Australian General Practitioners knowledge of end-of-life law

A blog post written by Dr. Marcus Sellars, Prof. Ben White, Prof. Patsy Yates and Prof. Lindy Willmott

It has been estimated over 75% of Australians will use aged care services before they die. Yet despite end-of-life care being core business in aged care, it is relatively common for people to receive end-of-life treatment that does not reflect their values, goals or informed choices.

Limited availability of specialty health services, including appropriate palliative care, paired with an ageing population has led to Australian General Practitioners (GPs) playing an increased role in end-of-life decision-making for people accessing aged care.

Although it can be complex, the law aims to support good medical practice at the end of life. It seeks to ensure a person’s legal rights are not infringed and to facilitate health care being given that is consistent with the resident's values and goals. However, for this to occur it is important that clinical staff involved in those decisions have knowledge of end-of-life law.

To inform the development of the End of Life Direction for Aged Care (ELDAC) Legal Toolkit, we surveyed 160 GPs from Queensland, New South Wales, and Victoria who currently worked in aged care to understand their perceived and actual knowledge of end-of-life law and experience with end-of-life care.

Overall, most doctors perceived their own knowledge of end-of-life law to be low and this was consistent with their actual knowledge of end-of-life law, with scores averaging low to moderate.

This was despite most GPs reporting involvement with experiences in their clinical practices that potentially engaged end-of-life law. Over three quarters of the survey respondents had made decisions about whether to withhold or withdraw life-sustaining treatment from adults who lack capacity and a similar proportion (75%) had experienced conflict with a substitute decision-maker or family member about treatment for a person with a life limiting illness.

One complexity in Australia is the key differences between the laws in the States and Territories, and this appeared to influence end-of-life law knowledge for the GPs in our study. In contrast to NSW and VIC, QLD law does not require clinicians to follow a valid advance care directive (a legal document that guides healthcare decision-making when a person is no longer able to speak for themselves) refusing life-sustaining treatment if that treatment is clinically indicated. However, according to their survey response, the majority of QLD GPs (61%) incorrectly believed this was a legal requirement to do so.

Findings from our study 'Knowledge of end-of-life law: A cross-sectional survey of general practitioners working in aged care' suggest that a greater understanding of the law amongst GPs may ensure aged care residents' rights are not infringed at end of life and are better aligned with their wishes. In addition, greater understanding of end-of-life law may also assist GPs to manage legal risk in their practice.

This study was undertaken as part of the ELDAC project which is funded by the Australian Government, Department of Health. The ELDAC Legal Toolkit aims to provide information, guidance and resources to Australian GPs working in the aged care sector regarding end-of-life law.

Dr. Marcus Sellars
Research Fellow
The Australian National University

Prof. Ben White
Professor of End-of-Life Law and Regulation and an Australian Research Council Future Fellow  in the Australian Centre for Health Law Research
Queensland University of Technology

Prof. Patsy Yates
Executive Dean of the Faculty of Health
Queensland University of Technology

Prof. Lindy Willmott
Professor of Law in the Australian Centre for Health Law Research
Queensland University of Technology