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Twycross R. Assisted dying: principles, possibilities, and practicalities. An English physician's perspective. BMC Palliat Care 2024; 23:99. [PMID: 38609945 PMCID: PMC11015689 DOI: 10.1186/s12904-024-01422-6] [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: 09/29/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
It seems probable that some form of medically-assisted dying will become legal in England and Wales in the foreseeable future. Assisted dying Bills are at various stages of preparation in surrounding jurisdictions (Scotland, Republic of Ireland, Isle of Man, Jersey), and activists campaign unceasingly for a change in the law in England and Wales. There is generally uncritical supportive media coverage, and individual autonomy is seen as the unassailable trump card: 'my life, my death'.However, devising a law which is 'fit for purpose' is not an easy matter. The challenge is to achieve an appropriate balance between compassion and patient autonomy on the one hand, and respect for human life generally and medical autonomy on the other. More people should benefit from a change in the law than be harmed. In relation to medically-assisted dying, this may not be possible. Protecting the vulnerable is a key issue. Likewise, not impacting negatively on societal attitudes towards the disabled and frail elderly, particularly those with dementia.This paper compares three existing models of physician-assisted suicide: Switzerland, Oregon (USA), and Victoria (Australia). Vulnerability and autonomy are discussed, and concern expressed about the biased nature of much of the advocacy for assisted dying, tantamount to disinformation. A 'hidden' danger of assisted dying is noted, namely, increased suffering as more patients decline referral to palliative-hospice care because they fear they will be 'drugged to death'.Finally, suggestions are made for a possible 'least worse' way forward. One solution would seem to be for physician-assisted suicide to be the responsibility of a stand-alone Department for Assisted Dying overseen by lawyers or judges and operated by technicians. Doctors would be required only to confirm a patient's medical eligibility. Palliative-hospice care should definitely not be involved, and healthcare professionals must have an inviolable right to opt out of involvement. There is also an urgent need to improve the provision of care for all terminally ill patients.
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Affiliation(s)
- Robert Twycross
- Emeritus Clinical Reader in Palliative Medicine, Oxford University, Oxford, UK.
- Sir Michael Sobell House, Churchill Hospital, Old Rd, Headington, Oxford, OX3 7LE, UK.
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White BP, Jeanneret R, Willmott L. Barriers to connecting with the voluntary assisted dying system in Victoria, Australia: A qualitative mixed method study. Health Expect 2023; 26:2695-2708. [PMID: 37694553 PMCID: PMC10632633 DOI: 10.1111/hex.13867] [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: 07/17/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Voluntary assisted dying (VAD) is increasingly being legalised internationally. In Australia, all six states have now passed such laws, with Victoria being the first in 2019. However, early research in Victoria on the patient experience of seeking VAD shows that finding a connection to the VAD system is challenging. This study analyses the causes of this 'point of access' barrier. METHODS We conducted semi-structured qualitative interviews with family caregivers and a person seeking VAD, with participants recruited via social media and patient interest groups. Data were thematically analysed. We also undertook documentary analysis (content and thematic) of publicly available reports from the oversight body, the Voluntary Assisted Dying Review Board. RESULTS We interviewed 32 family caregivers and one patient across 28 interviews and analysed six Board reports. Finding a point of access to the VAD system was reported as challenging in both interviews and reports. Four specific barriers to connecting with the system were identified: (1) not knowing VAD exists as a legal option; (2) not recognising a person is potentially eligible for VAD; (3) not knowing next steps or not being able to achieve them in practice; and (4) challenges with patients being required to raise the topic of VAD because doctors are legally prohibited from doing so. CONCLUSION Legal, policy and practice changes are needed to facilitate patients being able to find a connection to the VAD system. The legal prohibition on doctors raising the topic of VAD should be repealed, and doctors and institutions who do not wish to be involved in VAD should be required to connect patients with appropriate contacts within the system. Community awareness initiatives are needed to enhance awareness of VAD, especially given it is relatively new in Victoria. PATIENT OR PUBLIC CONTRIBUTION Families and a patient were the focus of this research and interviews with them about the experience of seeking VAD were the primary source of data analysed. This article includes their solutions to address the identified point of access barriers. Patient interest groups also supported the recruitment of participants.
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Affiliation(s)
- Ben P. White
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Ruthie Jeanneret
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
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Snelling J, Young J, Beaumont S, Diesfeld K, White B, Willmott L, Robinson J, Moeke-Maxwell T. Health care providers' early experiences of assisted dying in Aotearoa New Zealand: an evolving clinical service. BMC Palliat Care 2023; 22:101. [PMID: 37480024 PMCID: PMC10362551 DOI: 10.1186/s12904-023-01222-4] [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: 12/20/2022] [Accepted: 07/05/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND In November 2021, assisted dying (AD) became lawful in Aotearoa New Zealand. A terminally ill person may now request, and receive, pharmacological assistance (self-administered or provided by a medical practitioner/nurse practitioner) to end their life, subject to specific legal criteria and processes. Exploring the experiences of health providers in the initial stage of the implementation of the End of Life Choice Act 2019 is vital to inform the ongoing development of safe and effective AD practice, policy and law. AIM To explore the early experiences of health care providers (HCPs) who do and do not provide AD services seven months after legalisation of AD to provide the first empirical account of how the AD service is operating in New Zealand's distinctive healthcare environment and cultural context. DESIGN Qualitative exploratory design using semi-structured individual and focus group interviewing with a range of HCPs. RESULTS Twenty-six HCPs participated in the study. Through a process of thematic analysis four key themes were identified: (1) Difference in organisational response to AD; (2) challenges in applying the law; (3) experiences at the coal face; and (4) functionality of the AD system. CONCLUSION A range of barriers and enablers to successful implementation of AD were described. Adoption of open and transparent organisational policies, ongoing education of the workforce, and measures to reduce stigma associated with AD are necessary to facilitate high quality AD service provision. Future research into the factors that influence responses to, and experience of AD; the impact of institutional objection; and the extent to which HCP perspectives evolve over time would be beneficial. In addition, further research into the integration of AD within Māori health organisations is required.
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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
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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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Asai A, Okita T, Shimakura Y, Tanaka M, Fukuyama M. Japan should initiate the discussion on voluntary assisted dying legislation now. BMC Med Ethics 2023; 24:5. [PMID: 36726120 PMCID: PMC9890417 DOI: 10.1186/s12910-023-00886-0] [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: 04/01/2022] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND No laws or official guidelines govern voluntary assisted dying (VAD) in Japan. A legislative bill on the termination of life-sustaining measures has yet to be sent to deliberations for legislation, due to strong opposition that has prevented it from being submitted to the Diet. However, Japan has recently witnessed several cases involving VAD. MAIN TEXT Against this backdrop, we argue that Japan should begin discussion on VAD legislation, referring to the Voluntary Assisted Dying Act 2017 (VADA2017), which was established in 2017 in Victoria, Australia. VADA2017 puts in place a wide range of stringent safeguards and is considered worldwide to be the safest and most conservative policy on a physician offering assisted dying based on the patient's premeditated request. We consider what opposing opinions from society would arise in response to the VADA2017. Among these will include arguments against VAD itself, those against the validation of this act, and opinions that oppose even the initiation of the dialogue on VAD. CONCLUSIONS We conclude that to protect the right to life among those placed in vulnerable positions and, at the same time, to respect decision-making of those who wish for immediate death due to unbearable suffering, the dialogue must immediately begin with that on introducing a policy more conservative than that of the VADA2017, which solidly considers arguments against VAD.
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Affiliation(s)
- Atsushi Asai
- grid.69566.3a0000 0001 2248 6943Department of Medical Ethics, Tohoku University Graduate School of Medicine, School of Public Health, 2-1 Seiryo, Aoba-Ku, Sendai, Miyagi 980-8575 Japan
| | - Taketoshi Okita
- grid.69566.3a0000 0001 2248 6943Department of Medical Ethics, Tohoku University Graduate School of Medicine, School of Public Health, 2-1 Seiryo, Aoba-Ku, Sendai, Miyagi 980-8575 Japan
| | - Yoko Shimakura
- grid.69566.3a0000 0001 2248 6943Department of Medical Ethics, Tohoku University Graduate School of Medicine, School of Public Health, 2-1 Seiryo, Aoba-Ku, Sendai, Miyagi 980-8575 Japan
| | - Masashi Tanaka
- grid.69566.3a0000 0001 2248 6943Department of Medical Ethics, Tohoku University Graduate School of Medicine, School of Public Health, 2-1 Seiryo, Aoba-Ku, Sendai, Miyagi 980-8575 Japan ,KARADA Internal Medicine Clinic, Tokyo, Japan ,grid.416239.bDivision of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Miki Fukuyama
- grid.274841.c0000 0001 0660 6749Course of Nursing, Faculty of Life Sciences, Kumamoto University, Kumamoto City, Japan
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Riley S, Sarbey B. The Unexamined Benefits of the Expansive Legalization of Medical Assistance-in-Dying. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:655-665. [PMID: 36156765 DOI: 10.1007/s11673-022-10211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/17/2022] [Indexed: 06/16/2023]
Abstract
If you slide far enough down the slippery slope envisioned by opponents of medical assistance-in-dying (MAiD), you eventually land in a ghastly society with industrialized euthanasia, rampant suicide, and devalued life. But what if the slippery slope leads us somewhere better? This paper explores the benefits of eliminating nearly all MAiD prohibitions and regulations. We anticipate three positive effects for public health: 1. Expanded access to those currently not qualified from MAiD by removing ineffective access criteria; 2. Harm reduction by making MAiD safer and by rerouting suicidal patients into alternate care; and 3. Improvements to the health system through lowered healthcare costs and increased patient activation in end-of-life care. Safeguards and prohibitions deny those who wish to die the ability to do so to prevent the potential danger of a few being subjected to an undesired early death.
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Affiliation(s)
- Sean Riley
- The Ohio State University Wexner Medical Center, 2050 Kenny Rd, Columbus, OH, 43215, USA.
| | - Ben Sarbey
- Duke University, 1364 Campus Dr., Durham, NC, 27705, USA
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Riley S. Watching the watchmen: changing tides in the oversight of medical assistance in dying. JOURNAL OF MEDICAL ETHICS 2022:jme-2022-108470. [PMID: 36150893 DOI: 10.1136/jme-2022-108470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
The recent wave of medical assistance in dying legalisation raises questions about proper oversight of the practice as new systems for data collection, case assessment and public reporting emerge. Newer systems, such as in Spain, New Zealand and Colombia, are eschewing the retrospective approach used for case assessment in older systems, particularly those in the Netherlands, Belgium and the USA, in favour of an approach requiring more extensive review prior to the procedure. This shift aims to increase compliance with each jurisdiction's specific safeguards and legal criteria as well as to protect vulnerable patients, but also risks stifling access to the practice and increasing administrative burden on clinicians and patients. Newer systems also tend to favour more extensive data collection than older systems, while failing to be as transparent with public reporting. Inconsistency in data collection and public reporting make it difficult for researchers, policymakers and the public to assess the practice and help achieve a balance between access and compliance. Research on oversight activities is sparse, and there is a need for clarity to determine how best to handle violations of the law and how to create best practices.
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Affiliation(s)
- Sean Riley
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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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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Richards AM, McGauran MJ. Voluntary assisted dying in gynaecological cancers: A discussion of the history, ethical principles and international perspectives. Aust N Z J Obstet Gynaecol 2022; 62:214-218. [PMID: 34994397 DOI: 10.1111/ajo.13475] [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: 07/01/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
Voluntary assisted dying (VAD) is a provocative and ethically charged subject that will potentially be an increasing component of our clinical practice. This paper aims to give the history of VAD, ethical principles, controversies and international perspectives regarding the laws in each jurisdiction. It provides a discussion on the topic with respect to gynaecological oncology to enable clinicians to feel more comfortable with this difficult subject.
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Affiliation(s)
- Anthony M Richards
- Department of Obstetrics and Gynaecology, Joan Kirner Women's and Children's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Melissa J McGauran
- Department of Gynaecology Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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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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McDougall RJ, Ko D. Eligibility and access to voluntary assisted dying: a view from Victoria, Australia. JOURNAL OF MEDICAL ETHICS 2021; 47:676-677. [PMID: 34526370 DOI: 10.1136/medethics-2021-107795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Rosalind J McDougall
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Danielle Ko
- Department of Palliative Care, Austin Health, Heidelberg, Victoria, Australia
- Department of Patient Safety and Clinical Excellence, Austin Health, Heidelberg, Victoria, Australia
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Rutherford J, Willmott L, White BP. What the Doctor Would Prescribe: Physician Experiences of Providing Voluntary Assisted Dying in Australia. OMEGA-JOURNAL OF DEATH AND DYING 2021:302228211033109. [PMID: 34282961 DOI: 10.1177/00302228211033109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Like many countries where voluntary assisted dying (VAD) is legal, eligible doctors in Victoria, Australia, have sole legal authority to provide it. Doctors' attitudes towards legalised VAD have direct bearing on their willingness to participate in VAD and consequently, on whether permissive laws can effectively facilitate access to VAD. The study aimed to explore how some Victorian doctors are perceiving and experiencing the provision of legalised VAD under a recently commenced law. METHODS Semi-structured interviews with 25 Victorian doctors with no in-principle objection to legalised VAD were conducted between July 2019-February 2020. Interviews were recorded, transcribed, and analysed using thematic analysis. Ethical approval from the relevant institution was obtained. RESULTS Doctors perceive or experience VAD to fundamentally challenge traditional medical practice. Barriers to access to VAD derive from applicant, communication, and doctor-related factors. Doctors' willingness to participate in VAD is situation specific.
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Affiliation(s)
- Jodhi Rutherford
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
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