Assisted dying: participation barriers and facilitators - qualitative interview study of doctors' perceptions

As more countries legalise assisted dying, it is of increasing significance for policy-makers and the medical profession. Doctors are needed for patients to access this choice; however, there is currently limited participation. Few studies identify what factors, if any, facilitate participation in assisted dying and how the inter-relationship of multiple factors may also influence participation. This study investigates factors influencing potential participation of doctors who have no in-principle objection to assisted dying in Queensland, Australia.

A qualitative interview study with 31 doctors who have no in-principle objection to assisted dying. Interviews were conducted between March 2022 and January 2023 during the implementation period, when the assisted dying law had passed but was not yet in effect.

Participants identified four categories of barriers to participation: personal burdens; professional ramifications; external constraints and the difference from the traditional role of a doctor. Facilitators to participation were: continuation of care; philosophical support for assisted dying; providing a good death and scope of provision. The interplay between barriers and facilitators influenced the degree of expected participation, if any. Three key decision points determining participation were also identified: providing for all patients or only their own patients; participation as the co-ordinating or consulting practitioner and whether to participate in practitioner administration.

Participation in assisted dying may be shaped by whether or not an individual doctor's philosophical support for this choice is outweighed by barriers to participation. Removing barriers could positively affect the future sustainability of an assisted dying workforce.