non-judgemental and patient focused regardless of whether voluntary assisted dying policy was implemented or not. Both opportunities and risks associated with implementation were identified by the participants. Conclusion There was common ground around the respect for the dying person and the ideal of a “safe place” despite opposing views on what this may mean in practice. There is a need for clarity in organisational responses around policy, risk management, education, and staff support.
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Affiliation(s)
- Kirsten Auret
- Rural Clinical School of Western Australia, University of Western Australia, M701 31 Stirling Terrace, Albany, Western Australia, 6330, Australia.
| | - Terri Pikora
- Rural Clinical School of Western Australia, University of Western Australia, M701 31 Stirling Terrace, Albany, Western Australia, 6330, Australia
| | - Kate Gersbach
- Albany Community Hospice, Diprose Crescent, Albany, Western Australia, 6330, Australia
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12
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Winters JP, Pickering N, Jaye C. Winging it: a qualitative study of knowledge-acquisition experiences for early adopting providers of medical assistance in dying. Palliat Care Soc Pract 2022; 16:26323524221103889. [PMID: 35722656 PMCID: PMC9203949 DOI: 10.1177/26323524221103889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Medical Assistance in Dying (MAID) was legalized in Canada without a designated period for implementation. Providers did not have access to customary alternatives for training and mentorship during the first 1–3 years after legalization. Objective: To report on how doctors prepared for their first provision of MAID in the early period after legalization in Canada. Design: Qualitative research design within an interpretive phenomenological theoretical framework. We asked participants to describe their experiences preparing for first MAID provision. Analysis of transcripts elicited themes regarding training and information desired by early adopters for provision of newly legalized MAID. Participants: Twenty-one early adopting physician-providers in five Canadian provinces were interviewed. Results: Few formal training opportunities were available. Many early-adopting providers learned about the procedure from novel sources using innovative methods. They employed a variety of strategies to meet their needs, including self-training and organizing provider education groups. They acknowledged and reflected on uncertainty and knowledge gained from unexpected experiences and missteps. Key phrases from participants indicated a desire for early training and mentorship. Limitations: This study included only the perspective of physicians who were providers of MAID. It does not address the training needs for all health practitioners who receive requests for assisted death nor report the patient/family experience. Conclusion: The Canadian experience demonstrates the importance of establishing accessible guidance and training opportunities for providers at the outset of implementation of newly legalized assisted dying.
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Affiliation(s)
- Janine Penfield Winters
- Bioethics Centre, University of Otago, 71 Frederick Street, North Dunedin, Dunedin 9010, New Zealand
| | - Neil Pickering
- Bioethics Centre, University of Otago, Dunedin, New Zealand
| | - Chrystal Jaye
- Department of General Practice and Rural Medicine, University of Otago, Dunedin, New Zealand
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13
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Medical practitioners' views and experiences of being involved in assisted dying in Victoria, Australia: A qualitative interview study among participating doctors. Soc Sci Med 2021; 292:114568. [PMID: 34801335 DOI: 10.1016/j.socscimed.2021.114568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/18/2021] [Accepted: 11/13/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE On June 19, 2019, Assisted Dying (AD) was legalized in the Australian state of Victoria, joining a small but growing cohort of jurisdictions internationally where AD is permitted. Few studies have examined perspectives of doctors who have participated in AD in jurisdictions where it has become legal, despite their pivotal role in the system. OBJECTIVE This study aimed to describe the beliefs, experiences and perspectives of doctors who had provided AD during the first 12 months of its operation in Victoria, Australia. METHOD In-depth, semi-structured interviews were conducted between April and July 2020 with 32 Victorian doctors who had been involved in the AD process during the first 12-months since it became legal in Victoria. The assumptions underpinning our methodology were guided by a phenomenological approach and reflexive thematic analysis was used to analyze the data. RESULTS Five major themes were identified: a nascent approach to care, practising within clinical and legal uncertainty, confronting practices, personal sacrifices and coping amid new challenges. A thematic schema was developed, illustrating that these themes were expressed as a balance of competing tensions of identity for doctors who provided AD for their patients in practice. A major tension was not just how doctors' perceptions impacted their own wellbeing and satisfaction, but also how these challenged their continued involvement in AD and, therefore, the system's overall ability to function. CONCLUSION Our findings show that while doctors discussed AD as an ethical practice, it also involved multiple identities with varying sources of meaning, and these identities were sometimes overlapping depending on context. As other jurisdictions increasingly move to legalize AD, a greater appreciation of the different role-based and group-based challenges involved in AD may improve AD implementation strategies.
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14
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Haining CM, Keogh LA. "I haven't had to bare my soul but now I kind of have to": describing how voluntary assisted dying conscientious objectors anticipated approaching conversations with patients in Victoria, Australia. BMC Med Ethics 2021; 22:149. [PMID: 34772412 PMCID: PMC8588572 DOI: 10.1186/s12910-021-00717-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) recognizes the inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process. METHODS Seventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically. RESULTS Our results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one's CO as identified by our participants. CONCLUSION The broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one's CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately.
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Affiliation(s)
- Casey Michelle Haining
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, 3010 Australia
| | - Louise Anne Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, 3010 Australia
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15
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Close E, Willmott L, White BP. Regulating voluntary assisted dying practice: A policy analysis from Victoria, Australia. Health Policy 2021; 125:1455-1474. [PMID: 34588128 DOI: 10.1016/j.healthpol.2021.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Victoria is the first state in Australia to legalise voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). The Victorian law took effect in 2019 after an 18-month implementation period designed to facilitate policy development and other regulatory infrastructure. OBJECTIVE To study publicly available policy documents regarding voluntary assisted dying in Victoria and the issues they seek to regulate. METHODS Policies were identified using a combination of search strategies to capture documents aimed at a broad range of stakeholders including health practitioners, patients, and families. The policies were thematically analysed using the Framework Method. RESULTS The study identified 60 policies and five themes: 1) conceptions of policy purpose; 2) degree of support for VAD; 3) guidance about process; 4) navigating conscientious objection; and 5) conceptualising voluntary assisted dying and its relationship with other aspects of end-of-life care. Outside of the detailed Victorian Government policies, there was little practical guidance for voluntary assisted dying provision. Instead, the non-governmental policies tended to focus on positioning regarding VAD and entry into the process. CONCLUSION The study demonstrates the value of a planned implementation period for jurisdictions contemplating voluntary assisted dying reform and highlights the challenges in policymaking for a practice that is contentious for some.
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Affiliation(s)
- Eliana Close
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Qld, 4001, Australia.
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Qld, 4001, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Qld, 4001, Australia
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16
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Sellars M, Tacey M, McDougall R, Hayes B, Pratt B, Hempton C, Detering K, Aldrich R, Benson M, Kirwan J, Gold M, O'Driscoll L, Ko D. Support for and willingness to be involved in voluntary assisted dying: A multisite, cross-sectional survey study of clinicians in Victoria, Australia. Intern Med J 2021; 51:1619-1628. [PMID: 34148272 DOI: 10.1111/imj.15434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT In the Australian state of Victoria, specialist doctors are central to the operation of Voluntary Assisted Dying (VAD). However, a broad range of clinicians may be involved in the care of patients requesting or using VAD. OBJECTIVES To conduct a multisite, cross-sectional survey of clinicians in seven Victorian hospitals, to describe levels of support for and willingness to be involved in VAD and consider factors associated with clinician support for the VAD legislation and physicians' willingness to provide VAD in practice. METHODS All clinicians were invited to complete an online survey measuring demographic characteristics, awareness of and support for the VAD legislation, willingness to participate in VAD related activities, and reasons for willingness or unwillingness to participate in VAD. RESULTS Of 5690 who opened the survey, 5159 (90.1%) were included in the final sample and 73% (n=3768) supported the VAD legislation. The strongest predictor of support for the VAD legislation was clinical role. Forty percent (n=238) of medical specialists indicated they would be willing to participate in either the VAD consulting or coordinating role. Doctors did not differ in willingness between high impact (44%) and low impact specialty (41%), however, doctors specializing in palliative care or geriatric medicine were significantly less willing to participate (27%). CONCLUSION Approximately 73% of surveyed staff supported Victoria's VAD legislation. However, only a minority of medical specialists reported willingness to participate in VAD, suggesting potential access issues for patients requesting VAD in accordance with the legal requirements in Victoria. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marcus Sellars
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University
| | - Mark Tacey
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Rosalind McDougall
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Barbara Hayes
- Advance Care Planning Program, Northern Health, Bundoora, Australia
| | - Bridget Pratt
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Courtney Hempton
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Waurn Ponds, Australia.,Monash Bioethics Centre, Monash University, Clayton, Australia
| | - Karen Detering
- Faculty of Health, Arts and Innovation, Swinburne University, Hawthorn, Melbourne, Australia.,Tasmanian Health Services, Tasmania, Australia
| | | | - Melanie Benson
- Department of Supportive and Palliative Care, Peninsula Health, Frankston
| | - Jeffrey Kirwan
- Research & Medical Services, Eastern Health, Box Hill, Australia
| | - Michelle Gold
- Palliative Care Service, Alfred Health, Prahran, Australia
| | - Lisa O'Driscoll
- 3mproving End of Life Care, Alfred Health, Prahran, Australia
| | - Danielle Ko
- Palliative Care, Quality and Patient Safety, Austin Health, Heidelberg, Australia
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17
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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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18
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Rutherford J. Conscientious participants and the ethical dimensions of physician support for legalised voluntary assisted dying. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106702. [PMID: 33184125 DOI: 10.1136/medethics-2020-106702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 05/24/2023]
Abstract
The Australian state of Victoria legalised voluntary assisted dying (VAD) in June 2019. Like most jurisdictions with legalised VAD, the Victorian law constructs physicians as the only legal providers of VAD. Physicians with conscientious objection to VAD are not compelled to participate in the practice, requiring colleagues who are willing to participate to transact the process for eligible applicants. Physicians who provide VAD because of their active, moral and purposeful support for the law are known as conscientious participants. Conscientious participation has received scant attention in the bioethics literature. Patient access to VAD is contingent on the development of a sufficient corpus of conscientious participants in permissive jurisdictions. This article reports the findings of a small empirical study into how some Victorian physicians with no in-principle opposition towards the legalisation of VAD, are ethically orientating themselves towards the law, in the first 8 months of the law's operation. It finds that in-principle-supportive physicians employ bioethical principles to justify their position but struggle to reconcile that approach with the broader medical profession's opposition. This study is part of the first tranche of empirical research emerging from Australia since the legalisation of VAD in that country for the first time in over 20 years.
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Affiliation(s)
- Jodhi Rutherford
- Australian Cente for Health Law Research, Queensland University of Technology Faculty of Law, Brisbane, Queensland, Australia
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19
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Philip J, Holmes A, Benson M, Boughey M, Yoong J, Clinch A, Moran J. Palliative care physicians' preparation and planning for the implementation of the Voluntary Assisted Dying Act in Victoria. Intern Med J 2020; 51:1645-1649. [PMID: 32743936 DOI: 10.1111/imj.15004] [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: 05/25/2020] [Revised: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In November 2017, the Victorian Voluntary Assisted Dying (VAD) Act was passed enabling people with a progressive terminal illness to end their life voluntarily. Heated debate abounded including, to some extent within palliative care, which was also challenged with developing processes around the legislation enactment. AIM In response, the lead author convened a series of meetings of palliative care physicians to: (i) share ideas about preparations being undertaken within services; and (ii) re-establish professional cohesion following the divide that the legislation had presented. METHODS A series of three closed meetings were held between the legislation passage and its implementation, with all Victorian palliative care physicians invited to attend. Meetings were facilitated by an experienced psychiatrist from outside the field. RESULTS These meetings proved very valuable as physicians collectively sought to define and respond to challenges, simultaneously reflecting on the personal and professional implications for individuals and the field. Key areas raised including gauging institutional 'readiness' for the legislation through staff surveys; the educational role of palliative care staff of the legislation implications; communication skills training; the role (if any) of palliative care in the processes of VAD; and the perceptions of palliative care itself in health services and the community. It was during the processes of discussing challenges and sharing solutions that the attendees appeared to reaffirm their professional interconnections. CONCLUSION A description of the key elements of these discussions may be useful to others who may yet face similar circumstances with the introduction of VAD legislation.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia.,Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre and Royal Melbourne Hospitals, Melbourne, Victoria, Australia
| | - Alex Holmes
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, Melbourne Health, Melbourne, Victoria, Australia
| | - Melanie Benson
- Palliative Care Service, Peninsula Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Boughey
- Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jaclyn Yoong
- Palliative Care Service, Northern Health, Melbourne, Victoria, Australia.,Palliative Care Service, Monash Health, Melbourne, Victoria, Australia
| | - Alexandra Clinch
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre and Royal Melbourne Hospitals, Melbourne, Victoria, Australia
| | - Juli Moran
- Palliative Care Service, Austin Health, Melbourne, Victoria, Australia
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20
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McDougall R, Pratt B. Too much safety? Safeguards and equal access in the context of voluntary assisted dying legislation. BMC Med Ethics 2020; 21:38. [PMID: 32404097 PMCID: PMC7222560 DOI: 10.1186/s12910-020-00483-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In June 2019, the Australian state of Victoria joined the growing number of jurisdictions around the world to have legalised some form of voluntary assisted dying. A discourse of safety was prominent during the implementation of the Victorian legislation. MAIN TEXT In this paper, we analyse the ethical relationship between legislative "safeguards" and equal access. Drawing primarily on Ruger's model of equal access to health care services, we analyse the Victorian approach to voluntary assisted dying in terms of four dimensions: horizontal equity, patient agency, high quality care, and supportive social norms. We argue that some provisions framed as safeguards in the legislation create significant barriers to equal access for eligible patients. CONCLUSIONS While safety is undoubtedly ethically important, we caution against an overemphasis on safeguarding in voluntary assisted dying legislation given the implications for equal access.
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Affiliation(s)
- Rosalind McDougall
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie St, Melbourne, VIC, 3010, Australia.
| | - Bridget Pratt
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie St, Melbourne, VIC, 3010, Australia
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