Medical Oncology Group of Australia position statement and membership survey on voluntary assisted dying

Abstract

The controversial topic of voluntary assisted dying (VAD) is receiving significant attention at state government levels and in the community. Acknowledging potential legalisation of VAD, the Medical Oncology Group of Australia (MOGA) undertook a survey of members to inform the development of a position statement on the subject. All MOGA members were invited to complete an anonymous online survey. The survey comprised 12 closed-response categorical questions. Descriptive statistics were used to summarise the survey data. Majority views expressed in the survey would form the basis of a MOGA position statement on VAD. A total of 362 members completed the questionnaire, representing 55% of the membership; 47% of respondents disagreed with VAD; 36% agreed with VAD and the remaining members (17%) were 'neutral'. A clear majority position was not established. Only 14% agreed that physicians involved in VAD should be required personally to administer the lethal medication; 94% supported conscientious objection of physicians to the VAD process; 95% agreed that a palliative care physician consultation should be required and 86% agreed with the need for the involvement of specialist psychiatry medical services before a patient can be deemed as suitable for VAD. The MOGA membership expressed a range of views on the topic of VAD. A clear majority-held view to support a MOGA position that either supports or opposes VAD was not established. The position statement that flows from the survey encourages informed debate on this topic and brings into focus important considerations.

Too much safety? Safeguards and equal access in the context of voluntary assisted dying legislation

“…There is an extensive literature in ethics and health law about the justifiability of legal protections for conscientious objectors in medicine (eg [35,36]). In the Victorian context, while many practitioners who do not wish to participate in VAD are willing to refer [38], this aspect of the law creates a lottery for patients. It generates a system where some patients will receive support when they raise VAD with a health professional, while other equally eligible patients may receive nothing.…”

‘To die, to sleep’ – assisted dying legislation in Victoria: A case study

“…21 Medical practitioners have a clearly defined duty of care based on the four principles of bioethics, beneficence (acting in the best interest of the patient, support of patient autonomy, nonmaleficence (the minimisation or avoidance of harm) and the promotion of justice. 12 –14 Ethical discussions supporting assisted dying legislation focus on the patient’s right for autonomy to decide the circumstances under which they wish to end their life. These discussions also highlight the role compassion towards another has in the decision-making process of individuals who are living with a terminal illness.…”

“…10,11 Members of the Australian general public and politicians have exhibited emotive views based on their own experience or religious views, while the medical community has been more cautious, citing ethical viewpoints or feelings of failure to provide appropriate end-of-life care. 12 –14 The implementation of the Assisted Dying legislation in Victoria in 2019, sees a major paradigm shift in the care of terminally ill people, promoting patient self-determination and autonomy. 15 It provides Victorians living with terminal conditions with a choice regarding the circumstances surrounding their death, while continuing to generate discussion and debate.…”

Victoria's voluntary assisted dying law: clinical implementation as the next challenge

“…A designated 18‐month implementation period has seen an Implementation Taskforce appointed, and work is underway on projects including developing clinical guidance, models of care, medication protocols and training for doctors participating in voluntary assisted dying (VAD) . While some have written on the scope of, and reaction to, the VAD legislation, there has been very little commentary on its implementation. Yet, important choices must be made about translating these laws into clinical practice.…”