Voluntary Assisted Dying/Euthanasia: Will This Have an Impact on Cancer Care in Future Years?

Abstract

Opinion statementIn considering the impact of medically hastened death (MHD) on cancer care, a wide range of variables needs to be considered including demographic factors, diagnoses, local cultural factors, and the legislative frameworks in place. Here, we present a synthesis of recently available published literature and empirical data collected following legislative change to enable MHD in Victoria, Australia to explore in detail the potential impact of MHD on cancer care with a focus on patients/families and professional groups. Our findings reveal that for patients and families, both physical and existential distress frequently underlie MHD requests, with the latter less readily recognised by health professionals. The responses of those around the patient making the request may have a very significant impact on relationships within families and upon the nature of the subsequent bereavement. For palliative care, while differing views may remain, it appears that there has been some accommodation of MHD into or alongside practice over time. The recognition of a shared commitment to relief of suffering of palliative care and MHD appears a helpful means of establishing how these practices may co-exist. In cancer practice more broadly, as individual professionals reflect upon their own roles, new relationships and pathways of patient movement (or referral) must be established in response to patients’ requests. Our findings also highlight many unanswered questions in understanding the impact of MHD, including that upon those dying who choose not to access MHD, First Nations peoples, the participating health professionals’ longer term, and the relief of suffering itself. A systematic approach to the evaluation of MHD legislation must be adopted in order to understand its full impact. Only then could it be determined if the aspirations for such legislative change were being met.

“Walk me through the final day”: A thematic analysis study on the family caregiver experience of the Medical Assistance in Dying procedure day

“…While assisted dying is often seen as incompatible with palliative care, 1 studies with palliative care providers who were involved in assisted dying provision demonstrate that they perceived their involvement as congruent with their dedication to palliative care values, including the relief of suffering, practicing holistic and non-judgmental care, advocating for patient autonomy, and facilitating a good death, as defined by the patient. 35-38 Our findings echo these studies, underscoring the importance of incorporating palliative care expertise and values in assisted dying provision, particularly in offering family-centered care on the day of the procedure. The legalization of assisted dying in various jurisdictions has not been accompanied by sufficient guidance in clinical practice.…”

Voluntary assisted dying in Victoria: the report card is mixed but we now know what we have to do

“…For example, it has been difficult to assess the impact of VAD on end‐of‐life experiences and relief of suffering for patients. While there is no doubt that in many cases the hoped‐for outcomes of a ‘dignified’ death have been achieved, there are also cases in which the new system has been unable to resolve major issues or guarantee peaceful outcomes 4 …”

Demystifying Cancer Deaths—Location, Location, Location

“…10 This is a further area where educational input would be valuable to dispel the incorrect concept that utilization of advanced care planning will unduly shorten life or be more psychologically damaging to the patient and the family. The recent introduction of voluntary assisted dying in several countries may also add a further dimension to the discussion, particularly in patients with terminal cancer, 11 although this remains a controversial area that generates strong opinions and emotions across patients, families and clinicians alike. Financial implications are also important to consider if there is to be further transition from hospital to home or hospice deaths.…”