Voluntary assisted dying: impacts on health professionals
Geetanjali (Tanji) Lamba A B * , Camille LaBrooy F , Sophie Lewis C , Ian Olver D , Alexander Holmes E , Cameron Stewart C and Paul Komesaroff AA
B
C
D
E
F
Abstract
The introduction and implementation of voluntary assisted dying (VAD) legislation represents a major shift in Australian health policy. Given potential repercussions for health professionals, understanding how they are being affected by this legislation is important to guide future policy and legislative changes. This study aims to explore the perspectives and experiences of Australian health professionals on VAD and compare impacts on those working under different state legislation in Victoria and WA.
Data were collected using a cross-sectional survey design, targeting health professionals nationally, primarily doctors and nurses. The survey had closed and open-ended response options, was informed by previous publications and was piloted prior to further roll-out. Recruitment was via professional networks and social media. Quantitative data were descriptively analysed and qualitative data were coded using NVivo and thematically analysed.
There was a final sample size of 223. Impacts on clinicians identified include inadequate remuneration, a need for ongoing support and the recognition of barriers to mandatory training.
Impacts on health practitioners, if not addressed, have future implications for workforce sustainability. Increasing numbers of trained VAD practitioners may enable distribution of clinical load and prevent burnout. VAD practitioners are not being appropriately remunerated, which could be addressed by introducing dedicated Medicare Benefits Schedule items for VAD. Attention should also be given to incentivising training, including continuing professional development accreditation and appropriate funding. Strategies to support staff could include debriefing, mentoring, peer support and psychological consultations.
Keywords: attitude to death, bereavement, death, end-of-life, health care reform, health policy, implementation, voluntary assisted dying.
References
1 Willmott L, White BP, Sellars M, Yates PM. Participating doctors’ perspectives on the regulation of voluntary assisted dying in Victoria: a qualitative study. Med J Aust 2021; 215(3): 125-9.
| Crossref | Google Scholar | PubMed |
2 Haining CM, Willmott L, Towler S, White BP. Access to voluntary assisted dying in Australia requires fair remuneration for medical practitioners. Med J Aust 2023; 218(1): 8-10.
| Crossref | Google Scholar | PubMed |
3 Willmott L, Feeney R, Yates P, Parker M, Waller K, White BP. A cross-sectional study of the first two years of mandatory training for doctors participating in voluntary assisted dying. Palliat Support Care 2022; 1-7.
| Crossref | Google Scholar | PubMed |
4 Van Wesemael Y, Cohen J, Onwuteaka-Philipsen BD, Bilsen J, Deliens L. Establishing specialized health services for professional consultation in euthanasia: experiences in the Netherlands and Belgium. BMC Health Serv Res 2009; 9(1): 220.
| Crossref | Google Scholar | PubMed |
5 Digby R, McDougall R, Gold M, Ko D, O’Driscoll L, Bucknall T. Introducing Voluntary Assisted Dying: Staff Perspectives in an Acute Hospital. Int J Health Policy Manag 2022; 11(6): 777-85.
| Crossref | Google Scholar | PubMed |
6 Sellars M, White BP, Yates P, Willmott L. Medical practitioners’ views and experiences of being involved in assisted dying in Victoria, Australia: A qualitative interview study among participating doctors. Soc Sci Med 2022; 292: 114568.
| Crossref | Google Scholar | PubMed |
7 Australia Co. Medicare Benefits Schedule - Note GN.13.33. 2014. Available at https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.13.33&qt=noteID
8 Rutherford J, Willmott L, White BP. What the Doctor Would Prescribe: Physician Experiences of Providing Voluntary Assisted Dying in Australia. Omega 2023; 87(4): 1063-87.
| Crossref | Google Scholar | PubMed |
9 Beuthin R, Bruce A, Hopwood M-c, Robertson WD, Bertoni K. Rediscovering the art of medicine, rewards, and risks: physicians’ experience of providing medical assistance in dying in Canada. SAGE Open Med 2020; 8: 2050312120913452.
| Crossref | Google Scholar | PubMed |
10 Khoshnood N, Hopwood M-C, Lokuge B, Kurahashi A, Tobin A, Isenberg S, et al. Exploring Canadian Physicians’ Experiences Providing Medical Assistance in Dying: A Qualitative Study. J Pain Symptom Manage 2018; 56(2): 222-9.e1.
| Crossref | Google Scholar | PubMed |
11 Bellens M, Debien E, Claessens F, Gastmans C, Dierckx de Casterlé B. “It is still intense and not unambiguous.” Nurses’ experiences in the euthanasia care process 15 years after legalisation. J Clin Nurs 2020; 29(3–4): 492-502.
| Crossref | Google Scholar | PubMed |
12 Oczkowski SJW, Crawshaw D, Austin P, Versluis D, Kalles-Chan G, Kekewich M, et al. How We Can Improve the Quality of Care for Patients Requesting Medical Assistance in Dying: A Qualitative Study of Health Care Providers. J Pain Symptom Manage 2021; 61(3): 513-21.e8.
| Crossref | Google Scholar | PubMed |
13 Queensland Government. Community of practices. Queensland Health; 2022. Available at https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/voluntary-assisted-dying/support/community-of-practices
14 VADANZ. Voluntary Assisted Dying Australia and New Zealand. 2023. Available at https://www.vadanz.com.au/
15 McLaren CJ, Mewett G. Update on voluntary assisted dying in Australia. Med J Aust 2021; 215(3): 115-6.
| Crossref | Google Scholar | PubMed |
16 Dickinson GE, Clark D, Winslow M, Marples R. US physicians’ attitudes concerning euthanasia and physician-assisted death: A systematic literature review. Mortality 2005; 10(1): 43-52.
| Crossref | Google Scholar |
17 Kouwenhoven PS, Raijmakers NJ, van Delden JJ, Rietjens JA, Schermer MH, van Thiel GJ, et al. Opinions of health care professionals and the public after eight years of euthanasia legislation in the Netherlands: a mixed methods approach. Palliat Med 2013; 27(3): 273-80.
| Crossref | Google Scholar | PubMed |
18 McCormack R, Clifford M, Conroy M. Attitudes of UK doctors towards euthanasia and physician-assisted suicide: a systematic literature review. Palliat Med 2012; 26(1): 23-33.
| Crossref | Google Scholar | PubMed |
19 ABS. Australian Standard Classification of Cultural and Ethnic Groups (ASCCEG). 2019. Available at https://www.abs.gov.au/statistics/classifications/australian-standard-classification-cultural-and-ethnic-groups-ascceg/latest-release
20 ABS. Australian Standard Classification of Religious Groups. 2024. Available at https://www.abs.gov.au/statistics/classifications/australian-standard-classification-religious-groups/latest-release
21 ABS. Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables. 2021. Available at https://www.abs.gov.au/statistics/standards/standard-sex-gender-variations-sex-characteristics-and-sexual-orientation-variables/2016
22 Whitaker C, Stevelink S, Fear N. The Use of Facebook in Recruiting Participants for Health Research Purposes: A Systematic Review. J Med Internet Res 2017; 19(8): e290.
| Crossref | Google Scholar | PubMed |
23 Lewis S, La , Brooy C, Kerridge I, Holmes A, Olver I, Hudson P, et al. Choreographing a good death: Carers’ experiences and practices of enacting assisted dying. Sociol Health Illn 2024; 46: 1345-63.
| Crossref | Google Scholar | PubMed |
25 Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health 2019; 11(4): 589-97.
| Crossref | Google Scholar |
26 Department of Health, Tasmanian Government. Voluntary Assisted Dying Training. Available at https://www.health.tas.gov.au/health-topics/voluntary-assisted-dying/training-voluntary-assisted-dying
27 Crumley ET, Kelly S, Young J, Phinney N, McCarthy J, Gubitz G. How is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study. BMJ Open 2021; 11: e048698.
| Crossref | Google Scholar | PubMed |
28 NSW Health. Voluntary assisted dying awareness module for NSW healthcare workers. 2024. Available at https://www.health.nsw.gov.au/voluntary-assisted-dying/Pages/general-awareness-training.aspx
29 Sandham M, Carey M, Hedgecock E, Jarden R. Nurses’ experiences of supporting patients requesting voluntary assisted dying: A qualitative meta-synthesis. J Adv Nurs 2022; 78(10): 3101-15.
| Crossref | Google Scholar | PubMed |
30 Mathews JJ, Hausner D, Avery J, Hannon B, Zimmermann C, Al-Awamer A. Impact of Medical Assistance in Dying on palliative care: A qualitative study. Palliat Med 2021; 35(2): 447-54.
| Crossref | Google Scholar | PubMed |
31 Shaw J, Wiebe E, Nuhn A, Holmes S, Kelly M, Just A. Providing medical assistance in dying: Practice perspectives. Can Fam Physician 2018; 64(9): e394-9.
| Google Scholar | PubMed |
32 Snir JT, Ko DN, Pratt B, McDougall R. Anticipated impacts of voluntary assisted dying legislation on nursing practice. Nurs Ethics 2022; 29(6): 1386-400.
| Crossref | Google Scholar | PubMed |
33 Kresin T, Hawgood J, De Leo D, Varghese F. Attitudes and Arguments in the Voluntary Assisted Dying Debate in Australia: What Are They and How Have They Evolved Over Time? Int J Environ Res Public Health 2021; 18(23): 12327.
| Crossref | Google Scholar | PubMed |
