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

Abstract

Medical specialists prioritise patient-related clinical factors over law when confronted with a scenario where legal compliance is inconsistent with what they believe is clinically indicated. Although legally knowledgeable specialists were more likely to comply with the law, compliance in the scenario was not motivated by an intention to follow law. Ethical considerations (which are different from, but often align with, law) are suggested as a more important influence in clinical decision-making. More education and training of doctors is needed to demonstrate the role, relevance and utility of law in end-of-life care.

Comparing doctors’ legal compliance across three Australian states for decisions whether to withhold or withdraw life-sustaining medical treatment: does different law lead to different decisions?

“…Elsewhere we have identified significant gaps in doctors’ legal knowledge [ 11 ] but increasing knowledge is not sufficient, in and of itself, to lead to compliance with law. It is also necessary for the role, utility and relevance of law to be understood [ 12 ] and acted upon. That said, increasing knowledge may have an effect on compliance where the law in question is counterintuitive and/or inconsistent with widely held views in the medical profession and with accepted ethical positions.…”

“…It is part of a three-year study which has considered the role of law in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. Previous papers from this study have examined issues such as whether doctors know the law in this area [ 11 ], whether legally knowledgeable doctors are more likely to follow the law [ 12 ], and the role of law for palliative care specialists, including their part in advancing end-of-life legal knowledge as a trusted source of information for other doctors, nurses, patients and families [ 13 ]. The focus of the present paper is a natural experiment which tests the impact of critical differences in end-of-life law across three Australian jurisdictions: New South Wales (NSW), Victoria and Queensland.…”

Doctors’ perspectives on adhering to advance care directives when making medical decisions for patients: an Australian interview study

“…A 2007 study found that the presence of an ACD did not influence healthcare providers’ decisions in using life-sustaining treatments or initiating comfort care plans 12. More recently, Australian researchers presented doctors from New South Wales and Victoria with a hypothetical case scenario to investigate compliance with ACDs 13. In responding to the scenario, only 32% of doctors reported that they would adhere to the ACD in accordance with the law.…”

Testamento vital: verificação e compartilhamento de informações em um hospital português

“…In fact, several studies have pointed to a lack of knowledge regarding living wills among health professionals, as opposed to positive attitudes towards the document [16][17][18][19] , with a direct relationship between the level of knowledge and characteristics such as previous experience and academic education 18,19 . Likewise, procedures that do not comply with end-oflife legislation have already been associated with a lack of familiarity with these legal principles 20 .…”