‘This is uncharted water for all of us’: challenges anticipated by hospital clinicians when voluntary assisted dying becomes legal in Victoria
Rosalind McDougall
A H , Barbara Hayes B C , Marcus Sellars D , Bridget Pratt A , Anastasia Hutchinson B E , Mark Tacey B C , Karen Detering C D , Cade Shadbolt A and Danielle Ko F G
A Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, Vic. 3010, Australia. Email: bridget.pratt@unimelb.edu.au; cade.shadbolt@unimelb.edu.au
B Northern Health, Northern Health Bundoora Centre, 1231 Plenty Road, Bundoora, Vic. 3083, Australia. Email: barbara.hayes@mh.org.au; mark.tacey@nh.org.au
C Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Alan Gilbert Building, Melbourne, Vic. 3010, Australia.
D Advance Care Planning Australia, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia. Email: marcus.sellars@austin.org.au; karen.detering@austin.org.au
E School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email: a.hutchinson@deakin.edu.au
F Department of Palliative Care, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia. Email: danielle.ko@austin.org.au
G Department of Quality and Patient Safety, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia.
H Corresponding author. Email: rmcdo@unimelb.edu.au
Australian Health Review 44(3) 399-404 https://doi.org/10.1071/AH19108
Submitted: 13 May 2019 Accepted: 22 July 2019 Published: 22 November 2019
Abstract
Objective The aim of this study was to identify the challenges anticipated by clinical staff in two Melbourne health services in relation to the legalisation of voluntary assisted dying in Victoria, Australia.
Methods A qualitative approach was used to investigate perceived challenges for clinicians. Data were collected after the law had passed but before the start date for voluntary assisted dying in Victoria. This work is part of a larger mixed-methods anonymous online survey about Victorian clinicians’ views on voluntary assisted dying. Five open-ended questions were included in order to gather text data from a large number of clinicians in diverse roles. Participants included medical, nursing and allied health staff from two services, one a metropolitan tertiary referral health service (Service 1) and the other a major metropolitan health service (Service 2). The data were analysed thematically using qualitative description.
Results In all, 1086 staff provided responses to one or more qualitative questions: 774 from Service 1 and 312 from Service 2. Clinicians anticipated a range of challenges, which included burdens for staff, such as emotional toll, workload and increased conflict with colleagues, patients and families. Challenges regarding organisational culture, the logistics of delivering voluntary assisted dying under the specific Victorian law and how voluntary assisted dying would fit within the hospital’s overall work were also raised.
Conclusions The legalisation of voluntary assisted dying is anticipated to create a range of challenges for all types of clinicians in the hospital setting. Clinicians identified challenges both at the individual and system levels.
What is known about the topic? Voluntary assisted dying became legal in Victoria on 19 June 2019 under the Voluntary Assisted Dying Act 2017. However there has been little Victorian data to inform implementation.
What does this paper add? Victorian hospital clinicians anticipate challenges at the individual and system levels, and across all clinical disciplines. These challenges include increased conflict, emotional burden and workload. Clinicians report concerns about organisational culture, the logistics of delivering voluntary assisted dying under the specific Victorian law and effects on hospitals’ overall work.
What are the implications for practitioners? Careful attention to the breadth of staff affected, alongside appropriate resourcing, will be needed to support clinicians in the context of this legislative change.
References
[1] Li M, Watt S, Escaf M, Gardam M, Heesters A, O’Leary G, Rodin G. Medical assistance in dying – implementing a hospital-based program in Canada. N Engl J Med 2017; 376 2082–8.| Medical assistance in dying – implementing a hospital-based program in Canada.Crossref | GoogleScholarGoogle Scholar | 28538128PubMed |
[2] Khoshnood N, Hopwood MC, Lokuge B, Kurahashi A, Tobin A, Isenberg S, Husain A. Exploring Canadian physicians’ experiences providing medical assistance in dying: a qualitative study. J Pain Symptom Manage 2018; 56 222–229.e1.
| Exploring Canadian physicians’ experiences providing medical assistance in dying: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 29775692PubMed |
[3] White B, Willmott L. Future of assisted dying reform in Australia. Aust Health Rev 2018; 42 616–20.
| Future of assisted dying reform in Australia.Crossref | GoogleScholarGoogle Scholar | 30465706PubMed |
[4] Yoong J, Franco M, William L, Poon P. Perspectives of cancer treatment providers regarding voluntary assisted dying in Victoria. Intern Med J 2018; 48 770–3.
| Perspectives of cancer treatment providers regarding voluntary assisted dying in Victoria.Crossref | GoogleScholarGoogle Scholar | 29984507PubMed |
[5] Blaschke SM, Schofield P, Taylor K, Ugalde A. Common dedication to facilitating good dying experiences: qualitative study of end-of-life care professionals’ attitudes towards voluntary assisted dying. Palliat Med 2019; 33 562–9.
| Common dedication to facilitating good dying experiences: qualitative study of end-of-life care professionals’ attitudes towards voluntary assisted dying.Crossref | GoogleScholarGoogle Scholar | 30688145PubMed |
[6] Karapetis CS, Stein B, Koczwara B, Harrup R, Milleshkin L, Parente P, Millward M, Haines I, Blinman P, Olver I. Medical Oncology Group of Australia position statement and membership survey on voluntary assisted dying. Intern Med J 2018; 48 774–9.
| Medical Oncology Group of Australia position statement and membership survey on voluntary assisted dying.Crossref | GoogleScholarGoogle Scholar | 29984513PubMed |
[7] Department of Health and Human Services Victoria. Health services information: health service participation in voluntary assisted dying and voluntary assisted dying statewide pharmacy service. 2018. Available at: https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/voluntary-assisted-dying/health-services-information [verified 9 July 2019].
[8] Calvary. Catholic Health and Aged Care services response to the ‘Voluntary Assisted Dying Act’. 12 June 2019. Available at: https://www.calvarycare.org.au/blog/2019/06/12/catholic-health-and-aged-care-services-response-to-the-voluntary-assisted-dying-act/ [verified 9 July 2019].
[9] Kitto SC, Chesters J, Grbich C. Quality in qualitative research. Med J Aust 2008; 188 243–6.
| Quality in qualitative research.Crossref | GoogleScholarGoogle Scholar | 18279135PubMed |
[10] Sandelowski M. Whatever happened to qualitative description? Res Nurs Health 2000; 23 334–40.
| Whatever happened to qualitative description?Crossref | GoogleScholarGoogle Scholar | 10940958PubMed |
[11] Beuthin R, Bruce A, Scaia M. Medical assistance in dying (MAiD): Canadian nurses’ experiences. Nurs Forum 2018; 53 511–20.
| Medical assistance in dying (MAiD): Canadian nurses’ experiences.Crossref | GoogleScholarGoogle Scholar | 29972596PubMed |
[12] Denier Y, Dierckx de Casterlé B, De Bal N, Gastmans C. ‘It’s intense, you know.’ Nurses’ experiences in caring for patients requesting euthanasia. Med Health Care Philos 2010; 13 41–8.
| ‘It’s intense, you know.’ Nurses’ experiences in caring for patients requesting euthanasia.Crossref | GoogleScholarGoogle Scholar | 19381871PubMed |
[13] Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA 2016; 316 79–90.
| Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe.Crossref | GoogleScholarGoogle Scholar | 27380345PubMed |
[14] Stevens KR. Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians. Linacre Q 2006; 73 203–16.
| Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians.Crossref | GoogleScholarGoogle Scholar | 17139816PubMed |
[15] Li M, Kain D. The other side of sorrow: physician reflections on assisted dying. CMAJ 2018; 190 E169–70.
| The other side of sorrow: physician reflections on assisted dying.Crossref | GoogleScholarGoogle Scholar | 30986198PubMed |
[16] Harman SM, Magnus D. Early experience with the California End of Life Option Act: balancing institutional participation and physician conscientious objection. JAMA Intern Med 2017; 177 907–8.
| Early experience with the California End of Life Option Act: balancing institutional participation and physician conscientious objection.Crossref | GoogleScholarGoogle Scholar | 28531248PubMed |
[17] Stewart DE, Rodin G, Li M. Consultation–liaison psychiatry and physician-assisted death. Gen Hosp Psychiatry 2018; 55 15–19.
| Consultation–liaison psychiatry and physician-assisted death.Crossref | GoogleScholarGoogle Scholar | 30199751PubMed |
[18] Snijdewind MC, van Tol DG, Onwuteaka-Philipsen BD, Willems DL. Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients’ relatives. J Pain Symptom Manage 2014; 48 1125–34.
| Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients’ relatives.Crossref | GoogleScholarGoogle Scholar | 24929029PubMed |
