Junior Doctors and Conscientious Objection to Voluntary Assisted Dying: Ethical Complexity in Practice
J Med Ethics, 48, 517-521 (2022)
5 Pages Posted: 4 Aug 2021 Last revised: 1 Aug 2022
Date Written: June 14, 2021
Abstract
In jurisdictions where voluntary assisted dying (VAD) is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture.
Note:
Funding: The project was funded by the Research Grant Support Scheme, Faculty of Medicine, Dentistry and Health Sciences at The University of Melbourne. BPW is a recipient of an Australian Research Council Future Fellowship (project number FT190100410: Enhancing end-of-life decision-making: optimal regulation of voluntary assisted dying) funded by the Australian Government
Declaration of Interests: BPW and LW were engaged by the Victorian Government to design and provide the legislatively mandated training for doctors involved in voluntary assisted dying. DK is a member of the Victorian Voluntary Assisted Dying Review Board. She has engaged in this research in her role as a clinical ethics researcher and palliative care specialist and not in her role as a member of the Board. Any views expressed in this paper are not to be attributed to the Board.
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