Anticipated impacts of voluntary assisted dying legislation on nursing practice

Background: The Voluntary Assisted Dying Act 2017 passed into law in Victoria, Australia, on the 29 November 2017. Internationally, nurses have been shown to be intimately involved in patient care throughout the voluntary assisted dying process. However, there is a paucity of research exploring Australian nurses’ perspectives on voluntary assisted dying and, in particular, how Victorian nurses anticipate the implementation of this ethically controversial legislation will impact their professional lives. Objectives: To explore Victorian nurses’ expectations of the ethical and practical impacts the voluntary assisted dying legislation will have on their professional lives. Research design: This qualitative study analysed nurses’ free text responses collected as part of a larger mixed methods online survey investigating staff views on the Voluntary Assisted Dying Act. Data were collected during the period between the passing of the voluntary assisted dying legislation and the start date and were analysed using inductive content analysis. Participants and research context: Free text survey responses were analysed from 1873 nurses employed across seven Victorian health services located in both metropolitan and regional areas of the state. Ethical considerations: The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation. Findings: This study identified three broad areas of Victorian nurses’ professional lives that they expected to be impacted by the implementation of voluntary assisted dying: professional identity, career development and workplace relationships. Conclusion: Participants anticipate diverse and nursing-specific impacts of the implementation of voluntary assisted dying in Victoria. Their insights can inform health services in jurisdictions considering or already implementing voluntary assisted dying, to develop policies, procedures and staff training programmes that safeguard the well-being and legal rights of their nursing staff

Effective fertility counselling for transgender adolescents : a qualitative study of clinician attitudes and practices

OBJECTIVE: Fertility counselling for trans and gender diverse (TGD) adolescents has many complexities, but there is currently little guidance for clinicians working in this area. This study aimed to identify effective strategies for-and qualities of-fertility counselling for TGD adolescents based on clinicians' experiences. DESIGN: We conducted qualitative semi-structured individual interviews in 2019 which explored clinician experiences and fertility counselling practices, perspectives of the young person's experience and barriers and facilitators to fertility preservation access. Data were analysed using thematic analysis. SETTING: This qualitative study examined experiences of clinicians at the Royal Children's Hospital-a tertiary, hospital-based, referral centre and the main provider of paediatric TGD healthcare in Victoria, Australia. PARTICIPANTS: We interviewed 12 clinicians from a range of disciplines (paediatrics, psychology, psychiatry and gynaecology), all of whom were involved with fertility counselling for TGD adolescents. RESULTS: Based on clinician experiences, we identified five elements that can contribute to an effective approach for fertility counselling for TGD adolescents: a multidisciplinary team approach; shared decision-making between adolescents, their parents and clinicians; specific efforts to facilitate patient engagement; flexible personalised care; and reflective practice. CONCLUSIONS: Identification of these different elements can inform and hopefully improve future fertility counselling practices for TGD adolescents, but further studies examining TGD adolescents' experiences of fertility counselling are also required

The ethical challenges associated with medical internship and residency

© 2009 Dr. Rosalind McDougallInternship and residency are the first years following graduation from medical school. Interns and residents work in hospitals as the junior members of hierarchical medical teams. To date there has been little systematic philosophical work that focuses specifically on this group. Instead, in ethical discussions, interns and residents tend to be included either with medical students or with their more senior colleagues. In this thesis, I argue that interns and residents differ from both medical students and more experienced doctors in ethically important ways. Their working context requires them to play multiple roles simultaneously, including doctor, subjugate team member, learner, and hospital employee. The demands of these multiple roles create a set of ethical challenges for junior doctors that is unique to their professional stage. Further, the potentially conflicting demands of these multiple roles limit the ways in which junior doctors can act in response to the ethical difficulties that they encounter. I thus propose that the ethical challenges associated with medical internship and residency can be fruitfully understood as role virtue conflicts. Aiming to produce a work of empirically-informed moral philosophy, I investigate junior doctors‟ ethical issues using a combination of literature review, semi-structured interviews, and philosophical analysis. In-depth interviews with fourteen Melbourne-based junior doctors formed a central element of this project, in order to ensure the project‟s focus on pressing practical issues. On the basis of these interviews and my review of research findings about junior doctors across various disciplines, I develop a typology of the kinds of ethical challenges associated with internship and residency. These include being involved in treatment perceived as futile, seniors discouraging disclosure of errors, and reporting unrostered hours. In addition to the typology of ethical issues, I develop and use a role-based framework as a way of analysing the ethical challenges faced by interns and residents. The method of ethical analysis that I propose conceptualises the good junior doctor as good qua four roles, each with a differing set of role virtues. I argue that this role-based framework both reflects and engages with junior doctors‟ specific position of agency and thus captures a fuller range of moral considerations than do other possible modes of analysis

The ethical junior: a typology of ethical problems faced by house officers

Although many studies have explored the experiences of doctors in their first postgraduate year, few have focused on the ethical issues encountered by this group. Based on an extensive literature review of research involving house officers, we argue that these doctors encounter a broad range of ‘everyday’ ethical challenges, from truth-telling to working in non-ideal conditions. We propose a typology of house officers' ethical issues and advocate prioritizing these issues in undergraduate medical ethics and law curricula

Within the ZPD: Focussing on Harm and Interests

Harm is a crucial concept in the ZPD framework. The concept of probable harm to the child forms the outer limit of the zone of parental discretion, marking the point where parents' decisions should be overridden. This chapter focuses on defining and explaining the concept of harm, and the closely related concept of interests, specifically in relation to children. In short, harm is done to a child when she experiences a large setback to her interests. In explaining what might count as a large setback to interests, the authors set out various accounts of what children's interests are in general, and suggest a possible list of children's interests that are specific to healthcare. An assessment of harmfulness involves comparing the overall extent to which a child's various interests are promoted or set back by the different possible options. The authors suggest that, in the end, this will always involve some degree of individual judgment. There is no straightforward formula to calculate whether a parental choice is likely to set back a child's interests so much that it counts as harm to the child

Introducing voluntary assisted dying: staff perspectives in an acute hospital

Background: Voluntary assisted dying (VAD) was legalised in Victoria, Australia in June 2019. Physicians can now assist patients to end their lives by providing drugs for self-administration at their voluntary and competent request (or for physician administration in limited circumstances). This study investigates the opinions of clinicians on the implementation of the legislation in one Victorian hospital. Methods: This exploratory survey study was conducted at a 600-bed acute hospital in Melbourne, Australia in Jan 2019. 382 clinicians completed one or more qualitative questions. Participants commented on VAD, potential workplace challenges and staff support required. Free-text responses were analysed using inductive content analysis. Results: Six themes: (1) Polarised views; (2) Fear of conflict; (3) Emotional burden; (4) Vulnerable patients; (5) Organisational challenges; (6) Decision-making. There were diverse views including objections to VAD for religious or ethical reasons, and whole-hearted support based on a compassionate response to suffering and the right of patients to self-determination. Participants feared conflict between colleagues, families and patients, and aggression towards staff. Clinicians called for educational and psychological support. There was concern that vulnerable patients may be coerced to opt for VAD to lessen the burden on families or the health system. Clinicians feared workloads would increase with the introduction of VAD. Patient decision-making capacity in this context must be firmly established before proceeding, and thorough assessments for depression, and optimal symptom management must be implemented before VAD is approved. A dedicated VAD team was suggested to support staff and manage VAD patients. Conclusion: Participants expressed polarised opinions about VAD and showed considerable anxiety about its introduction. Additional education and support are required to ensure that clinicians understand details of the legislation and their professional and personal options. Tolerance and respect for alternative viewpoints must be advocated within the organisation and more broadly