Clinicians perceive barriers to voluntary assisted dying participation


By Geir O'Rourke

10 Jul 2024

Only a small minority of oncologists have a moral objection to voluntary assisted dying but many remain unwilling to participate in the process, Australian survey data suggest.

It comes just weeks after legislators in the ACT passed its voluntary assisted dying (VAD) bill, expected to come into effect by November 2025.

It means laws are now in place in every state and territory except the NT, which is currently preparing a VAD bill of its own after community consultation.

Despite this, access remains a major issue around the country,  with advocates pointing to the difficulty in finding doctors willing and able to provide VAD services as a key barrier (link here).

Some 41 medical oncologists and trainees in South Australia answered the poll in May last year, three months after the commencement of the state’s VAD scheme.

Most said they were not conscientious objectors, defined as individuals with a moral or philosophical disagreement towards VAD, who represented only 22% of the cohort. An additional five respondents (12%) said they were unsure whether they had a conscious objection.

But only 16 of the 41 respondents said they were willing to participate in all aspects of the VAD process, the researchers reported in Internal Medicine Journal (link here).

Another 10 respondents said they were unsure about participations, according to the study.

Interestingly, the highest number of respondents are willing to act as a consulting practitioner, whereas fewer physicians would participate as a coordinating practitioner or to write a prescription for a lethal substance, and very few were willing personally to administer a lethal substance, the authors said.

“This is consistent with the findings of other Australian studies, where roles that require greater time commitment, clinical complexity and involvement are less favoured by physicians,” they wrote.

“This is also consistent with this survey’s finding that ‘lack of time’ is the primary reported barrier to participation in VAD activities among surveyed physicians.”

Importantly, the main barriers to participation appeared to be modifiable, particularly organisational challenges such as lack of time and remuneration, the study investigators added.

“These barriers are well-established based on previous Australian studies, emphasising that logistical support for participating physicians is critical,” they wrote.

“Time is a fundamental constituent of high-quality healthcare, and physicians must have adequate time with patients to conduct VAD assessments.”

“Additional patient-facing time may be required to develop physician-patient rapport if the patient has been referred specifically for VAD activities because their usual medical oncologist does not participate in VAD.”

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