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?

(2017) BMC Palliative Care 16:63 DOI 10.1186/s12904-017-0249-1

8 Pages Posted: 9 Jan 2018

See all articles by Ben White

Ben White

Queensland University of Technology - Faculty of Law

Lindy Willmott

Queensland University of Technology - Faculty of Law

Colleen Cartwright

Southern Cross University

Malcolm Parker

University of Queensland - School of Medicine

Gail Williams

University of Queensland

Juliet Davis

Queensland University of Technology - Australian Center for Health Law Research

Date Written: January 4, 2018

Abstract

Background: Law purports to regulate end-of-life care but its role in decision-making by doctors is not clear. This paper, which is part of a three-year study into the role of law in medical practice at the end of life, investigates whether law affects doctors’ decision-making. In particular, it considers whether the fact that the law differs across Australia’s three largest states – New South Wales (NSW), Victoria and Queensland – leads to doctors making different decisions about withholding and withdrawing life-sustaining treatment from adults who lack capacity.

Methods: A cross-sectional postal survey of the seven specialties most likely to be involved in end-of-life care in the acute setting was conducted between 18 July 2012 and 31 January 2013. The sample comprised all medical specialists in emergency medicine, geriatric medicine, intensive care, medical oncology, palliative medicine, renal medicine and respiratory medicine on the AMPCo Direct database in those three Australian states. The survey measured medical specialists’ level of legal compliance, and reasons for their decisions, concerning the withholding or withdrawal of life-sustaining treatment. Multivariable logistic regression was used to examine predictors of legal compliance. Linear regression was used to examine associations between the decision about life-sustaining treatment and the relevance of factors involved in making these decisions, as well as state differences in these associations.

Results: Response rate was 32% (867/2702). A majority of respondents in each state said that they would provide treatment in a hypothetical scenario, despite an advance directive refusing it: 72% in NSW and Queensland; 63% in Victoria. After applying differences in state law, 72% of Queensland doctors answered in accordance with local law, compared with 37% in Victoria and 28% in NSW (p < 0.001). Doctors reported broadly the same decision-making approach despite differences in local law.

Conclusions: Law appears to play a limited role in medical decision-making at the end of life with doctors prioritising patient-related clinical and ethical considerations. Different legal frameworks in the three states examined did not lead to different decisions about providing treatment. More education is needed about law and its role in this area, particularly where law is inconsistent with traditional practice.

Keywords: End-of-life decision-making, Medical law, Withholding and withdrawing life-sustaining treatment, Compliance with law, Advance directives

Suggested Citation

White, Ben and Willmott, Lindy and Cartwright, Colleen and Parker, Malcolm and Williams, Gail and Davis, Juliet, 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? (January 4, 2018). (2017) BMC Palliative Care 16:63 DOI 10.1186/s12904-017-0249-1. Available at SSRN: https://ssrn.com/abstract=3096846

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/

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/

Colleen Cartwright

Southern Cross University ( email )

Lismore, New South Wales 2480
Australia

Malcolm Parker

University of Queensland - School of Medicine ( email )

St Lucia
Queensland 4072
Australia

Gail Williams

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Juliet Davis

Queensland University of Technology - Australian Center for Health Law Research ( email )

Australia

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