The Essential Role of Psychologists in End-of-Life Care

Recent research from Edith Cowan University highlights the critical role that psychologists could play in the realm of voluntary assisted dying (VAD) in Australia. Despite this potential, significant barriers currently prevent these mental health professionals from fully engaging in this important aspect of end-of-life care.

The study, led by Master's student Dr. Vivienne Heng and supported by Associate Professor Eyal Gringart, examines the perspectives of Provisionally Registered Psychologists (PRPs) regarding VAD. The findings are published in the journal OMEGA--Journal of Death and Dying.

Dr. Heng emphasizes the importance of understanding PRPs' views on VAD as Australia navigates the implementation of these new laws, which aim to bridge gaps in psychological support for those involved in VAD processes.

Through in-depth interviews with 20 PRPs, the study reveals a general support for VAD among participants, particularly for terminally ill patients and individuals suffering from dementia. However, many psychologists expressed reluctance to engage in VAD care due to various obstacles.

Participants cited emotional strain, fear of legal repercussions, a lack of education and professional experience, ambiguous ethical guidelines, and insufficient compensation as key factors deterring their involvement. Additionally, some psychologists reported feeling constrained by the so-called 'gag clause,' which exists in several Australian states and restricts healthcare professionals from discussing VAD.

As all Australian states and the ACT have now legalized VAD, with most moving into implementation phases, the need for psychological support during end-of-life decisions is becoming increasingly apparent. An aging population with a rise in chronic illnesses has created a growing demand for mental health services to assist individuals and families facing these profound choices.

Despite their specialized training in assessing mental capacity and providing emotional support, psychologists remain largely excluded from the VAD process. Dr. Heng notes that only about one percent of psychologists report having expertise in palliative care.

Associate Professor Gringart points out that the historical lack of engagement by psychologists with older populations may be contributing to their absence in VAD discussions. He suggests that early training in this area could enhance their involvement in the future.

With VAD being a relatively new field in Australia, ongoing changes in laws and eligibility criteria further complicate the landscape. The study's findings could potentially influence curriculum reforms in psychology programs across Australian universities, ensuring that future psychologists are better equipped to handle the psychological needs surrounding death and dying.

The research underscores the vital contributions psychologists can make in enhancing the well-being of patients, families, and healthcare providers involved in VAD. They are uniquely positioned to offer mental health care, grief counseling, capacity assessments, and community education, all of which are essential during these challenging times.

As VAD continues to evolve within Australian law and practice, understanding the psychological needs of all stakeholders will be crucial. This research aims to inform the future training of psychologists, ensuring they can provide compassionate, holistic, and evidence-based support to those navigating the complexities of end-of-life decisions.