Moral uncertainty and distress about voluntary assisted dying prior to legalisation and the implications for post-legalisation practice : A qualitative study of palliative and hospice care providers in Queensland, Australia

Journal article


Kirchhoffer, D., Lui, C. and Ho, Anita. (2023). Moral uncertainty and distress about voluntary assisted dying prior to legalisation and the implications for post-legalisation practice : A qualitative study of palliative and hospice care providers in Queensland, Australia. BMJ Open. 13(5), pp. 1-8. https://doi.org/10.1136/bmjopen-2022-065964
AuthorsKirchhoffer, D., Lui, C. and Ho, Anita
Abstract

Objectives: There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD.

Design: The study used a qualitative approach to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory.

Setting: The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities.

Participants: Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers.

Results: PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma.

Conclusions: The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs.

Keywordspalliative care providers; hospice care providers; voluntary assisted dying; moral uncertainties; distress
Year2023
JournalBMJ Open
Journal citation13 (5), pp. 1-8
PublisherBMJ Publishing Group
ISSN2044-6055
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjopen-2022-065964
Scopus EID2-s2.0-85159625610
Web address (URL)https://bmjopen.bmj.com/content/13/5/e065964
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-8
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online09 May 2023
Publication process dates
Accepted04 Apr 2023
Deposited03 Jun 2024
Additional information

© Author(s) (or their employer(s)) 2023.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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