Journal article

Intensive care specialists’ knowledge, attitudes and practice relating to the law about withholding and withdrawing life-sustaining treatment: a cross-sectional study

Health Law Euthanasia health law Medical law guardianship Withholding life-sustaining treatment Intensive care Compliance with law End of life decision making Australia

Objective: Decisions about life-sustaining treatment from adults who lack capacity are an integral part of intensive care (IC) practice. This paper compares Intensivists with six other specialties most often involved in end-of-life care as to their knowledge, attitudes and practice in relation to the law in this area.

Design: Cross-sectional postal survey of medical specialists.

Setting: Three largest Australian states by population.

Participants: 867 medical specialists from seven specialties most likely to be involved in end-of-life decision-making in the acute setting (emergency, geriatric, palliative, renal and respiratory medicine, medical oncology, and intensive care).

Main outcome measures: Attitudes to, and knowledge and practice of, law at the end of life.

Results: 867/2702 eligible completed questionnaires were returned, an overall response rate of 32% with an IC response rate also of 32% (125 from 388). Intensivists performed above average in terms of legal knowledge but important knowledge gaps remain. Intensivists had a more negative attitude to the role of law in this area than other specialty groups but reported being seen as a leading source of information about legal issues by other medical specialists and nurses. Intensivists also reported as being the specialty most frequently making decisions about end-of-life treatment.

Conclusions: Improved legal knowledge and open engagement with law can help manage the risk of harm to patients and to protect Intensivists from liability. IC guidelines and continuing professional development are important strategies to address these concerns.

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