Advances in medical science have led to an attitude that death is, to some extent, avoidable — or can at least be postponed. But at what point does the provision of treatment become harmful for patients?
The issue of family is a particularly difficult one for healthcare providers. When it comes to end-of-life care, there is clear potential for a doctor's duty to their patient to conflict with the expectations of people who face losing a loved one. Doctors may feel pressure to persist with unnecessary treatment because they fear legal and other consequences.
A 2013 paper produced by the Australian Centre for Health Research, Monash University and the University of Melbourne investigated the problematic and sensitive issue of end-of-life care, and questioned our culture that views stopping treatment as a 'failure'. It also points to junior doctors in emergency care settings lacking the authority or experience to make difficult decisions about end-of-life treatment, and instead continuing treatment out of an adherence to policy or process, perhaps for fear of ramifications with their employers.
These issues point to a problem with rigid and arguably unresponsive treatment regimens being applied to a highly sensitive and emotive situation. It's obviously a difficult situation for patients and their families, but also for doctors who are asked to walk a tightrope between their duties, hospital policies and family expectations.
The importance of end-of-life planning
As a firm, one thing we always emphasise — particularly to those people who may be suffering from a terminal illness — is that planning your end-of-life care and ensuring that you have appointed a medical power of attorney to act on your behalf is important for maintaining a sense of control: without a plan in place, you may not have control over your own circumstances, something which may understandably be very distressing. It's therefore in everyone's best interests to plan ahead.
In the event that a loved one has not appointed a medical power of attorney, the first approach for the family and the hospitals is to plan for care as collaboratively as possible. In rare circumstances, where there is a disagreement — for example, a hospital has decided that there is little point in continuing treatment — a family may head to the courts to seek an order to continue treatment. Conversely, it can be difficult for a family to convince the hospital to withdraw treatment if the hospital believes that treatment is still required.
These situations reinforce the need for a clear plan. While patients are still competent, they can work with hospitals to develop an Advance Care Directive, which is a plan that will discuss how much care the patient would like towards the end of their life and when to withdraw treatment.
To properly understand the issues around effective end-of-life treatment and planning, we need to look at our own attitudes as a community. For a lot of us, death has become a relatively unknown or infrequent event. While we’re all grateful for this, it has also led to death becoming a somewhat more remote idea than perhaps it should, which makes it much harder to accept when it finally arrives.
Perhaps it's time for a new debate, and examination of attitudes and guidelines for treatment. Treatment may not always be in a patient's best interests and may even lead to unnecessary suffering and loss of dignity. A more sensitive and responsive approach from everyone involved would clearly be beneficial, and help maintain peace of mind during what is usually a very difficult time.
Tom Ballantyne is a senior associate in Maurice Blackburn’s Melbourne office.