Withholding and withdrawing life-sustaining medical treatment from adults who lack capacity: The role of law in medical practice: Final report 2017

Decisions to withhold or withdraw life-sustaining treatment (WWLST) are a necessary and legitimate part of mainstream medical practice in Australia and precede almost 40,000 adult deaths each year1. Such decisions can only be lawful if made under certain conditions. Yet, despite the significance and frequency of these decisions, there is little evidence about whether or not doctors know and comply with the law when deciding to stop providing, or not to provide, life-sustaining treatment. An unlawful decision in this context has grave consequences for both the medical practitioners themselves and for their patients: ending life, and exposing doctors and their employers to criminal and civil sanctions. Despite this, it is likely that doctors sometimes do not comply with the law, partly because the law is complex and ambiguous1-5 but also from lack of awareness of their legal duties.

The role of doctors in WWLST decisions is legally significant: guardianship legislation may grant them power to be a decision-maker (e.g., in an emergency) or to supervise decisions made by others; they make choices to limit treatment options; and they give information about the lawful decision-making process to be followed.

This study sought to understand the role of law in medical decision-making and to determine doctors’ legal awareness, identify training needs, and find ways to improve the law. Lawful decision-making is already a key issue and will become even more important with Australia’s ageing population and medical advances prolonging the lives of very ill patients. The study was motivated by concerns that doctors’ lack of knowledge and the inadequacy of the law could lead to unlawful decisions to WWLST. There was evidence of non-compliance in legally reported cases6 and a gap in the evidence base because the nature and extent of the problem had not been rigorously investigated. In this context, not only are patients’ lives and liberties at stake, but doctors and their employers (including governments) have a vital interest in ensuring best practice that is both lawful and medically sound. These legal, medical and moral interests made the need for this research compelling.

The study explored knowledge of medical practitioners in Queensland, New South Wales and Victoria about the law with respect to WWLST from adult patients who have lost capacity. It was carried out by a multi-disciplinary team of researchers from the Queensland University of Technology, Southern Cross University and the University of Queensland.

White B, Willmott L, Cartwright C, Parker M, Williams G. Withholding and withdrawing life-sustaining medical treatment from adults who lack capacity: The role of law in medical practice: Final report 2017 (570kb pdf). Brisbane: Queensland University of Technology; 2017.

© White, Willmott, Cartwright, Parker & Williams