Navigating the legal landscape of end-of-life care: the role of paramedics
An article written by Dr Rachel Feeney, Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology
Paramedics are increasingly recognised as essential contributors to end-of-life care, often supporting patients approaching the end of their lives. They play a vital role in end-of-life care by managing acute health issues, providing pain and symptom relief, and supporting patients at home to reduce unnecessary hospital admissions.
The law provides a comprehensive framework for end-of-life decision-making, including regulation of life-sustaining and palliative treatments, and determining who can make healthcare decisions and under what conditions. It also outlines processes for resolving disputes and offers legal protection to health professionals who act within its boundaries. The laws vary across Australian states and territories and depend on factors such as the patient’s age and decision-making capacity. Non-binding guidelines and ethical standards further shape paramedic practice in end-of-life care.
Although end-of-life law is complex, there has been limited focused analysis of the specific legal issues relevant to paramedics in Australia. As paramedics take on a greater role in end-of-life care, understanding the legal dimensions of their practice is crucial.
A recent scoping review [1] examined the literature on legal issues in end-of-life care for Australian paramedics. It is hoped that the findings of this review will assist paramedics to navigate the challenging legal issues that can arise with end-of-life decision-making.
Study summary and findings
The review identified 22 documents through searches of electronic databases, Google Scholar, professional organisations, State/Territory health department websites, reference lists, and the review authors’ existing knowledge. These included 16 policy-based resources - such as clinical practice guidelines from State and Territory Ambulance Services and Health Departments - and six scholarly works. The high number of policy documents reflects the volume produced by state-run ambulance services. All documents primarily focused on adult clinical practice. Nearly half included some discussion of legal issues in paediatric care, but only one focused specifically on this topic.
The documents varied in focus, from outlining the role of law in clinical decision-making to presenting empirical research and offering practical legal guidance. Some contextualised legal issues within end-of-life care, while others addressed them more generally. Common legal issues were consent to treatment, decision-making capacity, withholding and withdrawing life-sustaining treatment, advance care planning, substitute decision-making and urgent treatment.
The literature lacked comprehensive coverage in some significant areas. There was limited guidance on paediatric end-of-life care and voluntary assisted dying. Additionally, not all jurisdictions have clinical practice guidelines for managing palliative care patients, and not all existing guidelines address legal issues. These gaps highlight the need for more comprehensive, jurisdiction-specific resources on some legal topics.
Moving forward: strengthening legal awareness
Paramedics need a sound understanding of the legal frameworks that shape their clinical decisions - particularly in end-of-life care. This includes knowing that the law is relevant to their end-of-life clinical practice, recognising what the relevant legal issues are, and understanding broad legal principles that apply to their clinical practice.
To support this, the review recommends further development of targeted policies on end-of-life care, including discussion of the relevant law. More detailed guidance is also needed on the legal aspects of end-of-life decision-making for children. Additionally, paramedics require clarity on voluntary assisted dying in jurisdictions where such guidance is currently lacking.
A strong foundation of research and policy guidance is essential to equip paramedics with the knowledge and confidence to deliver legally sound, compassionate care at the end of life. Enhanced legal education is also needed. One example is the federally funded End of Life Law for Clinicians (ELLC) program - a free training initiative designed to build knowledge and confidence in navigating the legal aspects of end-of-life practice for paramedics and other health professionals.
References
1. Feeney R, Willmott L, White B. Legal issues in end-of-life care for paramedics: A scoping review. J Law Med. 2025;31(4):721-742.
Authors
Dr Rachel Feeney
Research Fellow - Australian Centre for Health Law Research
Queensland University of Technology