While doctors want to respect patient autonomy, many find it difficult to comply with the choices they have expressed in Advance Care Directives (ACD), an Australian study shows.
When faced with complex and often conflicting options in patient care, doctors tend to go with their clinical judgement and override an ACD, interviews with physicians at the Austin Hospital have revealed.
In response to vignettes of hypothetical end of life care decisions, doctors were motivated to act in what they considered to be the patient’s best interest, even if this meant direct contravention of their written instructions, according to study findings, published in in BMJ Open.
Most of the doctors expressed little concern about possible legal risks of their preference to override an ACD, saying they felt obliged to “err on the side of treatment.”
The research led by Advance Care Planning Australia, sought feedback on the real-life scenarios from 21 consultants and registrars in specialties including oncology, haematology, cardiology, gastroenterology and respiratory medicine.
One example was of a 65-year old man with ventricular fibrillation whose ACD included a “not for resuscitation” instruction that he be to allowed to “pass away in peace’ if it was unlikely he would recover to resume his daily routine of playing golf.
But many of the doctors said they would ignore this ACD instruction and likely provide urgent emergency treatment because the patient had a condition deemed to be potentially reversible.
Some doctors were reluctant to implement patients requests that they considered to be unreasonable, unusual or inconsistent with what a ‘normal’ person might want.