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Does voluntary assisted dying impact quality palliative care? A retrospective mixed-method study
  1. Natasha Michael1,2,
  2. David Jones3,4,
  3. Lucy Kernick2 and
  4. David Kissane1,2
  1. 1Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, VIC, Australia
  2. 2Faculty of Medicine, University of Notre Dame, Australia, Sydney, NSW, Australia
  3. 3Anscombe Bioethics Centre, Oxford, UK
  4. 4St Mary's University Twickenham, London, UK
  1. Correspondence to Associate Professor Natasha Michael, Faculty of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia; natasha.michael{at}


Objectives We aimed to explore the relationship between the pursuit of voluntary assisted dying (VAD) and the delivery of quality palliative care in an Australian state where VAD was newly available

Methods We adopted a retrospective convergent mixed-methods design to gather and interpret data from records of 141 patients who expressed an interest in and did or did not pursue VAD over 2 years. Findings were correlated against quality domains.

Results The mean patient age was 72.4 years, with the majority male, married/partnered, with a cancer diagnosis and identifying with no religion. One-third had depression, anxiety or such symptoms, half were in the deteriorating phase, two-thirds required help with self-care and 83.7% reported moderate/severe symptoms. Patients sought VAD because of a desire for autonomy (68.1%), actual suffering (57.4%), fear of future suffering (51.1%) and social concerns (22.0%). VAD enquiries impacted multiple quality domains, both enhancing or impeding whole person care, family caregiving and the palliative care team. Open communication promoted adherence to therapeutic options and whole person care and allowed for timely access to palliative care. Patients sought VAD over palliative care as a solution to suffering, with the withholding of information impacting relationships.

Significance of results As legislation is expanded across jurisdictions, palliative care is challenged to accompany patients on their chosen path. Studies are necessary to explore how to ensure the quality of palliative care remains enhanced in those who pursue VAD and support continues for caregivers and staff in their accompaniment of patients.

  • Palliative Care
  • Psychological care
  • Terminal care
  • Quality of life
  • euthanasia
  • assisted
  • suicide

Data availability statement

Data are available on reasonable request. The datasets generated during the study will be available from the corresponding author on reasonable request.

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Data availability statement

Data are available on reasonable request. The datasets generated during the study will be available from the corresponding author on reasonable request.

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  • Contributors DK and NM designed the study, NM and LK were involved in data collection and assimilation, DK, NM and DJ analysed the data and were involved with the drafting of the manuscript. NM wrote the initial manuscript and all authors approved the final manuscript. NM is responsible for the overall content as guarantor.

  • Funding This study was funded through the Sydney Bioethics Grant.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.