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 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.

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.

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.

Sign in / Sign up

Export Citation Format

Share Document