Emergency department and intensive care unit health professionals' knowledge and application of the law that applies to end-of-life decision-making for adults: A scoping review of the literature

Jayne Hewitt; Nemat Alsaba; Katya May; Halima Sadia Noon; Cooper Rennie; Andrea P Marshall

doi:10.1016/j.aucc.2022.08.002

Emergency department and intensive care unit health professionals' knowledge and application of the law that applies to end-of-life decision-making for adults: A scoping review of the literature

Aust Crit Care. 2023 Jul;36(4):628-639. doi: 10.1016/j.aucc.2022.08.002. Epub 2022 Sep 10.

Authors

Jayne Hewitt¹, Nemat Alsaba², Katya May³, Halima Sadia Noon⁴, Cooper Rennie⁵, Andrea P Marshall⁶

Affiliations

¹ Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia; Griffith University, Griffith Law School, Law Futures Centre, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia; Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia. Electronic address: j.hewitt@griffith.edu.au.
² Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia; Bond University, Faculty of Health Science and Medicine, 14 University Drive, Robina, Queensland, 4226, Australia. Electronic address: nalsaba@bond.edu.au.
³ Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia; Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia. Electronic address: katyamayphd@gmail.com.
⁴ Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia; James Cook University, College of Medicine and Dentistry, 1 James Cook Drive, Douglas, Townsville, Queensland, 4810, Australia. Electronic address: Halima.noon@my.jcu.edu.au.
⁵ Griffith University, School of Medical Science, Nathan Campus, 170 Kessels Rd, Nathan, Queensland 4111, Australia. Electronic address: Cooper.rennie@griffithuni.edu.au.
⁶ Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia; Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia. Electronic address: a.marshall@griffith.edu.au.

PMID: 36096921
DOI: 10.1016/j.aucc.2022.08.002

Abstract

Background: Laws that regulate healthcare practice at the end of life reflect the values of the society where they apply. Traditionally, healthcare professionals rely on their clinical knowledge to inform treatment decisions, but the extent to which the law also informs health professionals' decision-making at the end of life is uncertain.

Objective: The objective of this study was to describe what healthcare professionals working in emergency departments and intensive care units know about the law that relates to end-of-life decision-making for hospitalised adults and what affects its application.

Review method: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

Data sources: Data were sourced by searching the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL [via EBSCOhost]), Nursing and Allied Health and Health and Medical Collection (via ProQuest Central), Excerpta Medica dataBASE (Embase), PubMed, PsycINFO, and HeinOnline.

Results: Systematic screening of the search results and application of inclusion criteria resulted in the identification of 18 quantitative and three qualitative articles that were reviewed, summarised, and reported. Ten of the quantitative studies assessed knowledge and attitudes to law or end-of-life decision-making using hypothetical scenarios or vignettes. Qualitative studies focussed on how the law was applied when end-of-life decisions were made. End-of-life decision-making is mostly based on the clinical needs of the patient, with the law having a secondary role.

Conclusion: Around the world, there are significant gaps in healthcare professionals' legal knowledge. Clinical factors are considered more important to end-of-life decision-making than legal factors. End-of-life decision-making is perceived to carry legal risk, and this results in the provision of nonbeneficial end-of-life care. Further qualitative research is needed to ascertain the clinician-related factors that affect the integration of law with end-of-life decision-making.

Keywords: Decision-making; Emergency department; End of life; Intensive care unit; Law.

Publication types

Review

MeSH terms

Adult
Death
Emergency Service, Hospital
Health Personnel*
Humans
Intensive Care Units
Terminal Care*