Examining critical care nurses’ support for and willingness to participate in voluntary assisted dying: A mixed-method study

BACKGROUND: Voluntary assisted dying (VAD) is legal in most of Australia. Despite growing societal acceptance, clinicians' views remain mixed, particularly in critical care. AIM: The aim of this study was to identify and describe factors influencing critical care nurses' support for and willingness to participate in VAD. METHODS: convergent mixed-method study was undertaken involving (i) an online survey; (ii) individual interviews; and (iii) integration. Critical care nurses were recruited through multiple Australian nursing organisations. RESULTS: Forty-two critical care nurses completed the survey. Over half (57.1%, n = 21) provided end-of-life care at least monthly, 76.2% (n = 32) had at least some knowledge of VAD, and 92.9% (n = 39) were supportive of VAD. Almost all (97.6%, n = 40) were willing to participate in VAD by providing care, advice, or support to a person requesting VAD (97.6%, n = 40), even if family members did not agree (92.7%, n = 38), to care for a person after taking the VAD substance (92.7%, n = 38), and to be present at death (92.7%, n = 38). Willingness reflected respondents' support for patient choice, autonomy, and alignment with professional obligations and personal values. Critical care nurses' cultural beliefs, religion/spirituality, and workload concerns were less important. Eight critical care nurses were interviewed, providing greater detail about VAD in the intensive care unit (ICU) with three themes identified: (i) the complex context, describing tensions with the momentum of ICU care; (ii) if it's the person's wishes, upholding patient autonomy and choice; and (iii) VAD fit and function, reflecting scope of practice and legal concerns and the essential skills for participation. Nurse practitioners were universally regarded as possessing the skills and relational qualities necessary for VAD participation. CONCLUSIONS: Critical care nurses showed strong support for VAD, and a willingness to provide VAD-related care, grounded in professional values and commitment to patient autonomy. Policy and practice frameworks formally recognising critical care nurses' role in VAD in the ICU are essential.