Background Voluntary assisted dying (VAD) became legal in the Australian state of Victoria on 19 June 2019 and will be legal in Western Australia from 2021. Other Australian states are progressing similar law reform processes. In Australia and internationally, doctors are central to the operation of all legal VAD regimes. It is broadly accepted that doctors, as a profession, are less in favour of VAD law reform than the rest of the community. To date, there has been little analysis of the factors that motivate doctors’ support or opposition to legalised VAD in Australia.
Aim To review all studies reporting the attitudes of Australian doctors regarding the legalisation of VAD, including their willingness to participate in it, and to observe and record common themes in existing attitudinal data.
Design Scoping review and thematic analysis of qualitative and quantitative data.
Data sources CINAHL, Embase, Scopus, PubMed and Informit were searched from inception to June 2019.
Results 26 publications detailing 19 studies were identified. Thematic analysis of quantitative and qualitative findings was performed. Three overarching themes emerged. ‘Attitudes towards regulation’ encompassed doctors’ orientation towards legalisation, the shortcomings of binary categories of support or opposition and doctors’ concerns about additional regulation of their professional practices. ‘Professional and personal impact of legalisation’ described tensions between palliative care and VAD, and the emotional and social impact of being providers of VAD. ‘Practical considerations regarding access’ considered doctors’ concerns about eligibility criteria and their willingness to provide VAD.
Conclusion A detailed understanding of medical perspectives about VAD would facilitate the design of legislative models that take better account of doctors’ concerns. This may facilitate their greater participation in VAD and help address potential access issues arising from availability of willing doctors.
- end of life care
- clinical decisions
- terminal care
- methodological research
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Contributors JR contributed towards conception and design, data analysis and interpretation of data and drafting of the manuscript. LW and BW contributed to the review of studies and editing the manuscript. All authors have read and approved the final version to be published and agree to be accountable for this work.
Funding This work was completed by JR through a funded scholarship from the Australian Health and Medical Research Council through the Centre for Research Excellence into end of life care at the Queensland University of Technology.
Competing interests LW and BW receive funding from the Australian Research Council, the National Health and Medical Research Council and Commonwealth and State Governments for research and training about the law, policy and practice relating to end-of-life care. In relation to implementation of voluntary assisted dying, they have been engaged by the Victorian Government to design and provide the legislatively mandated training for doctors involved in voluntary assisted dying.
Provenance and peer review Not commissioned; externally peer reviewed.