Findings from a Queensland coronial inquest highlight the complex clinical, ethical and legal issues that arise in end-of-life care when clinicians and family members disagree about a diagnosis of clinical futility.
The tension between the law and best medical practice is highlighted in this case, as doctors are compelled to seek family consent to not commence a futile intervention.
Good communication between doctors and families, as well as community and professional education, is essential to resolve tensions that can arise when there is disagreement about treatment at the end of life.
- 1. Barnes M, State Coroner. Inquest into the death of June Woo (COR 2713/02). Brisbane: Queensland Coroner’s Court, 1 Jun 2009. http://www.courts.qld.gov.au/__data/assets/pdf_file/0003/131961/cif-woo-j-20090601.pdf (accessed Jan 2012).
- 2. White B, Willmott L. Issue 11: A requirement to provide futile treatment? In: Rethinking life-sustaining measures: questions for Queensland. Brisbane: Queensland University of Technology, 2005: 69-72. http://eprints.qut.edu.au/7093/1/7093_1.pdf (accessed Jan 2012).
- 3. Queensland Health. Quick guide to completing an Acute Resuscitation Plan (ARP). http://apps.health.qld.gov.au/acp/Public_Section/pdf_QuickGuide.pdf (accessed Jan 2012).
- 4. Murphy BF. What has happened to clinical leadership in futile care discussions? Med J Aust 2008; 188: 418-419. <MJA full text>
- 5. Holley CK, Mast BT. The impact of anticipatory grief on caregiver burden in dementia caregivers. Gerontologist 2009; 49: 388-396.
- 6. Weissman DE. Decision making at a time of crisis near the end of life. JAMA 2004; 292: 1738-1743.
- 7. Meltzer LS, Huckabay LM. Critical care nurses’ perceptions of futile care and its effect on burnout. Am J Crit Care 2004; 13: 202-208.
- 8. Ferrell BR. Understanding the moral distress of nurses witnessing medically futile care. Oncol Nurs Forum 2006; 33: 922-930.
- 9. Schluter J, Winch S, Holzhauser K, Henderson A. Nurses’ moral sensitivity and hospital ethical climate: a literature review. Nurs Ethics 2008; 15: 304-321.
- 10. Marco CA, Bessman ES, Kelen GD. Ethical issues of cardiopulmonary resuscitation: comparison of emergency physician practices from 1995 to 2007. Acad Emerg Med 2009; 16: 270-273.
- 11. Parker M. Futile choices: Wooing doctors to acknowledge the law in Queensland. J Law Med 2010; 18: 32-37.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.