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

2021 ◽  
Author(s):  
Casey M. Haining ◽  
Louise A. Keogh ◽  
Lynn H. Gillam
Keyword(s):  
Healthcare Providers ◽  
Conscientious Objection ◽  
Assisted Dying

scholarly journals Junior doctors and conscientious objection to voluntary assisted dying: ethical complexity in practice

2021 ◽  
pp. medethics-2020-107125
Author(s):  
Rosalind J McDougall ◽  
Ben P White ◽  
Danielle Ko ◽  
Louise Keogh ◽  
Lindy Willmott
Keyword(s):  
Health Professionals ◽  
Conscientious Objection ◽  
Career Progression ◽  
Junior Doctors ◽  
Assisted Dying ◽  
Moral Integrity ◽  
Institutional Policies ◽  
Australian State ◽  
Specific Support ◽  
Ethical Complexity

In jurisdictions where voluntary assisted dying (VAD) is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture.

Relational influences on experiences with assisted dying: A scoping review

2020 ◽  
Vol 27 (7) ◽  
pp. 1501-1516
Author(s):  
Caroline Variath ◽  
Elizabeth Peter ◽  
Lisa Cranley ◽  
Dianne Godkin ◽  
Danielle Just
Keyword(s):  
Scoping Review ◽  
Healthcare Providers ◽  
Family Members ◽  
Assisted Dying ◽  
Roles And Responsibilities ◽  
Integral Role ◽  
Unique Experience ◽  
Collaboration And Communication ◽  
Relational Framework ◽  
Sociopolitical Influences

Background: Family members and healthcare providers play an integral role in a person’s assisted dying journey. Their own needs during the assisted dying journey are often, however, unrecognized and underrepresented in policies and guidelines. Circumstances under which people choose assisted dying, and relational contexts such as the sociopolitical environment, may influence the experiences of family members and healthcare providers. Ethical considerations: Ethics approval was not required to conduct this review. Aim: This scoping review aims to identify the relational influences on the experiences of family members and healthcare providers of adults who underwent assisted dying and of those unable to access assisted dying due to the loss of capacity to consent. Methods: A literature search was conducted in four databases, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. The search retrieved 12,074 articles, a number narrowed down to 172 articles for full-text screening. Thirty-six articles met the established inclusion criteria. A feminist relational framework guided the data analysis. Results: Five key themes on the influences of family members’ and healthcare providers’ experiences throughout the assisted dying process were synthesized from the data. They include (1) relationships as central to beginning the process, (2) social and political influences on decision making, (3) complex roles and responsibilities of family members and healthcare providers, (4) a unique experience of death, and (5) varying experiences following death. Conclusion: The feminist relational lens, used to guide analysis, shed light on the effect of the sociopolitical influences and the relationships among patients, families, and healthcare providers on each other’s experiences. Addressing the needs of the family members and healthcare providers is vital to improving the assisted dying process. Including families’ and healthcare providers’ needs within institutional policies and enhancing collaboration and communication among those involved could improve the overall experience.

scholarly journals Secularity, abortion, assisted dying and the future of conscientious objection: modelling the relationship between attitudes

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Morten Magelssen ◽  
Nhat Quang Le ◽  
Magne Supphellen
Keyword(s):  
Conscientious Objection ◽  
Structural Equations ◽  
Assisted Dying ◽  
Moral Integrity ◽  
Patient Trust ◽  
Web Based ◽  
Main Driver ◽  
Abortion Attitudes ◽  
Sound Policy ◽  
The Relationship

Abstract Background Controversies arise over abortion, assisted dying and conscientious objection (CO) in healthcare. The purpose of the study was to examine the relationship between attitudes towards these bioethical dilemmas, and secularity and religiosity. Method Data were drawn from a 2017 web-based survey of a representative sample of 1615 Norwegian adults. Latent moderated structural equations modelling was used to develop a model of the relationship between attitudes. Results The resulting model indicates that support for abortion rights is associated with pro-secular attitudes and is a main “driver” for support for assisted dying and opposition to conscientious objection. Conclusions This finding should be regarded as a hypothesis which ought to be tested in other populations. If the relationship is robust and reproduced elsewhere, there are important consequences for CO advocates who would then have an interest in disentangling the debate about CO from abortion; and for health systems who ought to consider carefully how a sound policy on CO can safeguard both patient trust in the services and the moral integrity of professionals. It is suggested that if religiosity wanes and pro-secular and pro-abortion attitudes become more widespread, support for CO might decline, putting into question whether present policies of toleration of conscientious refusals will remain acceptable to the majority.

Conscientious Objection, Not Refusal: The Power of a Word

2021 ◽  
pp. 002436392110082
Author(s):  
Cynthia Jones-Nosacek
Keyword(s):  
Stem Cell ◽  
Healthcare Providers ◽  
Conscientious Objection ◽  
Not Given ◽  
Vitro Fertilization ◽  
Life Issues ◽  
End Of Life Issues ◽  
Roe V Wade ◽  
Over Time

Conscientious objection (CO) in medicine grew out of the need to protect healthcare providers who objected to performing abortions after the Roe v. Wade decision in the 1970s which has since over time expanded to include sterilization, contraception, in vitro fertilization, stem cell research, and end-of-life issues. Since 2006, there has been a growing amount of published literature arguing for the denial of CO. Over the last three years, there has also been an increase in calling this conscientious refusal. This article will argue that the term conscientious objection is more accurate than conscientious refusal because those who object are not refusing to provide care. CO also emphasizes that there are reasoned arguments behind one’s decision not to perform certain actions because of one’s own principles and values. Summary How something is presented matters. Objection emphasizes the thought behind the action while refusal gives the impression that medical care is not given.

scholarly journals Obaveza ljekara na pružanje medicinskih usluga v. prigovor savjesti u medicini

2021 ◽  
pp. 168-185
Author(s):  
Maja Čolaković ◽  
Keyword(s):  
Medical Practice ◽  
Religious Beliefs ◽  
Medical Service ◽  
Healthcare Providers ◽  
Conscientious Objection ◽  
Theory And Practice ◽  
Self Determination ◽  
Medical Services ◽  
Moral Beliefs ◽  
The Right

The patient's right to available and accessible healthcare is correlated with the physician's obligation to provide the appropriate medical services. More recently, in medical practice in several countries, there have been an increasing number of cases where physicians (and other healthcare providers) refuse to provide a specific medical service, referring to their religious and moral beliefs i.e. the right to conscientious objection. Do physicians violate their professional obligation to act for the benefit of the patient and provide the necessary medical services? Does this interfere with the patient's right to self-determination and his other rights? Does this lead to discrimination against patients and indirect imposition of physicians' moral and religious beliefs? These are just several questions raised in theory and practice due to the conscientious objection in medicine. This paper explores the doctrinal and legislative approaches of the right to conscientious objection in medicine in Europe and worldwide.

scholarly journals Junior Doctors and Conscientious Objection to Voluntary Assisted Dying: Ethical Complexity in Practice

2021 ◽  
Author(s):  
Rosalind McDougall ◽  
Ben White ◽  
Danielle Ko ◽  
Louise Keogh ◽  
Lindy Willmott
Keyword(s):  
Conscientious Objection ◽  
Junior Doctors ◽  
Assisted Dying ◽  
Ethical Complexity

scholarly journals “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

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Casey Michelle Haining ◽  
Louise Anne Keogh
Keyword(s):  
Health Professional ◽  
End Of Life ◽  
Health Professionals ◽  
Medical Service ◽  
Qualitative Interviews ◽  
Conscientious Objection ◽  
Assisted Dying ◽  
Moral Integrity ◽  
Conscientious Objectors ◽  
Education Needs

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.

Conscientious participants and the ethical dimensions of physician support for legalised voluntary assisted dying

2020 ◽  
pp. medethics-2020-106702
Author(s):  
Jodhi Rutherford
Keyword(s):  
Empirical Study ◽  
Empirical Research ◽  
Conscientious Objection ◽  
Assisted Dying ◽  
Patient Access ◽  
Australian State ◽  
Scant Attention ◽  
The Law ◽  
Physician Support ◽  
First Time

The Australian state of Victoria legalised voluntary assisted dying (VAD) in June 2019. Like most jurisdictions with legalised VAD, the Victorian law constructs physicians as the only legal providers of VAD. Physicians with conscientious objection to VAD are not compelled to participate in the practice, requiring colleagues who are willing to participate to transact the process for eligible applicants. Physicians who provide VAD because of their active, moral and purposeful support for the law are known as conscientious participants. Conscientious participation has received scant attention in the bioethics literature. Patient access to VAD is contingent on the development of a sufficient corpus of conscientious participants in permissive jurisdictions. This article reports the findings of a small empirical study into how some Victorian physicians with no in-principle opposition towards the legalisation of VAD, are ethically orientating themselves towards the law, in the first 8 months of the law’s operation. It finds that in-principle-supportive physicians employ bioethical principles to justify their position but struggle to reconcile that approach with the broader medical profession’s opposition. This study is part of the first tranche of empirical research emerging from Australia since the legalisation of VAD in that country for the first time in over 20 years.

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