Eliana Close1, Malcolm Parker, Andrew Crowden, Lindy Willmott, Benjamin P White, Cindy Gallois, Nick Graves, Sarah Winch, Leonie Callaway
1Australian Centre For Health Law Research, QUT Faculty of Law, Brisbane, Australia
Context: Due to advances in medical technology, up to two-thirds of deaths in Western countries are now preceded by a decision to withhold or withdraw life-sustaining measures. A challenge of these decisions is how to address situations when a patient (or their substitute decision maker) requests treatment that doctors think is no longer warranted. The concept of “medical futility” is used to justify limiting treatment against a patient’s wishes. However, despite decades of debate about the concept, there is no universal definition of futility, raising concerns that it is an uncertain basis to justify unilateral action. These concerns have led to calls for medical policies to clarify terminology and provide procedural solutions to prevent and address disputes.
Aims: Australian medical futility policies are under-studied. This research sought to fill this gap by conducting a comprehensive audit of documents purporting to guide doctors’ decisions to limit life-sustaining treatment in adult patients. The central aim was to determine whether these policies provide sufficient guidance to promote transparent and collaborative decision making. Our analysis focused on: 1) the source and content of existing policies; 2) decision-making criteria; 3) guidance about the role of resources constraints; and 4) guidance about the decision-making process.
Key findings and implications: Australian policies on withholding and withdrawing life-sustaining treatment vary. While recent documents have paid more attention to the concept of futility, they use inconsistent terminology and definitions. Policies also vary in their scope and in strategies for managing conflict. This variation may foster confusion, leading to unfair and inconsistent decision making. There is a need for greater clarity in medical policies to improve transparency and consistency in end-of-life decisions, and to promote better dispute resolution.
Eliana Close is a PhD candidate with the Australian Centre for Health Law Research at QUT. Her doctorate emerged from the ARC Linkage Grant “Futile Treatment at the End of Life: Legal, Policy, Sociological and Economic Perspectives” and examines whether laws and policies distinguish between patient and societal interests in end-of-life decisions. Eliana has a BSc in Psychology (First Class Hons) from the University of Calgary and an MA in Law from Oxford University, where she was a Rhodes Scholar. Prior to her PhD she worked at Google, clerked for the Alberta Court of Appeal, and was a Crown Prosecutor.