15 Should voluntary assisted dying be raised in advance care planning: legal and ethical considerations
Bibliographic record
Abstract
Aim To explore the legal and ethical considerations associated with whether and when voluntary assisted dying (VAD) should be raised during advance care planning conversations. Background VAD is legal in some form in 17 countries. Experience with the practice ranges from decades through to laws which have passed but not yet started in force. For some health professionals and members of the community, VAD is controversial and so discussing it can be difficult, particularly where it has only been relatively recently legalised. For others, VAD is something they would like to discussed openly during advance care planning. Method An analysis of laws internationally that regulate how conversations about VAD may occur was undertaken. The ethical considerations associated with whether and when VAD should be raised in advance care planning conversations were identified and evaluated. Results A small number of jurisdictions (particularly Australian jurisdictions and New Zealand) specifically regulate through law how the topic of VAD may be raised with patients. In some of those jurisdictions, health professionals are prohibited from raising the topic first and in other jurisdictions this is permitted but certain mandated topic must also be discussed at the same time. Other jurisdictions’ laws do not address this topic. Ethical considerations include supporting any conscientious objection a health professional may have to raising or discussing VAD, managing local institutional policies which may limit VAD discussions, and ensuring patients are fully informed about all of their legal options. Discussion Health professionals need to be aware of local laws that govern how the topic of VAD may be raised and discussed in advance care planning. Ethical considerations will also shape individual and institutional behaviour. There is a case for including VAD in advance care planning conversations where appropriate to ensure patients are aware if this could be an option for them. Unique Contribution This presentation addresses a topical legal and ethical debate drawing on a range of international laws. This issue is the subject of current debate in places such as Australia, New Zealand and Canada and is actively being considered in new VAD laws in the UK. Implications In countries where VAD is legal, some patients will either raise VAD or want to know about it during advance care planning conversations. Understanding legal requirements and reflecting on ethical considerations associated with raising the topic of VAD will support lawful, patient-centred care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.165 | 0.263 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.016 | 0.040 |
| Scholarly communication | 0.017 | 0.014 |
| Open science | 0.004 | 0.016 |
| Research integrity | 0.012 | 0.016 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".