Psychology and assistance in dying

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Byrnes, Eric
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University College Cork
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Abstract 1: A systematic review of barriers and facilitators to implementing assisted dying: A qualitative evidence synthesis of professionals' perspectives. Background: Assisted dying frameworks are currently legal in thirteen jurisdictions worldwide and are becoming increasingly available as more countries move to legalise aid in dying. Assisted dying is a divisive topic and draws both lamenting and approving commentary from political, medical, legal, and philosophical domains. Safeguarding is considered the cornerstone of assisted dying frameworks. However, some reviews highlight that due care is not always adhered to resulting in potential harm being caused. Aims: This systematic review and qualitative evidence synthesis aims to understand the factors that healthcare professionals experience when working within assisted dying frameworks. Moreover, we aim to understand the impact of these factors on service delivery. Method: PRISMA guidelines were used to develop a systematic search of ten databases. Search results yielded 15,426 papers with 39 papers meeting inclusion criteria for this review. These remaining 39 papers were subjected to critical appraisal and a thematic synthesis. Results: Thirteen themes were identified with some themes representing the dimensional nature of human interaction and falling into two different domains. Eight themes fell under the domain of ‘barrier’ and represent different personal and professional factors that hinder professionals from delivering assisted dying healthcare. These include the impact of ‘poor training’, ‘communication’, ‘emotional challenges’, ‘manipulating time’, ‘protocols and procedures’, ‘assessment’, ‘conscientious objection’, and ‘alternative treatments’. Five themes came under the domain of ‘facilitators’ and represent factors that contribute to the smooth delivery of assisted dying services. These include ‘communication’, ‘action from values’, ‘protocols, procedures, and legislation’, ‘multi-disciplinary teamwork’, and ‘getting a good assessment of due care’. Conclusion: Health professionals experience a range of factors that both impede and propel delivery of assisted dying frameworks. Legislators and educators should consider these factors when developing or updating their respective frameworks. Keywords: assisted dying; euthanasia; barriers; facilitators; health professionals Abstract 2: Assisted dying in Ireland: Psychologists’ attitudes towards and perspectives of roles and best-practice guidelines. Background: Psychologists are becoming more involved in end-of-life healthcare provision including assisted dying frameworks. In some countries, psychologists are mandated to provide assessments of decisional capacity relating to requests to have a death hastened. However, there is a paucity of research exploring the perspectives of psychologists about assisted dying. This study aimed to glean a qualitative understanding of the attitudes towards assisted dying from psychologists working in Ireland. We also wanted to know how an assisted-dying framework could look like from the perspective of psychology. Method: Semi-structured interviews were conducted with ten clinical psychologists recruited from two healthcare organisations in the Republic of Ireland. Transcribed interviews were analysed using an inductive thematic analytic approach. Results: Participants were broadly in favour of assisted-dying. However, mistrust and ambivalence appeared to function and mediating factors that regulated how participants discussed and grappled with the complexity assisted-dying. Thematic analysis resulted in the formation of three primary themes: (1) making sense of assisted-dying, (2) my fear would be…, and (3) the omnipresent psychologist. Subthemes under ‘making sense’ relate to lay-understanding, psychological understanding, complexity, and what assisted dying should not be. Subthemes related to fear include harm being caused and the emergence of stigma. Omnipresence was associated with how psychologists viewed their responsibilities including assessment, support, and safeguarding. Conclusion: Psychologists can be broadly supportive of assisted-dying frameworks and can provide nuanced information regarding the role psychology could have within the framework. However, further exploration of the potential impact that psychologists’ world-view assumptions have on attitudes towards assisted-dying need to be further explored. Keywords: psychology; framework; assisted-dying; euthanasia; assisted-suicide
Assisted-dying , Euthanasia , Assisted-suicide , Barriers , Facilitators , Health professionals , Psychologists , Psychology , Framework , Attitudes , Opinions
Byrnes, E. 2020. Psychology and assistance in dying. DClinPsych Thesis, University College Cork.
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