White Ben P, Willmott Lindy, Sellars Marcus, Yates Patsy
Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia.
BMJ Support Palliat Care. 2021 Jun 6. doi: 10.1136/bmjspcare-2021-002972.
Assisted dying (AD) is increasingly becoming lawful internationally. While all AD models have oversight mechanisms, Victoria, Australia is rare in requiring formal approval before AD is permitted. Other jurisdictions are now enacting or implementing prospective approval models yet little is known about their operation. This paper reports the first empirical research internationally analysing the operation of a prospective approval model.
This qualitative study recruited doctors involved in providing lawful AD during the first year of the Victorian AD system. Recruitment occurred through the mandatory training doctors providing AD must undertake. Semistructured interviews were undertaken predominantly through Zoom conferencing, transcribed and thematically analysed.
32 doctors from diverse specialties (including general practice) and diverse AD experiences were interviewed. Six themes were identified: (1) The primary gatekeeping to AD in practice was by the administrative Secretariat of the oversight body, the Voluntary Assisted Dying Review Board, and not the government department who issues the final 'permit'; this may not have been intended by parliament. (2) The prospective oversight and approval process was bureaucratic and (3) the mandatory online system to manage AD was a barrier. (4) These factors caused unnecessary delays which (5) impeded AD for very sick patients. (6) However, this prospective process protected doctors and ensured system safety.
Potential barriers to accessing AD posed by prospective approval should be evaluated carefully by jurisdictions implementing or considering such a model. Attention is needed not only to law but to system design and how AD is implemented in practice.
辅助死亡（AD）在国际上越来越合法化。虽然所有辅助死亡模式都有监督机制，但澳大利亚维多利亚州在允许辅助死亡之前要求正式批准，这很罕见。其他司法管辖区目前正在制定或实施前瞻性批准模式，但对其运作知之甚少。本文报告了国际上第一项分析前瞻性批准模式运作情况的实证研究。
这项定性研究招募了在维多利亚州辅助死亡系统第一年参与提供合法辅助死亡的医生。通过提供辅助死亡的医生必须参加的强制性培训进行招募。主要通过Zoom会议进行半结构化访谈，进行转录并进行主题分析。
采访了32名来自不同专业（包括全科医学）和有不同辅助死亡经验的医生。确定了六个主题：（1）在实践中，辅助死亡的主要把关者是监督机构自愿辅助死亡审查委员会的行政秘书处，而不是发放最终“许可”的政府部门；这可能并非议会的本意。（2）前瞻性监督和批准过程官僚化，（3）管理辅助死亡的强制性在线系统是一个障碍。（4）这些因素导致了不必要的延误，（5）阻碍了重病患者的辅助死亡。（6）然而，这种前瞻性过程保护了医生并确保了系统安全。
实施或考虑这种模式的司法管辖区应仔细评估前瞻性批准对获得辅助死亡造成的潜在障碍。不仅要关注法律，还要关注系统设计以及辅助死亡在实践中的实施方式。
