End-of-life care missing a key player: The psychologist

Psychologists could play a vital role in helping Australians navigate voluntary assisted dying (VAD), but new Edith Cowan University (ECU) 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 VAD.

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.

“Understanding the perspectives of PRPs 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 PRPs revealed they supported VAD 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.

Dr. Heng said 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,” she said.

“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 legalized VAD and most are in the implementation phase. NT is currently in the consultation phase.

Dr. Heng said an aging population and a rise in chronic illnesses was creating an 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 percent 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 upcoming psychologists.”

The role psychologists could play

The study reinforces the vital role psychologists could play in supporting the well-being of patients, families and health care professionals during VAD through mental health care, grief and bereavement counseling, 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-judgmental way—psychologists are well-placed to help do that.”