School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
Centre for Quality and Patient Safety Research (QPS), Alfred Health Partnership, Melbourne, VIC, Australia.
Int J Health Policy Manag. 2022 Jun 1;11(6):777-785. doi: 10.34172/ijhpm.2020.216.
Voluntary assisted dying (VAD) was legalised in Victoria, Australia in June 2019. Physicians can now assist patients to end their lives by providing drugs for self-administration at their voluntary and competent request (or for physician administration in limited circumstances). This study investigates the opinions of clinicians on the implementation of the legislation in one Victorian hospital.
This exploratory survey study was conducted at a 600-bed acute hospital in Melbourne, Australia in Jan 2019. 382 clinicians completed one or more qualitative questions. Participants commented on VAD, potential workplace challenges and staff support required. Free-text responses were analysed using inductive content analysis.
Six themes: (1) Polarised views; (2) Fear of conflict; (3) Emotional burden; (4) Vulnerable patients; (5) Organisational challenges; (6) Decision-making. There were diverse views including objections to VAD for religious or ethical reasons, and whole-hearted support based on a compassionate response to suffering and the right of patients to self-determination. Participants feared conflict between colleagues, families and patients, and aggression towards staff. Clinicians called for educational and psychological support. There was concern that vulnerable patients may be coerced to opt for VAD to lessen the burden on families or the health system. Clinicians feared workloads would increase with the introduction of VAD. Patient decision-making capacity in this context must be firmly established before proceeding, and thorough assessments for depression, and optimal symptom management must be implemented before VAD is approved. A dedicated VAD team was suggested to support staff and manage VAD patients.
Participants expressed polarised opinions about VAD and showed considerable anxiety about its introduction. Additional education and support are required to ensure that clinicians understand details of the legislation and their professional and personal options. Tolerance and respect for alternative viewpoints must be advocated within the organisation and more broadly.
2019 年 6 月，澳大利亚维多利亚州将自愿协助死亡（VAD）合法化。医生现在可以根据患者自愿和有能力的请求（或在有限的情况下由医生管理），提供药物供其自行使用，从而协助患者结束生命。本研究调查了一名维多利亚州医院的临床医生对该立法实施的看法。
本探索性调查研究于 2019 年 1 月在澳大利亚墨尔本的一家 600 床急性医院进行。382 名临床医生完成了一个或多个定性问题。参与者对 VAD、潜在的工作场所挑战和所需的员工支持发表了评论。使用归纳内容分析法对自由文本回复进行分析。
有六个主题：（1）两极分化的观点；（2）对冲突的恐惧；（3）情绪负担；（4）弱势患者；（5）组织挑战；（6）决策。有各种各样的观点，包括出于宗教或伦理原因反对 VAD，以及出于对痛苦的同情反应和患者自我决定的权利的全力支持。参与者担心同事、家属和患者之间的冲突，以及对工作人员的攻击。临床医生呼吁提供教育和心理支持。有人担心弱势患者可能会被迫选择 VAD，以减轻家庭或医疗系统的负担。随着 VAD 的引入，临床医生担心工作量会增加。在这种情况下，必须在继续之前确定患者的决策能力，并在批准 VAD 之前进行彻底的抑郁评估和最佳症状管理。建议成立一个专门的 VAD 团队，以支持员工并管理 VAD 患者。
参与者对 VAD 持两极分化的观点，并对其引入表示出相当大的焦虑。需要进一步的教育和支持，以确保临床医生了解立法的细节及其专业和个人选择。必须在组织内部和更广泛的范围内倡导对替代观点的宽容和尊重。
