Balancing Patient and Societal Interests in Decisions About Potentially Life-Sustaining Treatment
- PDF / 495,738 Bytes
- 15 Pages / 547.087 x 737.008 pts Page_size
- 12 Downloads / 126 Views
ORIGINAL RESEARCH
Balancing Patient and Societal Interests in Decisions About Potentially Life-Sustaining Treatment An Australian Policy Analysis Eliana Close
&
Ben P. White & Lindy Willmott
Received: 24 November 2019 / Accepted: 15 July 2020 / Published online: 22 September 2020 # Journal of Bioethical Inquiry Pty Ltd. 2020
Abstract Background This paper investigates the content of Australian policies that address withholding or withdrawing life-sustaining treatment to analyse the guidance they provide to doctors about the allocation of resources. Methods All publicly available non-institutional policies on withholding and withdrawing life-sustaining treatment were identified, including codes of conduct and government and professional organization guidelines. The policies that referred to resource allocation were isolated and analysed using qualitative thematic analysis. Eight Australian policies addressed both withholding and withdrawing life-sustaining treatment and resource allocation. Results Four resource-related themes were identified: (1) doctors’ ethical duties to consider resource allocation; (2) balancing ethical obligations to patient and society; (3) fair process and transparent resource
allocation; and (4) legal guidance on distributive justice as a rationale to limit life-sustaining treatment. Conclusion Of the policies that addressed resource allocation, this review found broad agreement about the existence of doctors’ duties to consider the stewardship of scarce resources in decision-making. However, there was disparity in the guidance about how to reconcile competing duties to patient and society. There is a need to better address the difficult and confronting issue of the role of scarce resources in decisions about lifesustaining treatment.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11673-020-09994-7) contains supplementary material, which is available to authorized users.
In response to recent high-profile disputes, clinicians and ethicists have argued that limited medical resources are relevant to decisions to withhold or withdraw lifesustaining treatment (Truog 2017; Wilkinson and Savulescu 2019), a view shared by some members of the public (Brick et al. 2019). Although most doctorinitiated decisions to limit life-sustaining treatment are based on the rationale that ongoing active treatment is “futile” or “non-beneficial” (and therefore not in the patient’s best interests), distributive justice affords a distinct ethical justification for non-treatment, particularly in publicly funded healthcare systems (Truog 2017; Wilkinson and Savulescu 2019). Interventions at
E. Close (*) : B. P. White : L. Willmott Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, 2 George St, Brisbane, Queensland 4000, Australia e-mail: [email protected]
B. P. White e-mail: [email protected] L. Willmott e-mail: [email protected]
Keywords Medical futility . End-of-life care . Clinical decision-making . He
Data Loading...
