“I haven’t had to bare my soul but now I kind of have to”: describing how voluntary assisted dying conscientious objectors anticipated approaching conversations with patients in Victoria, Australia

Abstract

Background Dealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) recognizes the inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process. Methods Seventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically. Results Our results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one’s CO as identified by our participants. Conclusion The broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one’s CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately.

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

“…While there is a substantial body of empirical research on healthcare professionals’ views on VAD, and their experiences of providing or objecting (White, Willmott, and Close 2019 ; Rutherford 2020 ; Haining, Keogh, and Gillam 2021 ; Yoong et al 2018 ; Blaschke et al 2019 ; Karapetis et al 2018 ; Fujioka et al 2018 ; Beuthin, Bruce, and Scaia 2018 ; Bruce and Beuthin 2020 ), the existing literature on healthcare professionals’ views and experiences during an implementation period is very limited. Healthcare professionals’ experiences and views in an implementation period are potentially different from those prior to legislative change or those occurring once VAD is available in a health system.…”

“…Implementation challenges are anticipated to range from the level of the individual clinician to that of the hospital or health system as a whole (McDougall et al 2020 ; Booth, Eleftheriou, and Moody 2021 ). While the literature includes reflective pieces (Philip et al 2021 ; Lee 1997 ; Le and Philip 2018 ) and non-empirical analyses (White, Willmott, and Close 2019 ; Johnston and Cameron 2018 ; Moore, Hempton, and Kendal 2020 ) focused on implementation periods alongside survey reports, a study of pharmacists (Woods et al 2021 ) and a study of conscientious objectors (Haining and Keogh 2021 ) are, to our knowledge, the only interview studies examining practitioners’ views in an implementation period to date.…”

Rural healthcare professionals’ participation in Medical Assistance in Dying (MAiD): beyond a binary decision

“…Consistent with these Canadian studies, researchers from other western countries have found similar findings regarding the complexity of conscientious objection. In an Australian study of physicians, Haining and Keogh [ 35 ] postulate that based on the strength of the individual’s conscientious objection, physicians fit on a continuum of complicity that is contingent upon their interpretation of the moral acceptability in participating in the voluntary assisted dying process. Haining and Keogh suggest that institutional guidance and education that explicitly explains how physicians can effectively preserve and protect their moral integrity while ensuring patients’ access is not impeded should be offered.…”

Implications of voluntary assisted dying for advance care planning

“…Some opposed health practitioners may be willing to engage in advance care planning discussions that include voluntary assisted dying, but others may not. 22 However, objecting practitioners must still be aware of potential legal duties. For example, voluntary assisted dying laws in some states require that patients making a first formal request for voluntary assisted dying be provided specific information about it, including about practitioners or voluntary assisted dying services (Box 2).…”

“…Advance care planning programs must address conscientious objection, which is legally protected. Some opposed health practitioners may be willing to engage in advance care planning discussions that include voluntary assisted dying, but others may not 22 . However, objecting practitioners must still be aware of potential legal duties.…”