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Resuscitation decisions at the end of life: Medical views and the juridification of practice

Lookup NU author(s): Dr Fiona MacCormick, Dr Paul Paes, Professor Julian Hughes

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Abstract

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. Background Concerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decisionmaking practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking. Aim To analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors. Design The data presented in this paper were collected as part of a wider research study of end-of-life care in an acute hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach. Results Discussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways. Conclusions This paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient's wishes and preferences. Recommendations for future research are made and legal ramifications are discussed.


Publication metadata

Author(s): MacCormick FMA, Emmett C, Paes P, Hughes JC

Publication type: Article

Publication status: Published

Journal: Journal of Medical Ethics

Year: 2018

Volume: 44

Issue: 6

Pages: 376-383

Print publication date: 01/06/2018

Online publication date: 09/03/2018

Acceptance date: 05/02/2018

ISSN (print): 0306-6800

ISSN (electronic): 1473-4257

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/medethics-2017-104608

DOI: 10.1136/medethics-2017-104608


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