Doctors' knowledge of the law on withholding and withdrawing life‐sustaining medical treatment

Abstract

Among doctors who practise in the end-of-life field, there are some significant knowledge gaps about the law on withholding and withdrawing life-sustaining treatment from adults who lack decision-making capacity. Significant consequences for both patients and doctors can flow from a failure to comply with the law. Steps should be taken to improve doctors' legal knowledge in this area and to harmonise the law across Australia.

The role of law in decisions to withhold and withdraw life-sustaining treatment from adults who lack capacity: a cross-sectional study

“…This research demonstrates that to improve compliance with law, increasing legal knowledge is necessary,5 but not sufficient. This points to the need for education that addresses what the law is and the law's rationale and arguments for complying with it.…”

“…Not complying with law can result in patients being denied legal rights and place doctors at legal risk 5 6. Law, which is ultimately a reflection of community values, has an important role to play in medicine.…”

“…These laws aim to safeguard patient interests (including autonomy interests), provide certainty and protection for doctors acting within the law and establish a process for resolving otherwise intractable disputes 4. Failure to know the law and follow it can place doctors at legal risk and also risks patients' rights and interests 5 6. But what role does the law actually play in decisions about WWLST for adults who lack capacity?…”

“…There is a small but growing body of research that demonstrates legal knowledge gaps of doctors (or students) in this area in the UK,7–9 Australia5 10–12 and the USA 6 13–18. A few studies have also determined that perceptions of legal risk can alter medical decision-making at the end of life 13 19 20.…”

Developing a Taxonomy and Mapping Concepts of Shared Decision Making to Improve Clinicians Understanding

“…Limitations to treatment and ACP are promoted as being a support to patient autonomy, yet studies have found that patients and families that document their preferences show no improvement in control over their treatment or correspond with future care preferences. 44 Australian studies also show that physicians have a poor understanding of the law in relation to end of life care, 45 which presents a legal risk to their practice. Like SMS, some ACP models or practice may also neglect to introduce evidenced based information to help patients or their families reach decisions.…”