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Restricting conversations about voluntary assisted dying: implications for clinical practice
  1. Lindy Willmott1,
  2. Ben White1,
  3. Danielle Ko2,
  4. James Downar3 and
  5. Luc Deliens4,5
  1. 1Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia
  2. 2Austin Health, Heidelberg, Victoria, Australia
  3. 3Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  4. 4End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
  5. 5Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
  1. Correspondence to Lindy Willmott, Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, QLD 4001, Australia; l.willmott{at}qut.edu.au

Abstract

Objectives On 19 June 2019, assisted dying became lawful in Victoria, the second most populous state in Australia. Section 8 of the Voluntary Assisted Dying Act is a legislative safeguard that is designed to ensure a patient’s request for assistance to die is voluntary. This section prohibits health practitioners from initiating a conversation about assisted dying with the patient. This article explores the potential implications of this prohibition for effective communication between doctors and their patients, and the ability of doctors to provide high quality end-of-life (EOL) care in some cases.

Method The authors reviewed and analysed literature on the importance of communication at the EOL including the need to understand and appropriately respond to Desire to Die or Desire to Hasten Death statements. A legal critique of section 8 of the Victorian Voluntary Assisted Dying Act was also undertaken to determine the scope of this new duty and how it aligns with existing legal obligations that would otherwise require doctors to provide information about EOL options requested by a patient.

Results Contemporary literature suggests that open and honest communication between doctor and patient including the provision of information about all EOL options when sought by the patient represents good clinical practice and will lead to optimal EOL care. The provision of such information also reflects professional, ethical and legal norms.

Conclusion Despite (arguably) promoting an appropriate policy objective, the legislative prohibition on health professionals initiating conversations about voluntary assisted dying may, in cases where patients seek information about all EOL options, lead to less optimal patient outcomes.

  • end of life communication
  • desire to die
  • desire to hasten death
  • assisted dying
  • voluntary assisted dying
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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests LW has been engaged by the Victorian Government to design and provide the legislatively mandated training for doctors involved in voluntary assisted dying. LW is also a member of the board of Palliative Care Australia (but this article only represents her views not those of Palliative Care Australia). BW has been engaged by the Victorian Government to design and provide the legislatively mandated training for doctors involved in voluntary assisted dying. DK is on the Voluntary Assisted Dying Review Board (but this article represents her views only). JD is a former member of the Physicians’ Advisory Committee for Dying with Dignity Canada, a group that advocated for the legalisation of voluntary assisted dying in Canada. He currently works at Bruyere Continuing Care, a Catholic healthcare facility. LD has no competing interests.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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