Journal
JOURNAL OF MEDICAL ETHICS
Volume 45, Issue 6, Pages 373-379Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/medethics-2018-105199
Keywords
medical futility; resource allocation; health care rationing; clinical decision-making; withholding treatment
Funding
- Australian Research Council Linkage Projects scheme [LP121000096]
- Royal Brisbane and Women's Hospital
- Australian Government Research Training Program Scholarship
- National Health and Medical Research Council Centre of Research Excellence in End-of-Life Care Top-Up Scholarship
Ask authors/readers for more resources
Objective To increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility. Setting Three tertiary hospitals in metropolitan Brisbane, Australia. Design Qualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic analysis. Results Doctors' perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing. Conclusions Doctors' ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors' role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available