Psychologists could play a vital role in helping Australians navigate voluntary assisted dying (VAD), but new Edith Cowan University research shows there are significant barriers preventing them from doing so.
The study led by Master’s student Dr Vivienne Heng with Associate Professor Eyal Gringart is one of the first to explore Provisionally Registered Psychologists’ (PRPs) views of voluntary assisted dying.
‘Understanding the perspectives of PRP’s on VAD is important in the early phase of VAD implementation in Australia to help address gaps in psychological support for key VAD stakeholders in VAD care,’ Dr Heng said.
In-depth interviews with 20 psychologists revealed they supported voluntary assisted dying for terminally ill patients and expressed the potential for its use with people living with dementia. However, they expressed little interest in engaging with VAD care because of the barriers faced.
‘The participants interviewed reported emotional strain, fear of litigation, a lack of education and professional exposure, unclear practice and ethical guidelines, and inadequate remuneration as key deterrents,’ Dr Heng said.
Many PRPs also reported being discouraged from participating in VAD care because of the gag clause.
‘The gag clause is in effect in many states in Australia, with Victoria recently proposing amendments to repeal this clause,’ said Dr Heng. ‘It prevents health professionals like doctors and psychologists from raising the topic of VAD.’
VAD demand rising, but future psychologists not engaged
All Australian states and the ACT have now legalised VAD and most are in implementation phase. NT is currently in the consultation phase.
Dr Heng said an ageing population and a rise in chronic illnesses, was creating increasing demand for mental health support during end-of-life decisions.
However, psychologists, who are uniquely qualified to assess mental capacity and help patients and families manage the emotional weight of such decisions remained largely absent from the VAD process.
‘Despite their fit and relevance, psychologists are rarely involved in end-of-life care, and only about one per cent self-report palliative care expertise,’ Dr Heng said.
Research findings could help inform curriculum reform for end-of-life care
Associate Professor Gringart said historically psychologists have shown less interaction with and attraction to working with older adults and early training in that context has been proposed to increase their involvement.
‘However, VAD is a relatively new field in Australia and is still undergoing changes regarding laws and eligibility criteria,’ he said.
‘Psychology Masters students across all APAC accredited university programs in Australia are trained to provide mental health support around death and dying as well as grief.
‘VAD specific issues in Australia will be born out in research that could then inform curriculum.
‘Our findings are timely because as VAD gains ground in law and practice, research into the psychological needs of all VAD stakeholders can inform end-of-life curricula and training of our up-coming psychologists.’
The role psychologists could play
The study reinforces the vital role psychologists could play in supporting the wellbeing of patients, families and healthcare professionals during VAD through mental health care, grief and bereavement counselling, capacity assessments, and broader community education.
‘This is not just about ticking a box for mental capacity,’ Dr Heng said.
‘It’s about navigating life and death with compassion, providing inclusive, holistic and evidence-based care in an empathetic and non-judgemental way – psychologists are well-placed to help do that.’
The paper ‘The Perspectives of Provisionally Registered Psychologists on Voluntary Assisted Dying in Australia: An In-Depth Qualitative Investigation’ is published in the journal OMEGA – Journal of Death and Dying.
