Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, Australia.
Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia.
Soc Sci Med. 2022 Jan;292:114568. doi: 10.1016/j.socscimed.2021.114568. Epub 2021 Nov 15.
On June 19, 2019, Assisted Dying (AD) was legalized in the Australian state of Victoria, joining a small but growing cohort of jurisdictions internationally where AD is permitted. Few studies have examined perspectives of doctors who have participated in AD in jurisdictions where it has become legal, despite their pivotal role in the system.
This study aimed to describe the beliefs, experiences and perspectives of doctors who had provided AD during the first 12 months of its operation in Victoria, Australia.
In-depth, semi-structured interviews were conducted between April and July 2020 with 32 Victorian doctors who had been involved in the AD process during the first 12-months since it became legal in Victoria. The assumptions underpinning our methodology were guided by a phenomenological approach and reflexive thematic analysis was used to analyze the data.
Five major themes were identified: a nascent approach to care, practising within clinical and legal uncertainty, confronting practices, personal sacrifices and coping amid new challenges. A thematic schema was developed, illustrating that these themes were expressed as a balance of competing tensions of identity for doctors who provided AD for their patients in practice. A major tension was not just how doctors' perceptions impacted their own wellbeing and satisfaction, but also how these challenged their continued involvement in AD and, therefore, the system's overall ability to function.
Our findings show that while doctors discussed AD as an ethical practice, it also involved multiple identities with varying sources of meaning, and these identities were sometimes overlapping depending on context. As other jurisdictions increasingly move to legalize AD, a greater appreciation of the different role-based and group-based challenges involved in AD may improve AD implementation strategies.
2019 年 6 月 19 日，澳大利亚维多利亚州将协助死亡合法化，加入了在国际上允许协助死亡的少数司法管辖区之列。尽管医生在该制度中发挥了关键作用，但在已经将协助死亡合法化的司法管辖区中，很少有研究调查过参与协助死亡的医生的观点。
本研究旨在描述在澳大利亚维多利亚州协助死亡合法化的头 12 个月内提供协助死亡的医生的信念、经验和观点。
2020 年 4 月至 7 月期间，对 32 名在维多利亚州协助死亡过程中参与的医生进行了深入的半结构化访谈，这些医生在维多利亚州协助死亡合法化的头 12 个月内参与了该过程。我们的方法所依据的假设受到现象学方法的指导，并使用反思性主题分析来分析数据。
确定了五个主要主题：初步的护理方法、在临床和法律不确定性中实践、面对实践、个人牺牲和在新挑战中应对。制定了一个主题方案，说明这些主题表现为在为患者提供协助死亡的实践中，医生身份的竞争紧张关系的平衡。一个主要的紧张关系不仅在于医生的看法如何影响他们自己的幸福感和满意度，还在于这些看法如何挑战他们继续参与协助死亡，从而挑战该制度的整体运作能力。
我们的研究结果表明，尽管医生将协助死亡视为一种合乎伦理的做法，但它还涉及到具有不同意义来源的多种身份，并且这些身份有时会根据上下文重叠。随着其他司法管辖区越来越多地将协助死亡合法化，更多地了解协助死亡所涉及的不同基于角色和基于群体的挑战，可能会改善协助死亡实施策略。
