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Wibisono S, Mavandadi P, Wilkinson S, Amiot C, Forbat L, Thomas EF, Allen F, Decety J, Noonan K, Minto K, Breen LJ, Kho M, Crane M, Lizzio-Wilson M, Molenberghs P, Louis W. "More support, less distress?": Examining the role of social norms in alleviating practitioners' psychological distress in the context of assisted dying services. DEATH STUDIES 2024:1-12. [PMID: 38597737 DOI: 10.1080/07481187.2024.2337189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
This study explores how providing assisted dying services affects the psychological distress of practitioners. It investigates the influence of professional norms that endorse such services within their field. Study 1 included veterinarians (N = 137, 75.2% female, Mage = 43.1 years, SDage = 12.7 years), and Study 2 health practitioner students (N = 386, 71.0% female, Mage = 21.0 years, SDage = 14.4 years). In both studies, participants indicated their degree of psychological distress following exposure to scenarios depicting assisted dying services that were relevant to their respective situations. In Study 1, we found that higher willingness to perform animal euthanasia was associated with lower distress, as were supportive norms. In Study 2, a negative association between a greater willingness to perform euthanasia and lower psychological distress occurred only when the provision of such services was supported by professional norms. In conclusion, psychological distress is buffered by supportive professional norms.
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Affiliation(s)
- Susilo Wibisono
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Payam Mavandadi
- Institute for Social Neuroscience, ISN Psychology, Ivanhoe, Australia
| | - Stuart Wilkinson
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Catherine Amiot
- Department of Psychology, The Université du Quebec à Montreal, Montreal, Canada
| | - Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Emma F Thomas
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia
| | - Felicity Allen
- Department of Psychology, Charles Darwin University, Darwin, Australia
| | - Jean Decety
- Department of Psychology, and Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Kerrie Noonan
- School of Psychology, Western Sydney University, Penrith, Australia
- Western NSW Local Health District, Dubbo, Australia
| | - Kiara Minto
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia
| | - Lauren J Breen
- Curtin School of Population Health and Enable Institute, Curtin University, Perth, Australia
| | - Madison Kho
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Monique Crane
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | | | | | - Winnifred Louis
- School of Psychology, University of Queensland, Brisbane, Australia
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Wibisono S, Minto K, Lizzio-Wilson M, Thomas EF, Crane M, Molenberghs P, Kho M, Amiot CE, Decety J, Breen LJ, Noonan K, Forbat L, Louis W. Attitudes Toward and Experience With Assisted-Death Services and Psychological Implications for Health Practitioners: A Narrative Systematic Review. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221138997. [PMID: 36357863 DOI: 10.1177/00302228221138997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
A narrative systematic review was conducted to review studies that examine mental health implications of involvement in assisted-death services among health practitioners. Qualitative and quantitative studies were included to understand health practitioners' attitudes and experiences with assisted dying services, as well as to identify the mental health consequences. We identified 18 articles from 1591 articles drawn from seven major scientific databases (i.e., PubMed, MEDLINE, CINAHL, PsycINFO, Embase, Web of Science, and Scopus). Two raters independently evaluated the exclusion and inclusion decisions of the articles and examined methodological flaws in the selected articles. We found that engagement in assisted death services were not reliably associated with mental health outcomes such as anxiety and moral distress. Both positive and negative outcomes were reported, and psychological outcomes for practitioners were shown to vary based on factors including social support for health practitioners' views; their perceived capacity to care for the patients; and legislation.
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Affiliation(s)
- Susilo Wibisono
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- Department of Psychology, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Kiara Minto
- School of Historical and Philosophical Inquiry, University of Queensland, Brisbane, QLD, Australia
| | - Morgana Lizzio-Wilson
- 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
| | - Monique Crane
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Madison Kho
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Catherine E Amiot
- Department of Psychology, The Universite du Quebec a Montreal, Montreal, QC, Canada
| | - Jean Decety
- Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - Lauren J Breen
- Curtin School of Population Health and Enable Institute, Curtin University, Perth, WA, Australia
| | - Kerrie Noonan
- School of Social Sciences, Western Sydney University, Kingswood, Australia
| | - Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Winnifred Louis
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
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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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Rutherford J, Willmott L, White BP. Physician attitudes to voluntary assisted dying: a scoping review. BMJ Support Palliat Care 2020; 11:200-208. [PMID: 32563993 DOI: 10.1136/bmjspcare-2020-002192] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/07/2020] [Accepted: 05/18/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Voluntary assisted dying (VAD) became legal in the Australian state of Victoria on 19 June 2019 and will be legal in Western Australia from 2021. Other Australian states are progressing similar law reform processes. In Australia and internationally, doctors are central to the operation of all legal VAD regimes. It is broadly accepted that doctors, as a profession, are less in favour of VAD law reform than the rest of the community. To date, there has been little analysis of the factors that motivate doctors' support or opposition to legalised VAD in Australia. AIM To review all studies reporting the attitudes of Australian doctors regarding the legalisation of VAD, including their willingness to participate in it, and to observe and record common themes in existing attitudinal data. DESIGN Scoping review and thematic analysis of qualitative and quantitative data. DATA SOURCES CINAHL, Embase, Scopus, PubMed and Informit were searched from inception to June 2019. RESULTS 26 publications detailing 19 studies were identified. Thematic analysis of quantitative and qualitative findings was performed. Three overarching themes emerged. 'Attitudes towards regulation' encompassed doctors' orientation towards legalisation, the shortcomings of binary categories of support or opposition and doctors' concerns about additional regulation of their professional practices. 'Professional and personal impact of legalisation' described tensions between palliative care and VAD, and the emotional and social impact of being providers of VAD. 'Practical considerations regarding access' considered doctors' concerns about eligibility criteria and their willingness to provide VAD. CONCLUSION A detailed understanding of medical perspectives about VAD would facilitate the design of legislative models that take better account of doctors' concerns. This may facilitate their greater participation in VAD and help address potential access issues arising from availability of willing doctors.
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Affiliation(s)
- Jodhi Rutherford
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
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Sheahan L. Exploring the interface between 'physician-assisted death' and palliative care: cross-sectional data from Australasian palliative care specialists. Intern Med J 2017; 46:443-51. [PMID: 26762669 DOI: 10.1111/imj.13009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Legalisation of physician-assisted dying (PAD) remains a highly contested issue. In the Australasian context, the opinion and perspective of palliative care specialists have not been captured empirically, and are required to inform better the debate around this issue, moving forward. AIM To identify current attitudes and experiences of palliative care specialists in Australasia regarding requests for physician-assisted suicide and voluntary euthanasia, and to capture the opinion of palliative care specialists on the legalisation of these practices in the Australasian context. METHOD An anonymous, cross-sectional, online survey of Australasian specialists in palliative care, addressing the following six areas: (i) demographics; (ii) frequency of requests, and response given; (iii) understanding of the term 'voluntary euthanasia'; (iv) opinion regarding legalisation of physician-assisted suicide and voluntary euthanasia in Australasia, and willingness to participate if legal; (v) identification of the most important values guiding this opinion; and (vi) anticipated impact that legalisation of assisted death would have on palliative care practice. RESULTS Important findings include: (i) palliative care specialists are largely opposed to the legalisation of PAD; (ii) the proportional titration of opioids is not understood by any palliative care specialist studied to be 'voluntary euthanasia'; and (iii) there is a wide variation in frequency of requests, and one-third of palliative care specialists express discomfort in dealing with requests for assisted suicide or euthanasia. CONCLUSION Key areas for future research at the interface between PAD and best practice end-of-life care are identified, including exploration into why palliative care specialists are largely opposed to PAD, and consideration of the impact 'the opioid misconception' may have on the literature informing this debate.
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Affiliation(s)
- L Sheahan
- St George and Calvary Hospitals, Sydney, New South Wales, Australia.,Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia.,Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Inghelbrecht E, Bilsen J, Mortier F, Deliens L. Nurses' attitudes towards end-of-life decisions in medical practice: a nationwide study in Flanders, Belgium. Palliat Med 2009; 23:649-58. [PMID: 19605604 DOI: 10.1177/0269216309106810] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated on a nationwide level the attitudes of nurses towards end-of-life decisions (ELDs) that may hasten death and towards their role in those decisions. We took a representative random sample of 6000 nurses in Flanders, Belgium. Response rate was 62.5%. Most nurses agreed with the practice of withholding/withdrawing potentially life-prolonging treatments (93%), with decisions to alleviate symptoms with possible life-shortening side effects (96%) and with the practice of euthanasia (92%). Their support for the different decisions existed regardless of whether they had cared for terminally ill patients or not. Most nurses also thought that they have an important role to play especially in the ELD-making process. Nurses' views on their proper role in the administration of drugs in euthanasia and continuous deep sedation showed a large dispersal. Overall, nurses' work setting determines their opinions on nurses' role in ELDs. In conclusion, nurses accept a wide variety of ELDs being practiced with terminally ill patients.
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Affiliation(s)
- E Inghelbrecht
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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Abstract
Within developed nations, there is increasing public debate about and apparent endorsement of the appropriateness of euthanasia as an autonomous choice to die in the face of intolerable suffering. Surveys report socio-demographic differences in rates of acceptance of euthanasia, but there is little in-depth analysis of how euthanasia is understood and positioned within the social and moral lives of individuals, particularly those who might be considered suitable candidates-for example, terminally-ill cancer patients. During discussions with 28 such patients in Australia regarding medical decisions at the end of life, euthanasia was raised by 13 patients, with the others specifically asked about it. Twenty-four patients spoke positively of euthanasia, 19 of these voicing some concerns. None identified euthanasia as a currently favoured option. Four were completely against it. Endorsement for euthanasia was in the context of a hypothetical future or for a hypothetical other person, or temporally associated with acute pain. Arguments supporting euthanasia framed the issue as a matter of freedom of choice, as preserving dignity in death, and as curbing intolerable pain and suffering, both of the patient and of those around them. A common analogy featured was that of euthanising a dog. These arguments were typically presented as self-evident justification for euthanasia, construed as an appropriate choice to die, with opposers positioned as morally inferior or ignorant. The difficulties of ensuring 'choice' and the moral connotations of 'choosing to die,' however, worked to problematise the appropriateness of euthanising specific individuals. We recommend further empirical investigation of the moral and social meanings associated with euthanasia.
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Affiliation(s)
- Jaklin A Eliott
- Cancer Council Australia, School of Psychology, The University of Adelaide, Adelaide, SA 5000, Australia.
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Holt J. Nurses' attitudes to euthanasia: the influence of empirical studies and methodological concerns on nursing practice. Nurs Philos 2008; 9:257-72. [DOI: 10.1111/j.1466-769x.2008.00373.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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