Dutch Healthcare Professionals Experiences of Assisted Dying: A Constructivist Qualitative Study Conducted in a Chronic Disease Care Centre and Hospice.

Abstract

Abstract Background: Assisted dying is a contemporary issue, but comprehensive consideration of healthcare professionals’ experiences has been lacking. This study sought to gain a deeper understanding of professionals’ experiences of assisted dying to inform the global debate surrounding its implementation. Methods: This constructivist, qualitative study, recruited twenty-one physicians, nurses and therapists from a Dutch chronic disease care centre and a hospice. Data were gathered in semi-structured interviews, conducted in English. Questioning focused on professionals’ experiences along a clinical trajectory from an initial request to beyond the death. Data were subjected to thematic analysis to identify main and subthemes. Results: Analytical procedures generated four broad themes ‘Assessment and its Challenges’, ‘Preparing Staff and Learners’, ‘Assisting a Death’ and ‘Bereavement Care and Beyond’, supported by subthemes. Assessment of requests involved all professional groups and required open dialogue, exploration of fears, palliative care optimisation and psychological evaluation. Such measures resolved the majority of requests. Assisted deaths were challenging, required careful management and were not perceived as normal. Administration of lethal drugs and reporting procedures were stressful for physicians. Structured debriefing and proactive psychological support were valued by all professionals, but resolving their emotions took time. Some physicians required a recovery period creating equity of access issues. Life and care experience aided the preparation of professionals, but resilience was also needed. Support for the provision of assisted dying was overwhelming, but this was unqualified in only a third of participants. Conclusions: Assisted dying creates significant challenges for healthcare professionals who require preparation and support. This is likely to require enhanced levels of palliative care education, legislative advice, and proactive psychological support to ensure professionals’ own well-being. Meeting these needs will have financial implications which should be addressed prior to implementing legislation which permits assisted dying.