Abstract
Background
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.
Objective
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.
Results
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.
Conclusion
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Australian Critical CareAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- What can we do to help Australians die the way they want to?.Med J Aust. 2015; 202: 10-11
- Review article: end-of-life care for older people in the emergency department: a scoping review.Emerg Med Australasia (EMA). 2020; 32: 7-19
- Health-services utilisation amongst older persons during the last year of life: a population-based study.BMC Geriatr. 2018; 18: 1-8
- They shouldn't be coming to the ED, should they?": a descriptive service evaluation of why patients with palliative care needs present to the emergency department.Am J Hosp Palliat Care. 2017; 34: 984-990
Society of Critical Care Medicine. Critical Care Statistics [Internet] Illinois: [cited 2022 May 25]. Available from: https://www.sccm.org/Communications/Critical-Care-Statistics.
- Variations in end-of-life practices in intensive care units worldwide (Ethicus-2): a prospective observational study.Lancet Respir Med. 2021 Oct 1; 9: 1101-1110
- Delirium in critical illness: clinical manifestations, outcomes, and management.Intensive Care Med. 2021; 47: 1089-1103
- Is there a role for law in medical practice when withholding and withdrawing life-sustaining medical treatment? Empirical findings on attitudes of doctors.J Law Med. 2016; 24: 342-355
- Medical Treatment Planning and Decisions Act. X, 2016 (Vic)
- The ten barriers to appropriate management of patients at the end of their life.Intensive Care Med. 2015; 41: 1700-1702
- The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment: Part 1 (New South Wales).J Law Med. 2011; 18: 498-522
- Australian doctors' knowledge of and compliance with the law relating to end-of-life decisions: implications for LGBTI patients.Cult Health Sex. 2018; 20: 845-857
- Nurses' knowledge of the law at the end of life and implications for practice: a qualitative study.Palliat Med. 2020; 34: 524-532
- Disagreement between clinicians and score in decision-making capacity of critically ill patients.Crit Care Med. 2019 Mar 1; 47: 337-344
- A scoping review on the conduct and reporting of scoping reviews.BMC Med Res Methodol. 2016; 16: 1-10https://doi.org/10.1186/s12874-016-0116-4
- Updated methodological guidance for the conduct of scoping reviews.JBI Evid Synth. 2020; 18: 2119-2126
- Rayyan: a web and mobile app for systematic reviews.Syst Rev. 2016; 5: 1-10https://doi.org/10.1186/s13643-016-0384-4
- Excel, version Office 365 [computer program]. Microsoft Corp., Redmond, WA2019
- Medical education and law: withholding/withdrawing treatment from adults without capacity.Intern Med J. 2015; 45: 634-640
- Doctors' knowledge of the law on withholding and withdrawing life-sustaining medical treatment.Med J Aust. 2014; 201: 229-232
- The role of law in decisions to withhold and withdraw life-sustaining treatment from adults who lack capacity: a cross-sectional study.J Med Ethics. 2017; 43: 327-333
- Emergency healthcare providers' knowledge about and attitudes toward advance directives: a cross-sectional study between nurses and emergency medical technicians at an emergency department.Int J Environ Res Publ Health. 2021; 18: 1158-1169
- Factors influencing decisions to withdraw or continue life support and attitudes towards treatment of the critically ill: a survey of registered nurses in intensive care units.Proc Singapore Healthc. 2011; 20: 181-189
- An interprofessional process for the limitation of life-sustaining treatments at the end of life in France.J Pain Symptom Manag. 2022; 63: 160-170
- End of life in the intensive care unit: should French law be adapted?.Ann Intensive Care. 2014; 4: 6-11
- The impact of the Rasouli decision: a survey of Canadian intensivists.J Med Ethics. 2016; 42: 180-185
- Medical practitioners' knowledge and self-reported practices of substitute decision making and implementation of advance care plans.Intern Med J. 2014; 44: 234-239
- Association between education in EOL care and variability in EOL practice: a survey of ICU physicians.Intensive Care Med. 2012; 38: 404-412
- Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia.JAMA Intern Med. 2015; 175: 363-371
- Emergency clinicians' attitudes and decisions in patient scenarios involving advance directives.Emerg Med J. 2012; 29: 720-724
- Attitudes and practices regarding resuscitation in emergency departments in Trinidad and Tobago.Emerg Med J. 2014; 31: 889-893
- Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: a survey study from Turkey.PLoS One. 2020; 15e0232743
- Development and validation of a questionnaire investigating the knowledge, attitudes and practices of healthcare workers in the field of anesthesiology concerning the Italian law on advance healthcare directives: a pilot study.Acta Biomed. 2021; 92e2021092
- Decisions that hasten death: double effect and the experiences of physicians in Australia.BMC Med Ethics. 2014; 15: 26-40https://doi.org/10.1186/1472-6939-15-26
- Making decisions about artificial ventilation at the end of life: does law affect medical practice?.Elder Law J. 2017; 24: 293-366
- End-of-life decisions in Hungarian intensive care units.Anaesth Intensive Care. 2011; 39: 116-121
- Attitude of the Macedonian intensivists regarding withdrawal of therapy in intensive care patients: curriculum for policy development.Med Arh. 2011; 65: 339-342
- Forgoing life-sustaining treatment: a comparative analysis of regulations in Japan, Korea, Taiwan, and England.BMC Med Ethics. 2020; 21: 1-15https://doi.org/10.1186/s12910-020-00535-w
- A national study of life-sustaining treatments in South Korea: what factors affect decision-making?.Cancer Res Treat. 2021; 53: 593-600
- Physician understanding and application of surrogate decision-making laws in clinical practice.AJOB Empir Bioeth. 2017; 8: 198-204
- Reasons doctors provide futile treatment at the end of life: a qualitative study.J Med Ethics. 2016; 42: 496-503
- Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians.J Med Ethics. 2012; 38: 540-545
- Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem.Int J Qual Health Care. 2016; 28: 456-469
- Understanding experiences of moral distress in end-of-life care among US and UK physician trainees: a comparative qualitative study.J Gen Intern Med. 2021; 36: 1890-1897
- Evolution and innovation in guardianship laws: assisted decision-making.Syd Law Rev. 2013; 35: 133-166
- Patient-centred care as an approach to improving health care in Australia.Collegian. 2018; 25: 119-123
- Crossing the quality chasm: a new health system for the 21st century.The National Academies Press, Washington, DC2001: 360
- Patient-centredness: a conceptual framework and review of the empirical literature.Soc Sci Med. 2000; 51: 1087-1110
- Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making.Patient Educ Counsel. 2014; 94: 291-309
- Law as clinical evidence: a new constitutive model of medical education and decision-Making.J bioeth Inq. 2018; 15: 101-109
- Critical care nurses' experiences of withdrawal of treatment: a systematic review of qualitative evidence.Int J Nurs Stud. 2018 Jan 1; 77: 15-26
Article info
Publication history
Published online: September 09, 2022
Accepted:
August 7,
2022
Received in revised form:
August 1,
2022
Received:
March 8,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
