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.
AbrahaoA.DownarJ.PintoH.DupréN.IzenbergA.KingstonW.KorngutL.O’ConnellC.PetrescuN.ShoesmithC.TandonA.Vargas-SantosA. B.ZinmanL. (2016). Physician-assisted death a Canada-wide survey of ALS health care providers. Neurology, 87(11), 1152–1160.
BélangerE.TowersA.WrightD. K.ChenY.TradounskyG.MacdonaldM. E. (2019). Of dilemmas and tensions: A qualitative study of palliative care physicians’ positions regarding voluntary active euthanasia in Quebec, Canada. Journal of Medical Ethics, 45(1), 48–53.
5.
Bernheim, Jan et al. (2008) ‘Development of palliative care and legalisation of euthanasia: antagonism or synergy?’. British Me dical Journal, 336(7649), 864–867
6.
BeuthinR.BruceA.HopwoodM-c.RobertsonW. D.BertoniK J S O M. (2020). Rediscovering the art of medicine, rewards, and risks: Physicians’ experience of providing medical assistance in dying in Canada. SAGE Open Medicine, 8, 2050312120913452.
7.
BouthillierM.-E.OpatrnyL. (2019). A qualitative study of physicians’ conscientious objections to medical aid in dying. Palliative Medicine, 33(9), 1212–1220.
8.
BrooksL. (2019). Health care provider experiences of and perspectives on medical assistance in dying: A scoping review of qualitative studies. Canadian Journal on Aging = La Revue Canadienne du Vieillissement, 38(3), 384–396.
9.
BrownJ.GoodridgeD.HarrisonA.KempJ.ThorpeL.WeilerR. (2020). Medical assistance in dying: Patients’, families’, and health care providers’ perspectives on access and care delivery. Journal of Palliative Medicine, 23(11), 1468–1477.
10.
BuchbinderM.LassiterD.MercierR.BryantA.LyerlyA. D. (2016). Reframing conscientious care: Providing abortion care when law and conscience collide. Hastings Center Report, 46(2), 22–30.
11.
BuitingH. M.GeversJ. K. M.RietjensJ. A. C.Onwuteaka-PhilipsenB. D.van der MaasP. J.van der HeideA.van DeldenJ. J. M. (2008). Dutch criteria of due care for physician-assisted dying in medical practice: A physician perspective. Journal of Medical Ethics, 34(9), e12. https://doi.org/10.1136/jme.2008.024976
12.
BuitingH.van DeldenJ.Onwuteaka-PhilpsenB.RietjensJ.RurupM.van TolD.GeversJ.van der MaasP.van der HeideA. (2009). Reporting of euthanasia and physician-assisted suicide in The Netherlands: Descriptive study. BMC Medical Ethics, 10(1), 1–10. https://doi.org/10.1186/1472-6939-10-18
13.
CairnsW. (2019). Palliative medicine, pain management and VAD. Medical Journal of Australia Insight, 24, 1–8.
14.
ChambaereK.BernheimJ. L. (2015). Does legal physician-assisted dying impede development of palliative care? The Belgian and Benelux experience. Journal of Medical Ethics, 41(8), 657–660.
15.
ChambaereK.CentenoC.HernándezE. A.Y. V. WM.Guillén-GrimaF.DeliensL.PayneS. (2011). Palliative care development in countries with a euthanasia law. Commission on Assisted Dying.
16.
ChochinovH M.FrazeeC J. (2016). Finding a balance: Canada's law on medical assistance in dying. The Lancet, 388(10044), 543–545.
17.
CookR. J.OlayaM. A.DickensB. M. (2009). Healthcare responsibilities and conscientious objection. International Journal of Gynecology & Obstetrics, 104(3), 249–252.
CurryL.SchwartzH. I.GrumanC.BlankK. (2000). Physicians’ voices on physician-assisted suicide: Looking beyond the numbers. Ethics & Behavior, 10(4), 337–361. https://doi.org/10.1207/S15327019EB1004_2
22.
CzarneckiD.AnspachR. R.De VriesR. G.DunnM. D.HauschildtK.HarrisL. H. (2019). Conscience reconsidered: The moral work of navigating participation in abortion care on labor and delivery. Social Science & Medicine (1982), 232, 181–189.
23.
de BoerM. E.DeplaM. F.den BreejenM.SlottjeP.Onwuteaka-PhilipsenB. D.HertoghC. M. (2019). Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners. Journal of Medical Ethics, 45(7), 425–429.
24.
DickensB. (2008). Conscientious commitment. The Lancet, 371(9620), 1240–1241.
25.
DickinsonG. E.LancasterC. J.ClarkD.AhmedzaiS. H.NobleW. (2002). U.K. physicians’ attitudes toward active voluntary euthanasia and physician-assisted suicide. Death Studies, 26(6), 479–490. https://doi.org/10.1080/074811802760139003
26.
DobschaS. K.HeintzR. T.PressN.GanziniL. J. (2004). Oregon physicians’ responses to requests for assisted suicide: A qualitative study. Journal of Palliative Medicine, 7(3), 451–461.
27.
DownarJ.FrancescuttiL. H. (2017). Medical assistance in dying: Time for physicians to step up to protect themselves and patients. Canadian Medical Association Journal = Journal de L'association Medicale Canadienne, 189(25), E849–E850.
28.
DyerC. (2011). Legalisation of assisted dying does not harm palliative care, study concludes. BMJ, 343(October), d6779–d6779.
29.
EmanuelE. J.Onwuteaka-PhilipsenB. D.UrwinJ. W.CohenJ. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA, 316(1), 79–90.
30.
FujiokaJ. K.MirzaR. M.KlingerC. A.McDonaldL. P. (2019). Medical assistance in dying: Implications for health systems from a scoping review of the literature. Journal of Health Services Research & Policy, 24(3), 207–216.
31.
FujiokaJ. K.MirzaR. M.McDonaldP. L.KlingerC. A. (2018). Implementation of medical assistance in dying (MAiD): A scoping review of health care providers’ perspectives. Journal of Pain and Symptom Management, 55(6), 1564–1576.e9.
32.
GalushkoM.FrerichG.PerrarK.GollaH.RadbruchL.NauckF.OstgatheC.VoltzR. (2016). Desire for hastened death: How do professionals in specialized palliative care react?Psycho‐Oncology, 25(5), 536–543.
33.
GamesterN.Van den EyndenB. (2009). The relationship between palliative care and legalized euthanasia in Belgium. Journal of Palliative Medicine, 12(7), 589–591.
34.
GanziniL.FennD. S.LeeM. A.HeintzR. T.BloomJ. D. (1996). Attitudes of Oregon psychiatrists toward physician-assisted suicide. The American Journal of Psychiatry, 153(11), 1469–1475.
35.
GanziniL.NelsonH. D.LeeM. A.KraemerD. F.SchmidtT. A.DeloritM. A. (2001). Oregon physicians’ attitudes about and experiences with end-of-life care since passage of the Oregon death with dignity act. JAMA, 285(18), 2363–2369.
36.
GanziniL.NelsonH. D.SchmidtT. A.KraemerD. F.DeloritM. A.LeeM. A. (2000). Physicians’ experiences with the Oregon death with dignity act. New England Journal of Medicine, 342(8), 557–563. https://doi.org/10.1056/NEJM200002243420806
37.
GeorgesJ.Onwuteaka-PhilipsenB.van der WalG. (2008). Dealing with requests for euthanasia: A qualitative study investigating the experience of general practitioners. Journal of Medical Ethics, 34(3), 150–155.
38.
GielenJ.Van den BrandenS.BroeckaertB. (2008). Attitudes of European physicians toward euthanasia and physician-assisted suicide: A review of the recent literature. Journal of Palliative Care, 24(3), 173–184.
39.
GroenewoudJ. H.van der HeideA.Onwuteaka-PhilipsenB. D.WillemsD. L.van der MaasP. J.van der WalG. (2000). Clinical problems with the performance of euthanasia and physician-assisted suicide in the Netherlands. New England Journal of Medicine, 342(8), 551–556.
40.
HaleyK.LeeM. (1998). The Oregon death with dignity act: A guidebook for health care providers. Center for Ethics in Health Care, Oregon Health Sciences University.
41.
HarmanS. M.MagnusD. (2017). Early experience with the California end of life option act: Balancing institutional participation and physician conscientious objection. JAMA Internal Medicine, 177(7), 907–908.
HesselinkB. A.PasmanH. R. W.van der WalG.van der MaasP. J.van der HeideA.Onwuteaka-PhilipsenB. D. (2010). Development and dissemination of institutional practice guidelines on medical end-of-life decisions in Dutch health care institutions. Health Policy, 94(3), 230–238.
44.
HudsonP.HudsonR.PhilipJ.BougheyM.KellyB.HertoghC. (2015). Physician-assisted suicide and/or euthanasia: Pragmatic implications for palliative care [corrected]. Palliative & Supportive Care, 13(5), 1399–1409. https://doi.org/10.1017/S1478951515000176
45.
KarapetisC. S.SteinB.KoczwaraB.HarrupR.MilleshkinL.ParenteP.MillwardM.HainesI.BlinmanP.OlverI. (2018). Medical oncology group of Australia position statement and membership survey on voluntary assisted dying. Internal Medicine Journal, 48(7), 774–779.
46.
KellyB.HandleyT.KissaneD.VamosM.AttiaJ. (2020). “An indelible mark” the response to participation in euthanasia and physician-assisted suicide among doctors: A review of research findings. Palliative & Supportive Care, 18(1), 82–88. https://doi.org/10.1017/S1478951519000518
47.
KhoshnoodN.HopwoodM.-C.LokugeB.KurahashiA.TobinA.IsenbergS.HusainA. (2018). Exploring Canadian physicians’ experiences providing medical assistance in dying: A qualitative study. Journal of Pain and Symptom Management, 56(2), 222–229.e1.
48.
KozlovE.McDarbyM.ReidM. C.CarpenterB. D. (2018). Knowledge of palliative care among community-dwelling adults. The American Journal of Hospice & Palliative Care, 35(4), 647–651.
49.
LavoieM.GodinG.Vézina-ImL.-A.BlondeauD.MartineauI.RoyL. (2015). Psychosocial determinants of physicians’ intention to practice euthanasia in palliative care. BMC Medical Ethics, 16(1), 6.
50.
LeeW.PriceA.RaynerL.HotopfM. (2009). Survey of doctors’ opinions of the legalisation of physician assisted suicide. BMC Medical Ethics, 10(1), 1.
51.
LoB. (2018). Beyond legalization—Dilemmas physicians confront regarding aid in dying. The New England Journal of Medicine, 378(22), 2060–2062.
52.
MaterstvedtL. J. (2013). Palliative care ethics: The problems of combining palliation and assisted dying. Progress in Palliative Care, 21(3), 158–164. https://doi.org/10.1179/1743291X12Y.0000000040
53.
McCormackR.CliffordM.ConroyM. (2012). Attitudes of UK doctors towards euthanasia and physician-assisted suicide: A systematic literature review. Palliative Medicine, 26(1), 23–33. https://doi.org/10.1177/0269216310397688
54.
McDougallR.PrattB. (2020). Too much safety? Safeguards and equal access in the context of voluntary assisted dying legislation. BMC Medical Ethics, 21(1), 1–10.
55.
MooreB.HemptonC.KendalE. (2020). Victoria’s voluntary assisted dying act: Navigating the section 8 gag clause. Medical Journal of Australia, 212(2), 67–68.e61.
56.
O’ConnorM.PhilipsJ. (2020). Challenges of implementing voluntary assisted dying in Victoria. International Journal of Palliative Nursing, 26(8), 425–430.
57.
OliphantA.FrolicA. N. (2020). Becoming a medical assistance in dying (MAiD) provider: An exploration of the conditions that produce conscientious participation. Journal of Medical Ethics, 47(1), 51–58.
58.
OliverP.WilsonM.MalpasP. (2017). New Zealand doctors’ and nurses’ views on legalising assisted dying in New Zealand. NZ Medical Journal, 130, 10–26.
59.
OtteI. C.JungC.ElgerB.BallyK. (2017). We need to talk!” Barriers to GPs’ communication about the option of physician-assisted suicide and their ethical implications: Results from a qualitative study. Medicine, Health Care and Philosophy, 20(2), 249–256.
60.
PatelP.LyonsL. (2020). Examining the knowledge, awareness, and perceptions of palliative care in the general public over time: A scoping literature review. The American Journal of Hospice & Palliative Care, 37(6), 481–487.
61.
RutherfordJ. (2020). Conscientious participants and the ethical dimensions of physician support for legalised voluntary assisted dying. Journal of Medical Ethics, 11(2), 200–208.
62.
SavulescuJ. (2006). Conscientious objection in medicine. BMJ, 332(7536), 294–297.
63.
SealeC. (2009). Legalisation of euthanasia or physician-assisted suicide: Survey of doctors’ attitudes. Palliative Medicine, 23(3), 205–212.
64.
SercuM.PypeP.ChristiaensT.GrypdonckM.DereseA.DeveugeleM. (2012). Are general practitioners prepared to end life on request in a country where euthanasia is legalised?Journal of Medical Ethics, 38(5), 274–280.
65.
ShalevA.PhongtankuelV.KozlovE.ShenM. J.AdelmanR. D.ReidM. (2018). Awareness and misperceptions of hospice and palliative care: A population-based survey study. The American Journal of Hospice & Palliative Care, 35(3), 431–439.
66.
ShawJ.WiebeE.NuhnA.HolmesS.KellyM.JustA. J. C. F. P. (2018). Providing medical assistance in dying: Practice perspectives. Canadian Family Physician, 64(9), e394–e399.
67.
SheahanL. (2016). Exploring the interface between ‘physician‐assisted death’ and palliative care: Cross‐sectional data from Australasian palliative care specialists. Internal Medicine Journal, 46(4), 443–451.
68.
SleemanK.ChalmersI. (2019). Assisted dying: Restricting access to people with fewer than six months to live is discriminatory. Bmj (Clinical Research ed.), 367, l6093.
69.
SmithA. K.WhiteD. B.ArnoldR. M. (2013). Uncertainty: The other side of prognosis. The New England Journal of Medicine, 368(26), 2448–2450.
70.
SnijdewindM. C.van TolD. G.Onwuteaka-PhilipsenB. D.WillemsD. L. (2018). Developments in the practice of physician-assisted dying: Perceptions of physicians who had experience with complex cases. Journal of Medical Ethics, 44(5), 292–296.
71.
TallisR. (2012). Our professional bodies should stop opposing assisted dying. BMJ (Clinical Research ed.), 344, e4115.
72.
ten CateK.van TolD. G.van de VathorstS. (2017). Considerations on requests for euthanasia or assisted suicide: A qualitative study with Dutch general practitioners. Family Practice, 34(6), 723–729. https://doi.org/10.1093/fampra/cmx041
73.
ThulesiusH. O.ScottH.HelgessonG.LynöeN. (2013). De-tabooing dying control—A grounded theory study. BMC Palliative Care, 12(1), 13.
74.
Torjesen, I. (2020). BMA should drop its opposition to assisting dying, say members in landmark poll. British Medical Journal, 371, m3936
75.
van MarwijkH.HaverkateI.van RoyenP.TheA. M. (2007). Impact of euthanasia on primary care physicians in The Netherlands. Palliative Medicine, 21(7), 609–614. https://doi.org/10.1177/0269216307082475
WhiteB.WillmottL. (2018). Future of assisted dying reform in Australia. Australian Health Review: A Publication of the Australian Hospital Association, 42(6), 616–620.
80.
WillmottL.WhiteB.KoD.DownarJ.DeliensL. (2020). Restricting conversations about voluntary assisted dying: Implications for clinical practice. BMJ Supportive & Palliative Care, 10(1), 105–110.
81.
WillmottL.WhiteB.StackpooleC.PurserK.McGeeA. (2016). (Failed) voluntary euthanasia law reform in Australia: Two decades of trends, models and politics. The University of New South Wales Law Journal, 39(1), 1–46.
YoongJ.FrancoM.WilliamL.PoonP. (2018). Perspectives of cancer treatment providers regarding voluntary assisted dying in Victoria. Internal Medicine Journal, 48(7), 770–773.
84.
ZenzJ.TrybaM.ZenzM. (2015). Palliative care professionals’ willingness to perform euthanasia or physician assisted suicide. BMC Palliative Care, 14(1), 1.
