Reasons Doctors Provide Futile Treatment at the End of Life: A Qualitative Study

Journal of Medical Ethics, Forthcoming

34 Pages Posted: 14 Jul 2016

See all articles by Lindy Willmott

Lindy Willmott

Queensland University of Technology - Faculty of Law

Ben White

Queensland University of Technology - Faculty of Law

Cindy Gallois

University of Queensland

Malcolm Parker

University of Queensland - School of Medicine

Nicholas Graves

Queensland University of Technology

Sarah Winch

University of Queensland

Leonie Callaway

University of Queensland

Nicole Shepherd

Queensland University of Technology

Eliana Close

Queensland University of Technology

Date Written: 2016

Abstract

Objective: Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment which they consider to be futile is sometimes provided at the end of a patient’s life.

Design: Semi‐structured in‐depth interviews.

Setting: Three large tertiary public hospitals in Brisbane, Australia.

Participants: 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine, and medical administration departments. Participants were recruited using purposive maximum variation sampling.

Results: Doctors attributed the provision of futile treatment to a wide range of inter‐related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk, and poor communication skills. Secondly, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty, and lack of information about patient wishes. Thirdly, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the main reasons for futile care.

Keywords: Futile Treatment, Futility, End of Life Decision-Making, Withholding and Withdrawing Life-Sustaining Treatment, Doctors' Perceptions

Suggested Citation

Willmott, Lindy and White, Ben and Gallois, Cindy and Parker, Malcolm and Graves, Nicholas and Winch, Sarah and Callaway, Leonie and Shepherd, Nicole and Close, Eliana, Reasons Doctors Provide Futile Treatment at the End of Life: A Qualitative Study (2016). Journal of Medical Ethics, Forthcoming. Available at SSRN: https://ssrn.com/abstract=2802394

Lindy Willmott

Queensland University of Technology - Faculty of Law ( email )

Level 4, C Block Gardens Point
2 George St
Brisbane, QLD 4000
Australia

HOME PAGE: http://staff.qut.edu.au/staff/willmott/

Ben White (Contact Author)

Queensland University of Technology - Faculty of Law ( email )

Level 4, C Block Gardens Point
2 George St
Brisbane, QLD 4000
Australia

HOME PAGE: http://staff.qut.edu.au/staff/whiteb/

Cindy Gallois

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Malcolm Parker

University of Queensland - School of Medicine ( email )

St Lucia
Queensland 4072
Australia

Nicholas Graves

Queensland University of Technology ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Sarah Winch

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Leonie Callaway

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Nicole Shepherd

Queensland University of Technology

2 George Street
Brisbane, Queensland 4000
Australia

Eliana Close

Queensland University of Technology ( email )

2 George Street
Brisbane, Queensland 4000
Australia

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