Australian patients are at risk of being killed or saved when they do not want to by doctors who do not understand laws regarding the withholding and withdrawing of life-sustaining medical treatment, research suggests.
A survey completed by 867 doctors in Victoria, NSW and Queensland in 2012 and 2013 found ‘‘critical gaps’’ in their legal knowledge that could expose them to criminal charges including murder, manslaughter or assault if they act against a patient's wishes.
A report on the survey, published in the Medical Journal of Australia on Monday, said on average doctors correctly responded to three out of seven questions about laws regarding end-of-life care. The questions covered the validity of advance directives and consent from and the authority of substitute decision makers. Participants included doctors who specialise in geriatrics, intensive care, oncology, palliative care, kidney, respiratory and emergency medicine.
‘‘Our findings strongly suggest that doctors in a speciality involving end-of-life decision making should improve their knowledge of the law, in the interests of their patients and for their own protection,’’ wrote the authors from the University of Technology in Queensland, Southern Cross University and University of Queensland.
The researchers, led by Professor Ben White, director of the Australian Centre for Health Law Research, said almost 40,000 adult deaths occur each year across Australia following a medical decision to withhold or withdraw life-sustaining treatment.
Doctors play a critical clinical and legal role in the provision of medical treatment at the end of life. For example, a doctor must assess whether a patient has the capacity to make a treatment decision, determine who the authorised decision maker is if the patient does not have the capacity, and know whether a person’s previously expressed wishes comprise a valid advance directive that must be followed.
The researchers said failure to comply with the various state and territory laws relating to these matters could have significant consequences for patients who could have their lives ended wrongly through unlawfully withheld or withdrawn treatment.
‘‘Conversely, life-sustaining treatment may be unlawfully provided; for example, despite a lawful refusal of treatment through an advance directive or by a substitute decision maker. This may infringe a patient’s legal right to bodily integrity, and cause patients to survive with poor quality of life, which they had sought to avoid.’’
‘‘For medical professionals, criminal responsibility could arise for murder or manslaughter (where treatment is withheld or withdrawn unlawfully) or for assault (where treatment is provided without appropriate consent or authorisation).’’
The researchers called for more uniform laws across Australia to make it easier for doctors to be educated about them. But for the moment, they said a lack of knowledge would not excuse doctors from liability.
‘‘Claims of civil liability may also flow from such actions, along with disciplinary or coronial proceedings,’’ they wrote.
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