Not infrequently, doctors working in the Emergency Department (ED) have to decide on how they are to provide treatment to dying patients. Specifically, they have to decide whether to actively treat or whether they should limit or withdraw treatment on patients who are not anticipated to live. Such decisions should be governed by legislature as well as standards set by the Australian Council on Health Care Standards (ACHCS). However, research conducted in our hospital has indicated that doctors consider a wide variety of factors including patient’s and family’s wishes when making such end-of-life decisions. We therefore raise the following questions. First, what factors do doctors take into account when they withdraw or withhold treatment in the ED? Second, are such decisions made in accordance with legislative requirements? To date, no research has examined this issue.
This study addresses this gap by focussing on the decisions leading to withdrawal of treatment in the ED. It is a multi-centre review of patients who die in 2009 in a number of Australian and New Zealand hospitals. The primary aim is to describe the factors that doctors consider when making the decisions to withdraw or withhold life-sustaining treatment. The secondary aims are to determine 1) whether Australian doctors are conducting such processes in line with ACHCS guidelines and 2) whether Queensland doctors are making such decisions in accordance with Queensland legislation.
In a study of responses relating to the care of 320 patients, the team found that emergency registrars were more likely to withdraw/withhold life-sustaining healthcare, provide partial treatment, rate different considerations as important and their patients took longer to die than that of emergency physicians. Focused education and training might improve decision-making consistency between physicians and training registrars.
In a comparison of the process of withdrawing and/or withholding life-sustaining-health-care between Emergency Physicians and Intensive Care Specialists, the team found that the majority of deaths that occurred a decision was made to withdraw and/or withhold life sustaining health care. Intensive care specialists were more likely to provide full treatment and their patients died more quickly than emergency physicians. Few patients were referred to a palliative care service.
- Richardson PG, Widdecombe N, Mahmoud I., "End-of-Life-Issues: Withdrawal and/or Withholding of Life Sustaining Health Care: A Comparison between Emergency Physicians and Intensive Care Specialists", 'J Eme Med Int Care', 2016; 2(2): 111
- Richardson P.G., Greenslade J., Isoardi J., Davey M., Gillett M., Tucker A., Klim S., Kelly A., Mahmoud I., “End-of-Life-Issues: Withdrawal and withholding of life-sustaining healthcare: A Comparison between Emergency Physicians and emergency registrars: A sub-study”, 'Emerg Med Australas', 2016;28(6):684-690. doi: 10.1111/1742-6723.12684
Dr Philip Richardson
Dr Jaimi Greenslade
A/Prof Kevin Chu
Dr Jonathon Isoardi
Dr Michael Davey
Dr Mark Gillett
Dr Alicia Tucker
Ms Sharon Klim
Prof Anne-Maree Kelly
Dr Ibrahim Abdelmahmoud
Dr Neil Widdicombe