A conversation on TED.com: When it comes to end of life care in hospitals, who should have the final say?

Ben Maudlin
Bondi Beach, Sydney
Australia

Registered Nurse, Prince of Wales Hospital

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When it comes to end of life care in hospitals, who should have the final say?

A patient has the right to refuse medical treatment. This can be problematic as it goes against the traditional role of healthcare professionals to enact interventions to save life. This becomes even more so the case when it comes to decision making around end of life care and the withdrawal of treatment (Staunton and Chiarella, 2007). Decisions related to this are not only difficult, but also can become both legally and ethically ambiguous.

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Elizabeth Albuquerque
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Dec 17 2011: I think at times, coercing people to take treatment might do more harm than good. There are cases where patients would attempt to sabotage hospital attempts to keep them alive, such as starve themselves, and a cycle goes on where treatment becomes dangerous. I think a general rule cannot always do this issue justice, and one has to look at the situation to truly decide. However, I am aware of the living will system in the U.S., and many seem to be in consensus about using it.
Colleen Steen 200+
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Nov 28 2011: With a "Living Will" or "Advance Directives for Health Care", the patient has the final say for health care issues. I believe both of these forms are available on line, and/or from advocates for the aging (Agency on Aging), and are honored in all areas of the USA.

Ben, are you sure there is no "Advance Directives for Health Care" in Australia? If not, it may be something you can get started, because it relieves everyone (patient, family and medical professionals) from making last minute unwanted decisions. It's also good to fill out these forms with the patient and family so everyone is on the same page regarding the patients wishes. Copies of the final document can be distributed to all concerned parties...primary doctor, hospitals in the area, family members...etc. etc.
- Ben Maudlin
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  Nov 28 2011: We do have such things, but the problem is that they aren't legally binding and often leave too much room for interpretation. If someone says they are not for resuscitation but not for ventilation and then they require ventilation for an unseen complication things get tricky. Or patients request to have medical treatment withdrawn if they reach a certain point such as brain death. But if they are in a vegetative state and there is no chance of recovery. I believe this has something to do with our legal system over here. I would love to be corrected, but from my experience, the doctor has final say. The advance care directive is taken into consideration but the final decision is medical.
  - Colleen Steen 200+
    
    +1
    Nov 28 2011: Wow...that's too bad. Here (USA) they ARE legally binding, and they are pretty clear, without much room for interpretation. There's not even much use in having advance medical directives if everyone is going to ignore it!!! There's a project for you Ben...if what you are saying is true...work on changing the system in Australia:>)
    - Ben Maudlin
      
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      Nov 29 2011: I will try my best but it involves changing the entire legal system because we have a common law system. Rather than the American style of legal system based legislation rather than president. But there is always a way to petition change and invoke other to help support this change!
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- Ben Maudlin
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  Nov 28 2011: I know, However, in Australia the decision to withdraw treatment is ultimately a medical one, made by a doctor rather than the patient