Navigating ethical diversity: A qualitative interview study of clinicians’ experiences in the implementation period prior to VAD becoming available in their hospital in Victoria, Australia

Dr Rosalind McDougall1, Dr Bridget  Pratt1, Dr Marcus Sellars2

1School of Population and Global Health, University of Melbourne, , Australia, 2Department of Health Services Research & Policy, The Australian National University, Australia

Background: In Victoria, legislation allowing voluntary assisted dying (VAD) passed through parliament in November 2017.  An eighteen month implementation period followed, allowing time for affected organisations to develop processes before the Act came into effect in June 2019.  This qualitative study investigates the experiences of a multidisciplinary sample of clinicians from a single metropolitan hospital during this implementation period.

Methods: Individual semi-structured interviews were conducted in the six weeks prior to the Act coming into effect, to understand clinicians’ experiences during the implementation period and their ethical decision-making about their own potential involvement in VAD-related care.  Maximum variation sampling was utilised to ensure breadth across discipline, speciality and stated level of support for the VAD legislation. The data was analysed thematically.

Results: The twelve participants included medical specialists, junior doctors, nursing, social work, physiotherapy and spiritual care.  Participants worked in oncology, palliative care, geriatrics, psychiatry, surgery, respiratory, emergency and general medicine.  Four key themes developed from the data: waiting in uncertainty, inability of the legislated approach to capture clinical nuances, the value of ethical diversity within the organisation, and building a respectful culture.

Conclusions: Given the momentum around legalising VAD in other Australian states and internationally, these participants’ experiences provide insights into the need for a broad multi-faceted educational program early in the implementation phase.  Such programs should go beyond specifics of the legislation and beyond senior medical staff, to also include support for nurses, junior doctors, and allied health staff with facilitated reflection on individual ethical decision-making about participation.


Dr Rosalind McDougall is an ethicist in the School of Population and Global Health at the University of Melbourne. Rosalind’s research and teaching focus on the ethical challenges faced by health professionals. She has been involved in providing clinical ethics support in Melbourne hospitals since 2008.

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