Article Text
PDF
Abstract
Background 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.
Methods 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.
Results 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.
Conclusions 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.
- end of life care
- terminal care
Data availability statement
Data are available on reasonable request. All data requests should be submitted to the corresponding author for consideration. Access to the anonymised data for this study might be granted following review by the corresponding author (in consultation with the authorial team) and the Queensland University of Technology (QUT) Human Research Ethics Committee (UHREC).
Statistics from Altmetric.com
Data availability statement
Data are available on reasonable request. All data requests should be submitted to the corresponding author for consideration. Access to the anonymised data for this study might be granted following review by the corresponding author (in consultation with the authorial team) and the Queensland University of Technology (QUT) Human Research Ethics Committee (UHREC).
Footnotes
Contributors LW, BPW and PY conceptualised the study design and obtained funding. BPW oversaw the literature search and analysis of literature. MS undertook data collection (interviews). MS did the initial coding and analysis of the data in consultation with BPW and LW. BPW undertook a further round of coding and analysis. BPW, LW and MS analysed the original data and participated in its interpretation. BPW wrote the first draft of the manuscript, including the figures, which was edited by LW and MS. PY critically reviewed and edited the manuscript. All authors approved the final manuscript.
Funding This research was supported by the Queensland University of Technology (Faculties of Health and Law). BPW is a recipient of an Australian Research Council Future Fellowship (project number FT190100410: Enhancing End-of-Life Decision-Making: Optimal Regulation of Voluntary Assisted Dying) funded by the Australian Government.
Competing interests BPW discloses that he is the recipient of an Australian Research Council Future Fellowship project number FT190100410: Enhancing End-of-Life Decision-Making: Optimal Regulation of Voluntary Assisted Dying funded by the Australian Government. BPW, LW and PY disclose that they were the recipients of grants from the Victorian Government (Australia) and Western Australian Government to design and provide the legislatively mandated training for doctors involved in voluntary assisted dying in each State.
Provenance and peer review Not commissioned; externally peer reviewed.