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Free education for health clinicians about end of life law in Australia

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Professor Ben White, Queensland University of Technology

“Not knowing the law can create problems for care provided to patients and their families.”

 A free national training program for clinicians and medical students to learn about end of life law in Australia has launched today. End of Life Law for Clinicians (ELLC) aims to support clinicians with this legal knowledge and caring for patients at the end of life.

Professor of law at Queensland University of Technology (QUT) and a member of QUT’s Australian Centre for Health Law Research, Professor Ben White spoke to Palliative Matters about the new training program and the importance of educating clinicians and medical students about end of life law.

“The training program aims to improve clinicians’ knowledge and awareness of end of life law, and enhance their capacity to manage legal issues in end of life decision-making.

“We hope that the training will enable clinicians to improve their legal knowledge and application of the law in practice, and will help them support their patients, and patients’ families at the end of life,” Professor White said. 

Designed for medical specialists and trainees, junior doctors and medical students, the training was refined after user testing with clinician focus groups.

“From our research, and consultations with clinicians and stakeholders, we identified areas of end of life law that clinicians are most likely to encounter in end of life practice. These include consent and decision-making capacity, Advance Care Planning, withholding and withdrawing treatment, substitute decision-making and providing palliative medication.

The program, funded by the Australian Department of Health under its National Palliative Care Projects initiative, comprises online training modules and national workshops which clarify the law that applies to end of life decision-making.

“Not knowing the law can create problems for care provided to patients and their families. For example, it can lead to treatment being wrongly removed or wrongly given, inadequate pain relief being provided due to legal concerns, and clinical practice that is inconsistent with individuals’ wishes.

“Gaps in legal knowledge also creates risks for clinicians including not following the law, with the potential for civil liability or criminal prosecution. It can lead to doctors practising defensive medicine, and under-palliation of patients. It can also result in poor doctor-patient communication and conflict with patients’ and families, or substitute decision-makers,” Professor White said.

ELLC was developed in in response to findings from earlier empirical research into doctors’ knowledge of the law on withholding and withdrawing life-sustaining medical treatment. The research undertaken by White and Willmott at QUT with colleagues the University of Queensland and Southern Cross University, surveyed doctors from seven specialties in Victoria, New South Wales and Queensland.

 “The results (published in the Medical Journal of Australia in 2014) revealed significant legal knowledge gaps, including uncertainty about how to determine whether an Advance Care Directive is valid, or whether or not to follow a Directive that refuses treatment in cases where treatment is clinically indicated.

“Encouragingly, the survey also revealed strong agreement that the law has a place in medical practice and decision-making, and most respondents were interested in knowing more about the law. This combination of an identified need with an interest in knowing more about law in this area was the impetus for us to develop the training program,” Professor White said.

“The online training modules also address the differences in the laws in all 8 Australian jurisdictions through End of Life Law in Australia, a resource we developed for health professionals and the broader community to find out more on end of life law,” Professor White said.

The training program can be accessed online through the ELLC online portal. The training can also be completed by nurses and allied health professionals. Certificates of completion are available on completion of a module, and CPD points may be available from medical colleges, societies or professional organisations.


Comments

  • HI Professor White, thank you so much for this article. I was so pleased to read your article and see that someone has finally realised the problems that some people experience at the end of their life. Their are so many amazing Doctors/Specialist' but also too many who don't know the law regarding End of Life Care. Maybe they are scared they will be sued by the family. My parents went into a Nursing Home and I thought I was prepared legally for their deaths. I had both Power of Attorney and Enduring Guardship and they both had detailed Health Care Directives in place. The Nursing Home assured me when the time came they would do everything my parents wanted. They were fully aware of my dad's health issues. Unfortunately the Doctor had different ideas where my dad Health was concerned. She totally ignore his wishes and those of his Cancer Specialist who advised he should be taken off all medications and bring in Palliative Care ASAP. I became the relative from hell I was angry and frustrated that they were ignoring his wishes as he deteriorated each day. Where was the Doctors Duty of Care to my Dad, his Health Care Directive and my Enduring guardian paperwork was done by his Solicitor, so it should have been legally binding. After several arguments and threats from me, Palliative Care was bought in and he finally got the medications he needed. He died a few days later. We had a heated meeting with the staff and were told "their are Good Deaths and Bad Deaths, your father had a Bad Death." This was so good to hear just days after he died. That was their excuse. Mum had end stage Dementia and had the same Doctor, was she also going to have a Bad Death. We got mum a different Doctor who was wonderful he cared about mum and did exactly what she wanted. I'm so sorry that this is so long, but this story proves that some Doctors have significant legal knowledge gaps. Not knowing the law means their are problems for both the patients and the relatives who have to sit and watch them suffer. If a Doctor doesn't follow the law and if it has been proved they have failed in their Duty of Care they should be liable for civil and criminal prosecution. Hopefully including End of Life Law in their medical studies will stop this happening in the future. Thanyounforvtakingbthevtime to read this.

    - Mrs Ann Leer

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