Skip to main content
Top
Published in: Journal of Bioethical Inquiry 3/2023

Open Access 10-07-2023 | Suicide | Original Research

Institutional Objection to Voluntary Assisted Dying in Victoria, Australia: An Analysis of Publicly Available Policies

Authors: Eliana Close, Lindy Willmott, Louise Keogh, Ben P. White

Published in: Journal of Bioethical Inquiry | Issue 3/2023

Login to get access

Abstract

Background

Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider

Objective

To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria.

Methods

Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection were thematically analysed using the framework method.

Results

The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice.

Conclusion

This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions’ public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions.
Footnotes
1
Some surveys suggest that a significant proportion (up to approximately 70%) of Catholics in Australia support VAD, though the authors note that public attitudes towards VAD are difficult to measure as they are influenced by framing effects and survey methodology (Cartwright and Douglas 2017).
 
Literature
go back to reference Annas, G.J. 1987. At law: Transferring the ethical hot potato. The Hastings Center Report 17(1): 20–21.CrossRefPubMed Annas, G.J. 1987. At law: Transferring the ethical hot potato. The Hastings Center Report 17(1): 20–21.CrossRefPubMed
go back to reference Brown, J., D. Goodridge, L. Thorpe, and A. Crizzle. 2021. “I am okay with it, but I am not going to do it”: The exogenous factors influencing non-participation in medical assistance in dying. Qualitative Health Research 31(12): 2274–2289.CrossRefPubMedPubMedCentral Brown, J., D. Goodridge, L. Thorpe, and A. Crizzle. 2021. “I am okay with it, but I am not going to do it”: The exogenous factors influencing non-participation in medical assistance in dying. Qualitative Health Research 31(12): 2274–2289.CrossRefPubMedPubMedCentral
go back to reference Bussey, B.W. 2018. The right of religious hospitals to refuse physician-assisted suicide. Supreme Court Law Review 85: 189–223. Bussey, B.W. 2018. The right of religious hospitals to refuse physician-assisted suicide. Supreme Court Law Review 85: 189–223.
go back to reference Chavkin, W., L. Leitman, and K. Polin. 2013. Conscientious objection and refusal to provide reproductive healthcare: A white paper examining prevalence, health consequences, and policy responses. International Journal of Gynecology and Obstetrics 123(3): S41–56.PubMed Chavkin, W., L. Leitman, and K. Polin. 2013. Conscientious objection and refusal to provide reproductive healthcare: A white paper examining prevalence, health consequences, and policy responses. International Journal of Gynecology and Obstetrics 123(3): S41–56.PubMed
go back to reference Close, E., L. Willmott, and B.P. White. 2021. Regulating voluntary assisted dying practice: A policy analysis from Victoria, Australia. Health Policy 125(11): 1455–1474.CrossRefPubMed Close, E., L. Willmott, and B.P. White. 2021. Regulating voluntary assisted dying practice: A policy analysis from Victoria, Australia. Health Policy 125(11): 1455–1474.CrossRefPubMed
go back to reference Crespigny, L.J. de, and J. Savulescu. 2008. Pregnant women with fetal abnormalities: The forgotten people in the abortion debate. Medical Journal of Australia 188(2): 100–103.CrossRefPubMed Crespigny, L.J. de, and J. Savulescu. 2008. Pregnant women with fetal abnormalities: The forgotten people in the abortion debate. Medical Journal of Australia 188(2): 100–103.CrossRefPubMed
go back to reference Duckett, S., and S. Willcox. 2015. The Australian health care system. 5 edition. South Melbourne, Victoria: Oxford University Press. Duckett, S., and S. Willcox. 2015. The Australian health care system. 5 edition. South Melbourne, Victoria: Oxford University Press.
go back to reference Durland, S.L. 2011. The case against institutional conscience. Notre Dame Law Review 86: 1655. Durland, S.L. 2011. The case against institutional conscience. Notre Dame Law Review 86: 1655.
go back to reference Flynn, C., and R. Wilson. 2013. Institutional conscience and access to services: Can we have both? AMA Journal of Ethics 15(3): 226–235.CrossRef Flynn, C., and R. Wilson. 2013. Institutional conscience and access to services: Can we have both? AMA Journal of Ethics 15(3): 226–235.CrossRef
go back to reference Freedman, L.R, U. Landy, and J. Steinauer. 2008. When there’s a heartbeat: Miscarriage management in Catholic-owned hospitals. American Journal of Public Health 98(10): 1774–1778.CrossRefPubMedPubMedCentral Freedman, L.R, U. Landy, and J. Steinauer. 2008. When there’s a heartbeat: Miscarriage management in Catholic-owned hospitals. American Journal of Public Health 98(10): 1774–1778.CrossRefPubMedPubMedCentral
go back to reference Gale, N.K, G. Heath, E. Cameron, S. Rashid, and S. Redwood. 2013. Using the Framework Method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology 13(1): 117.CrossRefPubMedPubMedCentral Gale, N.K, G. Heath, E. Cameron, S. Rashid, and S. Redwood. 2013. Using the Framework Method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology 13(1): 117.CrossRefPubMedPubMedCentral
go back to reference Gastmans, C., J. Lemiengre, G. van der Wal, P. Schotsmans, and B. Dierckx de Casterlé. 2006. Prevalence and content of written ethics policies on euthanasia in Catholic healthcare institutions in Belgium (Flanders). Health Policy 76(2): 169–178.CrossRefPubMed Gastmans, C., J. Lemiengre, G. van der Wal, P. Schotsmans, and B. Dierckx de Casterlé. 2006. Prevalence and content of written ethics policies on euthanasia in Catholic healthcare institutions in Belgium (Flanders). Health Policy 76(2): 169–178.CrossRefPubMed
go back to reference Gilbert, D. 2020. Faith and/in medicine: Religious and conscientious objections to MAiD. Dalhousie Law Journal 43 (2): 657–695. Gilbert, D. 2020. Faith and/in medicine: Religious and conscientious objections to MAiD. Dalhousie Law Journal 43 (2): 657–695.
go back to reference Haining, C.M., and L.A. Keogh. 2021. "I haven’t had to bare my soul but now I kind of have to": Describing how voluntary assisted dying conscientious objectors anticipated approaching conversations with patients in Victoria Australia. BMC Medical Ethics 22(1): 149–160.CrossRefPubMedPubMedCentral Haining, C.M., and L.A. Keogh. 2021. "I haven’t had to bare my soul but now I kind of have to": Describing how voluntary assisted dying conscientious objectors anticipated approaching conversations with patients in Victoria Australia. BMC Medical Ethics 22(1): 149–160.CrossRefPubMedPubMedCentral
go back to reference Haining, C.M., L.A. Keogh, and L.H. Gillam. 2021. Understanding the reasons behind healthcare providers' conscientious objection to voluntary assisted dying in Victoria, Australia. Journal of Bioethical Inquiry 18(2): 277–289.CrossRefPubMed Haining, C.M., L.A. Keogh, and L.H. Gillam. 2021. Understanding the reasons behind healthcare providers' conscientious objection to voluntary assisted dying in Victoria, Australia. Journal of Bioethical Inquiry 18(2): 277–289.CrossRefPubMed
go back to reference Kirby, J. 2021. Should institutional conscientious objection to assisted dying be accommodated? Canadian Journal of Bioethics 4(1): 15–20.CrossRef Kirby, J. 2021. Should institutional conscientious objection to assisted dying be accommodated? Canadian Journal of Bioethics 4(1): 15–20.CrossRef
go back to reference Lemiengre, J., B. Dierckx de Casterlé, K. Van Craen, P. Schotsmans, and C. Gastmans. 2007. Institutional ethics policies on medical end-of-life decisions: A literature review. Health Policy 83(2): 131–143.CrossRefPubMed Lemiengre, J., B. Dierckx de Casterlé, K. Van Craen, P. Schotsmans, and C. Gastmans. 2007. Institutional ethics policies on medical end-of-life decisions: A literature review. Health Policy 83(2): 131–143.CrossRefPubMed
go back to reference Lemiengre, J., B. Dierckx de Casterlé, Y. Denier, P. Schotsmans, and C. Gastmans. 2008. How do hospitals deal with euthanasia requests in Flanders (Belgium)?: A content analysis of policy documents. Patient Education and Counseling 71(2): 293–301.CrossRefPubMed Lemiengre, J., B. Dierckx de Casterlé, Y. Denier, P. Schotsmans, and C. Gastmans. 2008. How do hospitals deal with euthanasia requests in Flanders (Belgium)?: A content analysis of policy documents. Patient Education and Counseling 71(2): 293–301.CrossRefPubMed
go back to reference Lemiengre, J., C. Gastmans, P. Schotsmans, and B. Dierckx de Casterlé. 2010. Impact of written ethics policy on euthanasia from the perspective of physicians and nurses: A multiple case study in hospitals. AJOB Primary Research 1(2): 49–60.CrossRef Lemiengre, J., C. Gastmans, P. Schotsmans, and B. Dierckx de Casterlé. 2010. Impact of written ethics policy on euthanasia from the perspective of physicians and nurses: A multiple case study in hospitals. AJOB Primary Research 1(2): 49–60.CrossRef
go back to reference Lemiengre, J., B. Dierckx de Casterlé, P. Schotsmans, and C. Gastmans. 2014. Written institutional ethics policies on euthanasia: An empirical-based organizational-ethical framework. Medicine, Health Care and Philosophy 17(2): 215–228.CrossRefPubMed Lemiengre, J., B. Dierckx de Casterlé, P. Schotsmans, and C. Gastmans. 2014. Written institutional ethics policies on euthanasia: An empirical-based organizational-ethical framework. Medicine, Health Care and Philosophy 17(2): 215–228.CrossRefPubMed
go back to reference Lemiengre, J., B. Dierckx de Casterlé, G. Verbeke, K. Van Craen, P. Schotsmans, and C. Gastmans. 2008. Ethics Policies on euthanasia in nursing homes: A survey in Flanders, Belgium. Social Science & Medicine 66 (2): 376–386.CrossRef Lemiengre, J., B. Dierckx de Casterlé, G. Verbeke, K. Van Craen, P. Schotsmans, and C. Gastmans. 2008. Ethics Policies on euthanasia in nursing homes: A survey in Flanders, Belgium. Social Science & Medicine 66 (2): 376–386.CrossRef
go back to reference McDougall, R.J., B.P. White, D. Ko, L. Keogh, and L. Willmott. 2021. Junior doctors and conscientious objection to voluntary assisted dying: Ethical complexity in practice. Journal of Medical Ethics 48(8): 517–521.CrossRefPubMed McDougall, R.J., B.P. White, D. Ko, L. Keogh, and L. Willmott. 2021. Junior doctors and conscientious objection to voluntary assisted dying: Ethical complexity in practice. Journal of Medical Ethics 48(8): 517–521.CrossRefPubMed
go back to reference McLaren, C.J., and G. Mewett. 2021. Update on voluntary assisted dying in Australia. Medical Journal of Australia 215(3): 115–116.CrossRefPubMed McLaren, C.J., and G. Mewett. 2021. Update on voluntary assisted dying in Australia. Medical Journal of Australia 215(3): 115–116.CrossRefPubMed
go back to reference Minerva, F. 2017. Conscientious objection, complicity in wrongdoing, and a not-so-moderate approach. Cambridge Quarterly of Healthcare Ethics 26(1): 109–119.CrossRefPubMed Minerva, F. 2017. Conscientious objection, complicity in wrongdoing, and a not-so-moderate approach. Cambridge Quarterly of Healthcare Ethics 26(1): 109–119.CrossRefPubMed
go back to reference Parker, C., and J. Braithwaite. 2003. Regulation. In Oxford Handbook of Legal Studies, edited by P. Cane and M.V. Tushnet, 119–145. Oxford: Oxford University Press. Parker, C., and J. Braithwaite. 2003. Regulation. In Oxford Handbook of Legal Studies, edited by P. Cane and M.V. Tushnet, 119–145. Oxford: Oxford University Press.
go back to reference Rutherford, J. 2020. Doctors and the Voluntary Assisted Dying Act 2017: Knowledge and general perspectives. Journal of Law and Medicine 27(4): 952–966.PubMed Rutherford, J. 2020. Doctors and the Voluntary Assisted Dying Act 2017: Knowledge and general perspectives. Journal of Law and Medicine 27(4): 952–966.PubMed
go back to reference Shadd, P., and J. Shadd. 2019. Institutional non-participation in assisted dying: Changing the conversation. Bioethics 33(1): 207–214.CrossRefPubMed Shadd, P., and J. Shadd. 2019. Institutional non-participation in assisted dying: Changing the conversation. Bioethics 33(1): 207–214.CrossRefPubMed
go back to reference Silvius, J., A. Memon, and M. Arain. 2019. Medical assistance in dying: Alberta approach and policy analysis. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement 38(3): 397–406.CrossRefPubMed Silvius, J., A. Memon, and M. Arain. 2019. Medical assistance in dying: Alberta approach and policy analysis. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement 38(3): 397–406.CrossRefPubMed
go back to reference Stulberg, D.B., R.E. Lawrence, J. Shattuck, and F.A. Curlin. 2010. Religious hospitals and primary care physicians: Conflicts over policies for patient care. Journal of General Internal Medicine 25(7): 725–730.CrossRefPubMedPubMedCentral Stulberg, D.B., R.E. Lawrence, J. Shattuck, and F.A. Curlin. 2010. Religious hospitals and primary care physicians: Conflicts over policies for patient care. Journal of General Internal Medicine 25(7): 725–730.CrossRefPubMedPubMedCentral
go back to reference Stulberg, D.B, R.A. Jackson, and L.R. Freedman. 2016. Referrals for services prohibited in Catholic health care facilities. Perspectives on Sexual and Reproductive Health 48(3): 111–117.CrossRefPubMed Stulberg, D.B, R.A. Jackson, and L.R. Freedman. 2016. Referrals for services prohibited in Catholic health care facilities. Perspectives on Sexual and Reproductive Health 48(3): 111–117.CrossRefPubMed
go back to reference Sumner, L.W. 2019. Institutional refusal to offer assisted dying: A response to Shadd and Shadd. Bioethics 33(8): 970–972.CrossRefPubMed Sumner, L.W. 2019. Institutional refusal to offer assisted dying: A response to Shadd and Shadd. Bioethics 33(8): 970–972.CrossRefPubMed
go back to reference ____. 2021. Conscientious refusal to provide medically assisted dying. University of Toronto Law Journal 71(1): 1–31. ____. 2021. Conscientious refusal to provide medically assisted dying. University of Toronto Law Journal 71(1): 1–31.
go back to reference Waran, E., and L. William. 2020. Navigating the complexities of voluntary assisted dying in palliative care. Medical Journal of Australia 213(5): 204–206.e1.CrossRefPubMed Waran, E., and L. William. 2020. Navigating the complexities of voluntary assisted dying in palliative care. Medical Journal of Australia 213(5): 204–206.e1.CrossRefPubMed
go back to reference White, B., L. Willmott, E. Close, and J. Downie. 2021. Legislative options to address institutional objections to voluntary assisted dying in Australia. UNSW Law Journal Forum 3: 1–19. White, B., L. Willmott, E. Close, and J. Downie. 2021. Legislative options to address institutional objections to voluntary assisted dying in Australia. UNSW Law Journal Forum 3: 1–19.
go back to reference White, B.P., R. Jeanneret, E. Close, L. Willmott. 2023b. Access to voluntary assisted dying in Victoria: a qualitative study of family caregivers’ perceptions of barriers and facilitators. Medical Journal of Australia. ePub ahead of print, July 3. https://doi.org/10.5694/mja22.00904 White, B.P., R. Jeanneret, E. Close, L. Willmott. 2023b. Access to voluntary assisted dying in Victoria: a qualitative study of family caregivers’ perceptions of barriers and facilitators. Medical Journal of Australia. ePub ahead of print, July 3. https://​doi.​org/​10.​5694/​mja22.​00904
go back to reference Wicclair, M.R. 2019. Preventing conscientious objection in medicine from running amok: A defense of reasonable accommodation. Theoretical Medicine and Bioethics 40(6): 539–564.CrossRefPubMed Wicclair, M.R. 2019. Preventing conscientious objection in medicine from running amok: A defense of reasonable accommodation. Theoretical Medicine and Bioethics 40(6): 539–564.CrossRefPubMed
go back to reference ____. 2012. Conscientious objection in health care: An ethical analysis. Cambridge: Cambridge University Press. ____. 2012. Conscientious objection in health care: An ethical analysis. Cambridge: Cambridge University Press.
go back to reference Willmott, L., White, B.P., Sellars, M., and Yates, P.M. 2021. Participating doctors’ perspectives on the regulation of voluntary assisted dying in Victoria: A qualitative study. Medical Journal of Australia 215(3): 125–129.CrossRefPubMed Willmott, L., White, B.P., Sellars, M., and Yates, P.M. 2021. Participating doctors’ perspectives on the regulation of voluntary assisted dying in Victoria: A qualitative study. Medical Journal of Australia 215(3): 125–129.CrossRefPubMed
go back to reference Wolfe, I.D., and T.M. Pope. 2020. Hospital mergers and conscience-based objections—growing threats to access and quality of care. New England Journal of Medicine 382(15): 1388–1389.CrossRefPubMed Wolfe, I.D., and T.M. Pope. 2020. Hospital mergers and conscience-based objections—growing threats to access and quality of care. New England Journal of Medicine 382(15): 1388–1389.CrossRefPubMed
Metadata
Title
Institutional Objection to Voluntary Assisted Dying in Victoria, Australia: An Analysis of Publicly Available Policies
Authors
Eliana Close
Lindy Willmott
Louise Keogh
Ben P. White
Publication date
10-07-2023
Publisher
Springer Nature Singapore
Published in
Journal of Bioethical Inquiry / Issue 3/2023
Print ISSN: 1176-7529
Electronic ISSN: 1872-4353
DOI
https://doi.org/10.1007/s11673-023-10271-6

Other articles of this Issue 3/2023

Journal of Bioethical Inquiry 3/2023 Go to the issue