TREATMENT DECISION-MAKING AT THE END OF LIFE - A SURVEY OF AUSTRALIANDOCTORS ATTITUDES TOWARDS PATIENTS WISHES AND EUTHANASIA

Objective: To examine factors that influence medical practitioners' tr eatment decisions for patients with life-threatening or terminal illne sses. Design: Postal survey, conducted between September and November 1995, of a self-administered questionnaire, describing four clinical c ase scenarios, to a random sample of 2172 Australian doctors in all St ates and Territories. Respondents were asked to prescribe treatment fo r the patients described in the scenarios. Patients' characteristics v aried in terms of mental competence, illness severity, prognosis, the presence of advance directives, request for assisted death, and sociod emographic factors. The respondents' sociodemographic and medical trai ning characteristics were also obtained. Setting: Random national samp le of all active medical practitioners. Participants: Hospital trainee s, general practitioners, physicians, palliative care practitioners an d surgeons were surveyed. A response rate of 73% was achieved. Main ou tcome measures: Frequency of prescription of supportive, acute or inte nsive treatment for patients in the four clinical scenarios based on r espondents' sex, religion, medical training and country of medical deg ree. Results: Three main findings were: (i) doctors did not make consi stent decisions, but their decisions varied systematically by sociodem ographic and medical training factors; (ii) doctors generally adhered to patient and family wishes when these were known; (iii) doctors did not generally adhere to a patient's request for assisted death. Conclu sion: Treatment provided is significantly determined by the individual characteristics of the doctor and not solely by the nature of the med ical problem. Participation in the informed-consent process and in the preparation of advance health care directives would enable practition ers to be familiar with patient and family wishes and could reduce var iations of treatment related to sociodemographic and medical training factors. Stronger empirical data on the way that treatment decisions a re made could provide the basis for an informed euthanasia policy.