Anticipated impacts of voluntary assisted dying legislation on nursing practice

Abstract

Background: The Voluntary Assisted Dying Act 2017 passed into law in Victoria, Australia, on the 29 November 2017. Internationally, nurses have been shown to be intimately involved in patient care throughout the voluntary assisted dying process. However, there is a paucity of research exploring Australian nurses’ perspectives on voluntary assisted dying and, in particular, how Victorian nurses anticipate the implementation of this ethically controversial legislation will impact their professional lives. Objectives: To explore Victorian nurses’ expectations of the ethical and practical impacts the voluntary assisted dying legislation will have on their professional lives. Research design: This qualitative study analysed nurses’ free text responses collected as part of a larger mixed methods online survey investigating staff views on the Voluntary Assisted Dying Act. Data were collected during the period between the passing of the voluntary assisted dying legislation and the start date and were analysed using inductive content analysis. Participants and research context: Free text survey responses were analysed from 1873 nurses employed across seven Victorian health services located in both metropolitan and regional areas of the state. Ethical considerations: The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation. Findings: This study identified three broad areas of Victorian nurses’ professional lives that they expected to be impacted by the implementation of voluntary assisted dying: professional identity, career development and workplace relationships. Conclusion: Participants anticipate diverse and nursing-specific impacts of the implementation of voluntary assisted dying in Victoria. Their insights can inform health services in jurisdictions considering or already implementing voluntary assisted dying, to develop policies, procedures and staff training programmes that safeguard the well-being and legal rights of their nursing staff.

Clinician perspectives on voluntary assisted dying and willingness to be involved: a multisite, cross‐sectional survey during implementation in New South Wales, Australia

“…Emerging Australian data are consistent with prior international findings and with data from Australian jurisdictions where VAD is in operation, suggesting that a majority of clinicians support VAD legalisation (>70%), although support is less among medical specialists (51%), compared to nurses (79%) and allied health staff (78%), and that a minority of medical specialists report being willing to participate in formal VAD roles (<45%) 16,17 . Research also demonstrates that during VAD implementation, clinicians identify a range of expected challenges to do with increased conflict, emotional burden, clinical uncertainty, logistics and the prospect of moral distress and uncertainty 19–23 …”

“…16,17 Research also demonstrates that during VAD implementation, clinicians identify a range of expected challenges to do with increased conflict, emotional burden, clinical uncertainty, logistics and the prospect of moral distress and uncertainty. [19][20][21][22][23] Broad similarities in VAD laws in Australian states and the context of their implementationsuch as federal regulations, health funding demands, technical clinical issues, shared professional values and knowledge sharing between state health bureaucraciessuggest that similar issues may emerge in the NSW context of VAD implementation.…”

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

“…The larger survey study aimed to collect data about the willingness of clinical staff to participate in VAD, in order to inform decision-making by the health services about which of the model of care pathways was the appropriate choice for their organization. The results of the larger survey study are reported elsewhere (Sellars et al, 2021a ; Snir et al 2022 ; McDougall et al 2020 ).…”

“…Further, during an implementation period, clinicians are experiencing an impending real change in relation to the health system in which they practise, rather than either a hypothetical scenario of legislative change or lived experience of VAD being legally available. To date, published data about this time period have primarily been limited to survey responses (McDougall et al 2020 ; Fuscaldo et al 2021 ; Booth, Eleftheriou, and Moody 2021 ; Sellars et al 2021a ; Snir et al 2022 ), which provide important insights but limited detail and nuance in relation to participants’ views. The existing data indicate that support for the implementation of VAD may be lower among medical specialists, particularly palliative care specialists (Sellars et al 2021a ; Philip et al 2021 ), than among other hospital staff (Fuscaldo et al 2021 ; Sellars et al 2021a ).…”

“…As well as focusing on the implementation period specifically, a key aspect of the conceptual framework of this study was conceptualizing the individual clinician as part of a team, department, and organization in relation to VAD (Oliphant and Frolic 2021 ). Existing research on clinicians’ views and experiences in relation to VAD tends to focus on individual decision-making and practice within specific professional groups such as oncology (Yoong et al 2018 ; Karapetis et al 2018 ), palliative care (Blaschke et al 2019 ; Wright et al 2021 ), geriatrics (Munday and Poon 2020 ), nursing (Snir et al 2022 ; Wilson, Oliver, and Malpas 2019 ), or pharmacy (Woods et al 2021 ). Our focus went beyond participants’ individual decision-making to investigate their experiences as part of a team and an organization navigating this significant change in the healthcare landscape.…”