Understanding the Reasons Behind Healthcare Providers’ Conscientious Objection to Voluntary Assisted Dying in Victoria, Australia

Abstract

During the debates about the legalization of Voluntary Assisted Dying (VAD) in Victoria, Australia, the presence of anti-VAD health professionals in the medical community and reported high rates of conscientious objection (CO) to VAD suggested access may be limited. Most empirical research on CO has been conducted in the sexual and reproductive health context. However, given the fundamental differences in the nature of such procedures and the legislation governing it, these findings may not be directly transferable to VAD. Accordingly, we sought to understand how CO operates in the context of VAD. Prior to the implementation of the VAD legislation in June 2019, we conducted semistructured interviews with seventeen health professionals with a self-declared CO to VAD, to explore what motivated their CO. Participants identified multiple motivations, which can be broadly categorized as: concerns for oneself; concerns for patients; concerns about the current Victorian legislation; and concerns for the medical profession. Participants' moral commitments included personal, professional, and political commitments. In some cases, one's CO was specific to Victoria's current legislation rather than VAD more broadly.Our findings suggest CO motivations extend beyond those traditionally cited and suggest a need to better understand and manage CO in the healthcare context.

Support for and willingness to be involved in voluntary assisted dying: a multisite, cross‐sectional survey study of clinicians in Victoria, Australia

“…There is currently a lack of research examining reasons underlying doctors' willingness to participate (or not) in VAD. 12 Understanding clinician attitudes to VAD, and underlying factors influencing support for and willingness to be involved in VAD, will assist healthcare institutions implementing VAD to develop context specific policies, procedures and resources better tailored to staff's needs. Moreover, given Victoria's requirement that one of the assessing doctors be an expert in a requesting patient's terminal disease, 13 baseline information regarding support for VAD among specialists working in fields likely to receive VAD requests, 14,15 such as oncology and neurology, is a critical consideration for any institution contemplating providing VAD to their patients.…”

“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

“…In order to test for saturation, the code ‘motivation for CO’ was used. Data analysis of this code has been published elsewhere [ 4 ]. Once no new sub-themes emerged from the transcripts, saturation was deemed to be reached.…”

“…CO in health care occurs when health professionals exempt themselves from providing or participating in a legally permitted health service on moral, religious or philosophical grounds [ 3 ]. Traditionally CO claims were thought to be the product of religious convictions; however, there is evidence to suggest that the motivations behind one’s CO are diverse and may stem from both religious and secular convictions [ 4 ]. It is postulated that by permitting health professionals to claim a CO, they will be able to deliver health care without compromising their moral integrity [ 5 ].…”

“…During the 18-month implementation period before VAD became operational, CO was identified as one of the implementation challenges [ 29 ]. While there is literature that examine CO and assisted dying [ 4 , 30 – 32 ], there are limited empirical studies that examine how exactly health professionals with CO to VAD approach conversations with patients requesting or merely asking about VAD. The majority of studies that examine how health professionals exercise their CO are conducted in the context of abortion and accordingly have limited generalizability to VAD.…”

Goodbye Hippocrates?

“…For now, these authors feel that this very restrictive prognostic access gives excessive power to doctors and diminishes true autonomous choice in dying. Haining, Keogh, and Gillam (2021) conducted semi-structured interviews with seventeen health professionals in Victoria before the implementation of VAD, to further understand conscientious objection (CO), which was thought to be a significant barrier to public access. They found a greater diversity of personal and professional objections than expected and a number who objected to the specific Victorian legislation rather than to VAD itself.…”