Emergency department and intensive care unit health professionals' knowledge and application of the law that applies to end-of-life decision-making for adults: A scoping review of the literature

  • Jayne Hewitt
    Corresponding author.
    Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia

    Griffith University, Griffith Law School, Law Futures Centre, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia

    Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia
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  • Nemat Alsaba
    Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia

    Bond University, Faculty of Health Science and Medicine, 14 University Drive, Robina, Queensland, 4226, Australia
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  • Katya May
    Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia

    Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia
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  • Halima Sadia Noon
    Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia

    James Cook University, College of Medicine and Dentistry, 1 James Cook Drive, Douglas, Townsville, Queensland, 4810, Australia
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  • Cooper Rennie
    Griffith University, School of Medical Science, Nathan Campus, 170 Kessels Rd, Nathan, Queensland 4111, Australia
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  • Andrea P. Marshall
    Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia

    Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia
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Published:September 09, 2022DOI:



      Laws that regulate healthcare practice at the end of life reflect the values of the society where they apply. Traditionally, healthcare professionals rely on their clinical knowledge to inform treatment decisions, but the extent to which the law also informs health professionals’ decision-making at the end of life is uncertain.


      The objective of this study was to describe what healthcare professionals working in emergency departments and intensive care units know about the law that relates to end-of-life decision-making for hospitalised adults and what affects its application.

      Review method

      This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

      Data sources

      Data were sourced by searching the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL [via EBSCOhost]), Nursing and Allied Health and Health and Medical Collection (via ProQuest Central), Excerpta Medica dataBASE (Embase), PubMed, PsycINFO, and HeinOnline.


      Systematic screening of the search results and application of inclusion criteria resulted in the identification of 18 quantitative and three qualitative articles that were reviewed, summarised, and reported. Ten of the quantitative studies assessed knowledge and attitudes to law or end-of-life decision-making using hypothetical scenarios or vignettes. Qualitative studies focussed on how the law was applied when end-of-life decisions were made. End-of-life decision-making is mostly based on the clinical needs of the patient, with the law having a secondary role.


      Around the world, there are significant gaps in healthcare professionals’ legal knowledge. Clinical factors are considered more important to end-of-life decision-making than legal factors. End-of-life decision-making is perceived to carry legal risk, and this results in the provision of nonbeneficial end-of-life care. Further qualitative research is needed to ascertain the clinician-related factors that affect the integration of law with end-of-life decision-making.


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