Knowledge, attitudes and practices of multiprofessional clinicians towards assisted dying in ICU: A scoping review

Care of the dying is at the forefront in intensive care unit (ICU); however there is persistent debate surrounding clinicians' interventions to aid the dying process and make this more bearable and compassionate for patients. Since the expansion of assisted dying internationally, it is unclear how common this occurs within critical care. This work aims to evaluate the knowledge, attitudes and international practices of ICU clinicians about assisted dying.

Systematic literature search of PubMed, Embase and CINAHL including articles discussing the knowledge or attitudes towards and/or practices of assisted dying in ICU. The preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines were followed. Records were included from 2002 as the year when assisted dying was first legalised in Belgium and by healthcare professionals. A qualitative data synthesis approach was used.

17 studies were eligible and included in the qualitative analysis. Knowledge of assisted dying was rarely assessed directly in the data, though self-reported knowledge was low apart from in one Canadian survey of ICU physicians. Abilities to define modalities of assisted dying were low across all studies where it was measured. Attitudes were highly variable, ranging from 23.6% to 76.5% in support of assisted dying, though clinicians' answers were inconsistent within and between studies. Actual practices of assisted dying in ICU were rarely measured or discussed, despite evidence of assisted dying in Canada and The Netherlands. Outside of legal pathways, there is also evidence of covert interventions either via non-framework approaches where it is otherwise legal or in countries where there is no supportive legislation.

ICU clinicians have heterogeneous knowledge and attitudes towards assisted dying, and overall familiarity remains low. The relevance of assisted dying to the ICU setting remains controversial, and its incidence is unclear.

Evaluating the attitudes and experiences of ICU clinicians about assisted dying is important to gain insight about clinical practices. This holistic viewpoint is key to develop management strategies focused on humanisation of care for patients and families while understanding how to support multidisciplinary clinicians in critical care so they can provide safe and respectful interventions. The identification of its incidence in legal and illegal frameworks and knowledge gaps is key when developing further research and planning tailored interventions.