‘Can a relative override a patient’s Advance Care Directive?’: end-of-life legal worries of general practitioners and nurses working in aged care

Ben White; Rachel Feeney; Marcus Sellars; Penny Neller; Patsy Yates; Lindy Willmott

doi:10.1071/PY23213

RESEARCH ARTICLE (Open Access)

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‘Can a relative override a patient’s Advance Care Directive?’: end-of-life legal worries of general practitioners and nurses working in aged care

Ben White ^A , Rachel Feeney

^A ^* , Marcus Sellars ^A ^C , Penny Neller ^A , Patsy Yates ^B and Lindy Willmott ^A

+ Author Affiliations

- Author Affiliations

^A Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Qld, Australia.

^B Faculty of Health, Office of the Executive Dean, Queensland University of Technology, Brisbane, Qld, Australia.

^C Present address: Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, Canberra, ACT, Australia.

^* Correspondence to: rachel.feeney@qut.edu.au

Australian Journal of Primary Health 30, PY23213 https://doi.org/10.1071/PY23213

Submitted: 12 December 2023 Accepted: 31 January 2024 Published: 15 February 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY)

Abstract

Background

This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting.

Methods

An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken.

Results

Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death.

Conclusions

Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce.

Keywords: Advance Care Planning, aged, end-of-life care, general practitioners, health law, medical law, nurses, palliative care.

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