Oral Presentation Australasian Association of Bioethics & Health Law and New Zealand Bioethics Conference

Balancing patient and societal interests in decisions about potentially life-sustaining treatment: An Australian policy analysis (1027)

Eliana Close 1 , Ben P White 1 , Lindy Willmott 1
  1. Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia

Decisions about withholding and withdrawing life-sustaining treatment are usually centered on the patient, with doctors making assessments about treatments that may be ‘futile’ or ‘non-beneficial’. However, in publicly-funded health systems such as Australia, these decisions are made against a backdrop of the need to use scarce health resources efficiently. A previous study we conducted indicated doctors who make end-of-life decisions are conflicted by being the ‘gatekeeper’ to treatment, and perceive a lack of adequate regulatory support for resource-based decisions. It also demonstrated that for some the concept of ‘futility’ is a mask for conscious and unconscious rationing, raising concerns about transparency. Medical policies (including codes of ethics and professional guidelines) are one mechanism that can promote fair and transparent processes to guide decision making and conflict resolution in this area, however, the Australian policy environment is under-studied.

This review of publicly-available policies on withholding and withdrawing life-sustaining treatment found that there is limited guidance about how to reconcile patient interests with distributive justice. Although the policies emphasise doctors’ obligations to be stewards of scarce resources, overall there is inadequate guidance about how to operationalise this in practice. End-of-life decision making would be enhanced by an Australian policy environment that has a greater emphasis on transparent decision making and more community engagement with the resource implications of these decisions.