Emergency clinicians' attitudes and decisions in patient scenarios involving advance directives

Abstract

Hypothetical treatment decisions involving ADs made by emergency clinicians appear to be more influenced by ethical and clinical factors than by legal obligations.

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

“…Although ADs can influence treatment that patients receive at the end of life,39 our findings accord with other studies that show low rates of compliance with ADs that are inconsistent with what is clinically indicated 20 22 24 25. However, this study is significant because it explores whether accurate legal knowledge improves compliance, and the role that the law plays in specialists' decision-making.…”

“…The sample, which included all doctors from the seven specialties most likely to be involved in end-of-life decision-making in the largest Australian states, is more representative than previous related studies which have generally been drawn from those participating in specified training courses or cohorts,7 9 20 specific health facilities13 14 21 25 or a single specialty or society 11 12 18 19 22 24. However, our results from seven specialties in the acute setting may not be generalisable to other doctors or other settings.…”

Should law have a role in end‐of‐life care?

“…For example, there is only limited work in the United States, Denmark and the United Kingdom that purports to examine in a systematic way what doctors know of this area of law 2–5 . In Australia, no comprehensive empirical research has been conducted, although there have been studies into parts of the law that can be relevant to these decisions 6–10 . A further gap in understanding in this area is that the few Australian studies that exist have tended to focus only on particular subsets of doctors, such as general practitioners, 6,7 emergency physicians 8 or intensivists 9 .…”

“…In Australia, no comprehensive empirical research has been conducted, although there have been studies into parts of the law that can be relevant to these decisions 6–10 . A further gap in understanding in this area is that the few Australian studies that exist have tended to focus only on particular subsets of doctors, such as general practitioners, 6,7 emergency physicians 8 or intensivists 9 . We know very little about the medico‐legal understanding and perspectives of the wider group of physicians being surveyed in this study – those who specialise in geriatric medicine, medical oncology, palliative medicine, renal medicine and respiratory medicine – despite them playing a significant role in the provision of end‐of‐life care.…”

“…We know very little about the medico‐legal understanding and perspectives of the wider group of physicians being surveyed in this study – those who specialise in geriatric medicine, medical oncology, palliative medicine, renal medicine and respiratory medicine – despite them playing a significant role in the provision of end‐of‐life care. The limited body of research undertaken to date reveals gaps in legal knowledge and training for doctors 8–10 and calls for further research to be undertaken across specialties 8 …”