Professor Lindy Willmott
Associate Professor Ben White
Professor Colleen Cartwright
Professor Malcolm Parker
Professor Gail Williams
 ARC
Linkage Project:

‘Withholding and withdrawing Life-sustaining
treatment from Adults who Lack capacity: The
Role of Law in Medical Practice’

Seeking to find out about doctors’ knowledge
of the law, and the role law plays in medical
practice at the end of life

Survey of doctors in Qld, NSW and Victoria
 Legal
research and analysis
 Focus
groups in Qld, NSW and Victoria
 Develop
survey instrument
 Pre-pilot
 Pilot
 Eight

specialties
Emergency, geriatric, intensive, palliative,
oncology, renal, respiratory and general medicine
 12
specialists per category in each of Qld,
NSW and Victoria

Exception – palliative care physicians where 5
specialists per state were approached
 Total

n = 259 specialists
[8 surveys = return to sender]
 67



surveys returned
44 returned from first mail-out
17 returned from first follow-up
6 returned from second follow-up
 Overall
response rate of 26%
Self-Reported Specialty
Emergency Medicine
General medicine
Geriatric Medicine
Intensive Medicine
Oncology
Palliative Medicine
Renal Medicine
Respiratory Medicine
Other
Total
6
2
13
8
3
10
11
9
3
65
 Response



Qld = 26
NSW = 17
Vic = 24
 Response


by States
by gender
Male = 42
Female = 24
 Mean
age = 52
 13
6







pages long
sections
Section A: Your perspectives on the law
Section B: Education and training on the law
Section C: Your knowledge of [State] law
Section D: Your practice and the law in [State]
Section E: Your experience of the law in [State]
Section F: About you
Plus free text comments at end
 First

question
6 statements

True/false/I don’t know responses
 Second

question
Brief scenario


Asked a specific question about the scenario
Range of response options including ‘I don’t know’
 Mean
correct response overall = 2.76 (out of
possible score of 6)
 Correct



Qld = 2.46
NSW = 3.29
Vic = 2.71
 Correct

response by State
response by age
No significant difference
 Correct

Participants have reasonably good insight into
their level of knowledge
 Effect



of CPD training on law on WWLST
Receive training: mean = 3
No training: mean = 2.5
 ‘It

response by perceived knowledge
is not important for me to know the law’
Strongly agree: mean (knowledge) = 2
Strongly disagree: mean (knowledge) = 3
 Correct
response by specialty
Emergency Medicine
2.67
General medicine
2.00
Geriatric Medicine
3.08
Intensive Medicine
2.88
Oncology
3.67
Palliative Medicine
3.20
Renal Medicine
2.64
Respiratory Medicine
2.44
Other
2.33
 Which
of listed definitions best reflects your
understanding of futile treatment:
n (N=65)
%
Futile if has 0% chance
9
14%
Futile if cannot achieve acceptable quality
of life
Futile if either <1% chance success or no
acceptable quality of life
Futile if burdens outweigh benefit of
treatment
Futile if it will not benefit patient attaining
goal
2
3%
30
46%
18
28%
6
9%
 Other
definitions provided
“The treatment is unlikely to lead to a
reasonable outcome in a reasonable period of
time given the expenditure of reasonable
resources.”
 General
(but not universal) view that
assessment should be from the patient (or
family’s) perspective, not doctor’s
 ‘Futility’
setting
not particularly helpful in clinical
“The last 6-12 months of life for most
elderly people with chronic and irreversible
medical conditions, involve multiple long
hospital admissions (ICU) and “futile”
extensive investigations and treatment.
Most of this is done, mainly to protect the
medical professional from complaints from
families and legal fraternity. My pet dog
received more humane treatment and death
with dignity than most of my elderly
patients.”
 Concerns
about how advance directives work
in medical practice
 Complexity
and confusing nature of the law
 Time-consuming
if involve tribunal or public
officials
 Doctors
need training in the law
“If you act in the patient’s interest I didn’t
feel that the “law” got in the way
(sometimes lawyers did!)”
“Current legal environment is such that it
is far easier to treat than not (except
where there is an AHD). Contributor to
relentless and unsustainable health care
costs.”
 Law
doesn’t generally impinge on medical
practice if good communication
 Doctors need training in guiding patients and
carers through ‘end of life journey’
 Some concerns about nature of medical
practice at end of life
“Our medical and political culture positively
encourages doctors to play God, and to
normalise dangerously paternalistic
behaviour.”
 Trends
regarding law and EOL medical
practice




Law has a role to play in the practice of medicine
Many would like to know more about the law
Some significant knowledge gaps
Generally, insight into knowledge levels
 Difficult
to get specialists to respond to
surveys!




Removed ‘general medicine’ from sample
Significantly reduced the size of the survey
Professionally formatted
Developed a targeted recruitment strategy
 Australian
 Partner







Research Council
organisations
Queensland Civil and Administrative Tribunal
Office of the Adult Guardian (Qld)
Office of the Public Advocate (Qld)
New South Wales Guardianship Tribunal
New South Wales Trustee and Guardian (The Public
Guardian)
Victorian Civil and Administrative Tribunal
Office of the Public Advocate (Vic)