2nd June 2017, Volume 130 Number 1456

Pam Oliver, Michael Wilson, Phillipa Malpas

In the past two decades, more than a dozen jurisdictions internationally have legalised assisted dying (AD) with varying regulatory regimes.1–3 Where jurisdictions internationally have legalised AD, the intent of the…

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Summary

This study explored the views of New Zealand doctors and nurses on legalising assisted dying (AD), including level of support or opposition for legalisation, willingness to engage in legal AD services, what factors might deter generally willing doctors and nurses from providing AD services and what professional supports were perceived as essential or desirable to enable willing engagement in AD service provision. While a majority of doctors in the sample still opposed legalising AD in New Zealand, a majority of nurses supported legalisation and were willing to participate in AD services. Both doctors and nurses supporting legal AD identified authorised guidelines, accountability processes, professional mentoring and a range of other professional supports as essential to safe practitioner engagement, and overwhelmingly saw it as the responsibility of the medical and nursing professional bodies to ensure the provision of robust professional supports for safe AD services.

Abstract

Assisted dying (AD) has been legalised by statute or court decisions in at least 15 jurisdictions internationally. Nonetheless, only three medical professional bodies (and none in nursing) across those jurisdictions have proactively developed authorised policy, practice standards, guidelines or protocols, or other professional supports for health practitioners who may legally participate in AD services, and the majority internationally remain formally opposed to AD. There is a perceived likelihood that AD may be legalised in New Zealand soon.

Aim

This study explored the views of doctors and nurses as to support for or opposition to legalising AD, including reasons for those views, what might deter generally willing doctors and nurses from providing AD services and what professional supports were perceived as essential or desirable to enable willing engagement in AD service provision.

Results

While only 37% of doctors supported legalising AD in New Zealand, 67% of nurses were supportive. Of those respondents who were willing in principle to provide AD services, large majorities identified a range of practical and ethical professional supports as essential to safe practitioner engagement. Those respondents overwhelmingly saw the provision of most of those supports as the responsibility of the medical and nursing professional bodies.

Conclusion

There is a substantial cohort of doctors and nurses in New Zealand who support legalising AD, potentially sufficient for reasonable seeker access to AD services once legalised. However, many doctors in particular still oppose AD, and international research shows that the main barrier to access to legal AD is a lack of capacity and capability among health professionals, due in large part to several related factors, in particular: a lack of either accredited training and education for the AD provider tasks and roles; inadequate immunities within the legislation to protect participating professionals; and most importantly, a lack of practice standards and guidelines authorised by the relevant medical and nursing professional bodies. The challenge is for such protections to be available well in advance of legalisation, so that health practitioners are not at risk ethically or otherwise in early participation.

Author Information

Pam Oliver, Director, Pam Oliver Ltd, Research and Evaluation, Waiheke Island; Michael Wilson, Independent Researcher, Wilson Associates, Adelaide, South Australia; Phillipa Malpas, Senior Lecturer in Clinical Medical Ethics, Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland.

Acknowledgements

We wish to thank the nurses and doctors who participated in this research for their participation and their frank and heartfelt comments, and the nursing and medical professional bodies that supported recruitment of respondents. This research was funded by the Health Research Council of New Zealand. Reference 12/657.

Correspondence

Phillipa Malpas, Senior Lecturer in Clinical Medical Ethics, Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland.

Correspondence Email

p.malpas@auckland.ac.nz

Competing Interests

Pam Oliver joined the Voluntary Euthanasia Society of New Zealand in 2014 for the purposes of obtaining information on that group’s activities for doctoral and other research purposes. Phillipa Malpas is a member of the ‘End of Life Choice’ Voluntary Euthanasia Society of New Zealand.

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