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Resource limitations and End of Life decision making

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Approximately 30% of adults in Australia die after a decision to stop or not start potentially life-sustaining treatments, including mechanical ventilation, artificial nutrition and hydration, and CPR. While these decisions are a common part of mainstream medical practice, they raise practical, legal and ethical challenges. A central justification for withholding or withdrawing life-sustaining treatment is that it is ‘futile’ or ‘non-beneficial’. Yet what does ‘futile’ mean, and who decides what constitutes a benefit? When doctors recommend stopping treatment is this based solely on a patient’s best interests, or do they also take into account society’s scarce healthcare resources and whether these resources could be better used by other patients?

Eliana Close has published a paper with colleagues (Doctors’ perceptions of how resource limitations relate to futility in end of life decision making: a qualitative analysis), investigating the extent to which doctors perceive resource constraints influence decisions to forgo life-sustaining treatment. Doctors from across eleven different medical specialties in three hospitals in Brisbane had divergent views. Some believed resource constraints were never relevant (outside of extreme situations such as pandemics), but others thought fair resource allocation was always one of many relevant considerations. A few believed that the term ‘futile’ masks conscious or unconscious rationing, where resources are the sole basis for the decision. Doctors were frustrated by a lack of appropriate regulatory supports for the necessary resource allocation decisions they had to make.

The research underscores the need for improved laws and policies to promote more transparent rationing decisions and guidelines for communicating resource-based decisions to patients and their families.

About Eliana Close

Eliana CloseEliana Close recently submitted her PhD, which she conducted as part of the end of life stream in the Australian Centre for Health Law Research. She will take up a position as a Lecturer and Postdoctoral Research Fellow with the Faculty of Law in May 2020. A former Crown Prosecutor, Eliana is admitted as a Barrister and Solicitor in Alberta, Canada. For nearly a decade Eliana has been engaged in transdisciplinary research on end-of-life decision making in the critical care context. Eliana is also currently a member of the Queensland Children’s Hospital Clinical Ethics Consultation Service, which provides ethical consultation for treating teams and a collaborative forum for complex case discussions.

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